Cabergoline as a possible treatment for acrocats: discussion

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Wendy&Neko, Sep 16, 2017.

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  1. Deena and Malby

    Deena and Malby Member

    Joined:
    Dec 6, 2016
    Hi everyone,
    I got Malachai's Cabergoline for $100 w/sugar free chicken flavor. I just went on Yelp and searched for compounding pharmacies in my area and about 10 came up so I just called each for pricing.
    The pharmacist mixed the Cabergoline with oil (instead of water), I was told it was better and would also extend the life of the Cabergoline.
    DOES ANYBODY KNOW IF THIS IS TRUE!?
    I was told it could have a shelf life of 6mo. although I was only given enough for 56days.
    I just want to make sure that after 30 days I'm not giving him medication thats bad.

    Also, I'm mixing his Cabergoline with his breakfast (2 cans of FF). Does anyone know if it's okay to mix it with THAT much food? I'm hoping it won't decrease its effectiveness.
     
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  2. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    I think it is strange that they have been quiet about the study. It seems like when it started they were open to sharing all the info they had. I'm not sure that any who has emailed recently has gotten any info on how it is going.
     
  3. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

    Joined:
    Dec 11, 2016
    HI How are you? I am trying to get my vet to understand the need for Amethyst to be on this drug How do I access this webpage and post THanks:bighug:
     
  4. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    I had to dig really deep and I found info that they presented last month. They did not observe any difference in 30 days time. I'm not sure if they are continuing on with the study. However cats on this forum have taken 30 days to earn insulin reductions.
    My vet was hesitant to prescribe it and Mav has been on it for about 10 days now. I figured what do I have to lose by trying? If I can get his Insulin like growth factor down and perhaps slow down the progression of acromegaly, it is worth it to me.
     
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  5. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
    Hi Where did you find their info?:cat:
     
  6. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    I will share it tonight when I am home.
     
  7. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
    Thank you!:cat:
     
  8. Deena and Malby

    Deena and Malby Member

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    Dec 6, 2016
    I would love to see it too! Thanks!
     
  9. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    I have attached the study that convinced me and I sent it to my vet.
    I am copy and pasting from EVCIM abstracts.

    I hope this helps!

    J Vet Intern Med 2017

    Research Communications of the
    27th ECVIM-CA Congress

    Intercontinental, Saint Julian’s, Malta, 14th to 16th September 2017


    ESVE – O – 6
    PILOT STUDY ASSESSING THE USE OF CABERGOLINE IN THE MANAGEMENT OF DIABETIC ACROMEGALIC CATS. C.J. Scudder, K. Hazuchova, R. Gostelow, V. Woolhead, Y. Forcada, D.B. Church, R.C. Fowkes, S.J.M. Niessen. Royal Veterinary College, Hatfield, UK

    Cabergoline is a dopamine 2 receptor (D2R) agonist which is a second line medical therapy for human acromegalic patients. Pasir- eotide, a somatostatin analogue, is the only effective medical man- agement option for feline acromegaly but its cost is a limiting factor for many owners. Our work has demonstrated dopamine receptors within the feline acromegalic pituitary and we hypothe- sized that cabergoline would improve diabetic control and IGF-1 concentrations of diabetic acromegalic cats.

    This was a prospective cohort study of client-owned diabetic acromegalic cats, Ethics approval URN 2016 1604. Enrolment cri- teria were: a diagnosis of diabetes mellitus, an IGF-1 concentra- tion >1000 ng/mL and owners declining alternative treatment options for acromegaly. Patients were admitted to the hospital on day 0, underwent pituitary imaging and started cabergoline ther- apy (Kelactin, Kela N.V.) on day 1. Cats were monitored in hospital until day 4 and were discharged to continue treatment at home. Serum IGF-1 and fructosamine were measured on day 0, day 4 and month 1. Any possible medication side effects were recorded. Descriptive statistics and non-parametric tests were used to analyze the data.

    Six cats were enrolled. The first three cats received 5 μg/kg q24 h PO and the second three cats received 10 ug/kg q24 h PO of cabergoline. The median IGF-1 concentration at day 0 was 1797 ng/mL (range 890–>2000) which was not statistically different to day 4 and month 1 (1884 ng/mL and 1754 ng/mL, respectively). The median fructosamine concentration on day 0 was 551 lmol/L (range 454–887) which was not statistically different from day 4 and month 1 (551 to 569, respectively). All cats were receiving PZI insulin (ProZinc, Boehringer) and the median dose on day 0 (1.1 units/kg q12 h) was not different to day 4 and month 1 (1.1 and
    1.2, respectively). Three patients experienced a single gastrointesti- nal upset event (inappetence, diarrhea) which resolved within three days. One of the six cats experienced an improvement of diabetic control (fructosamine day 0 was 454 lmol/L and month 1 was 288 lmol/L while insulin dose on day 0 was 1 unit/kg q12 h and month 1 was 0.2 units/kg q12 h) although there was no decrease of IGF-1 concentration (day 0: 890 ng/mL; month 1: 929 ng/mL).

    Cabergoline therapy, using the investigated dose and duration, was not associated with a reduction in IGF-1 concentration in the tested diabetic acromegalic cats; glycemic control improved in one. Additional cases, alternative dosing regimens and longer-term follow-up are being assessed.

    Disclosures: Disclosures to report.

    The diabetic remission clinic is supported by Nestle Purina and Boehringer Ingelheim.
     

    Attached Files:

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  10. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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  11. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
    Thank you How do I get a copy of this????
     
  12. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    Maybe google for it. It's 85 pages of abstracts so I don't want to attach them all.
     
  13. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
    OKay under what to google? Thanks!
     
  14. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
  15. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
  16. Chubba (GA)

    Chubba (GA) Well-Known Member

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    Apr 30, 2017
    I just emailed Chris at RVC and then sent that email to my vet. I can't remember the webpage, but I will try to look it up later. Although, it looks like @Mom2Maverick already posted a link to the study. Thank you! :):bighug:
     
  17. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    I was reading the Argentine paper on cabergoline for cats with acromegaly.
    It says:

    "After Cbg treatment, all three cats showed reduction of IGF-1, fructosamine and insulin requirements along with resolution of clinical signs by the third and sixth months. These results are similar to those by Gostelow et al. (2017) with short-action and long-acting pasireotide injection and, apparently, are more promising than thoseobtained with radiotherapy (the most commonly used treatment for cats with acromegaly), where no such improvement in IGF-1 levels has been observed despite improving clinical signs with reduction of insulin requirements (Reusch, 2015). "

    I am surprised that it says radiotherapy does not improve IGF-1 levels. Is that correct? Did you folks who did SRT have your cats' IGF-1 retested? Or does this line throw the whole paper into doubt?

    The paper also says:
    "Future studies should evaluate pituitary size in acromegalic cats after Cbg treatment, given the known antiproliferative and proapoptotic e ects of Cbg on corticotropinoma, somatotropinoma and prolactinoma neoplastic cells, both in humans and dogs (Castillo et al., 2008; Marazuela et al., 2014). "

    Wow. I didn't realize that the drug treatments might shrink the tumor.
     
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  18. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Very few people get the IGF-1 rested now after SRT, as it does not reduce the number. I didn't cause it wouldn't change how I did anything and was quite expensive. Julie's punkin's numbers actually went up a little. One of RVC's goals with cabergoline was to find a drug that did reduce the IFG-1. I haven't seen their results to see if it happened. The paper you quoted only had 3 cats in the study, not enough to be statistically significant.
     
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  19. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I went through the abstracts listed above, and pulled the content for the RVC presentation:

    ESVE–O–6
    PILOT STUDY ASSESSING THE USE OF CABERGOLINE IN THE MANAGEMENT OF DIABETIC ACROMEGALIC CATS.


    C.J. Scudder, K. Hazuchova, R. Gostelow, V. Woolhead, Y. Forcada, D.B. Church, R.C. Fowkes, S.J.M. Niessen. Royal Veterinary College, Hatfield, UK


    Cabergoline is a dopamine 2 receptor (D2R) agonist which is a second line medical therapy for human acromegalic patients. Pasireotide, a somatostatin analogue, is the only effective medical management option for feline acromegaly but its cost is a limiting factor for many owners. Our work has demonstrated dopamine receptors within the feline acromegalic pituitary and we hypothesized that cabergoline would improve diabetic control and IGF-1 concentrations of diabetic acromegalic cats.


    This was a prospective cohort study of client-owned diabetic acromegalic cats, Ethics approval URN 2016 1604. Enrolment criteria were: a diagnosis of diabetes mellitus, an IGF-1 concentration >1000 ng/mL and owners declining alternative treatment options for acromegaly. Patients were admitted to the hospital on day 0, underwent pituitary imaging and started cabergoline therapy (Kelactin, Kela N.V.) on day 1. Cats were monitored in hospital until day 4 and were discharged to continue treatment at home. Serum IGF-1 and fructosamine were measured on day 0, day 4 and month 1. Any possible medication side effects were recorded. Descriptive statistics and non-parametric tests were used to analyze the data.


    Six cats were enrolled. The first three cats received 5 μg/kg q24 h PO and the second three cats received 10 ug/kg q24 h PO of cabergoline. The median IGF-1 concentration at day 0 was 1797 ng/mL (range 890 – > 2000) which was not statistically different to day 4 and month 1 (1884 ng/mL and 1754 ng/mL, respectively). The median fructosamine concentration on day 0 was 551 lmol/L (range 454–887) which was not statistically different from day 4 and month 1 (551 to 569, respectively). All cats were receiving PZI insulin (ProZinc, Boehringer) and the median dose on day 0 (1.1 units/kg q12 h) was not different to day 4 and month 1 (1.1 and1.2, respectively). Three patients experienced a single gastrointestinal upset event (inappetence, diarrhea) which resolved within three days. One of the six cats experienced an improvement of diabetic control (fructosamine day 0 was 454 lmol/L and month 1 was 288 lmol/L while insulin dose on day 0 was 1 unit/kg q12 h and month 1 was 0.2 units/kg q12 h) although there was no decrease of IGF-1 concentration (day 0: 890 ng/mL; month 1: 929 ng/mL).


    Cabergoline therapy, using the investigated dose and duration, was not associated with a reduction in IGF-1 concentration in the tested diabetic acromegalic cats; glycemic control improved in one. Additional cases, alternative dosing regimens and longer-term follow-up are being assessed.


    Disclosures:

    Disclosures to report.

    The diabetic remission clinic is supported by Nestle Purina and Boehringer Ingelheim.
     
  20. Mom2Maverick

    Mom2Maverick Member

    Joined:
    Dec 15, 2016
    Yes, isn't that discouraging from the RVC? I'm wondering if they are continuing to give Cabergoline. The cats I have followed here took about 30 days to have improved blood sugars. My cat also, but I switched to Levemir around the same time. My vet is planning to repeat the IGIF-1 around the 3 month mark. Mav has had about 64 doses so far.
     
  21. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I'm glad they are researching it. And glad you all are posting the studies. It's too bad they didn't test more cats. For diabetic cats, there is a significant percentage which have Acro. They should have looked for 10-20 cats to be in the study.

    Leo has not been retested for IGF-1 levels. It was over $100 for the test. And the results will not affect his current treatments.
     
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  22. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    What doses are you folks using?
    What dose interval?
    What form? Compounded liquid?
    (I only see the information for Malachai here.)
    What does "q24 h PO" mean?

    The Argentine paper was
    An oral dose of 10 μg/Kg Cbg every 72 h (Wanke et al., 2002) was prescribed,

    The RVC study was
    The first three cats received 5 μg/kg q24 h PO and the second three cats received 10 ug/kg q24 h PO of cabergoline
    That study was only for 1 month, so I am not completely discouraged.

    Apologies. I only reviewed page 2 today. I see Wendy posted in the first entry that everyone is using liquid compounded cabergoline.
     
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  23. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    q24 h po means every 24hrs by mouth

    The Argentine paper gave 10mcg/kg every 3 days
    The RVC gave 5mcg/kg every 24hrs by mouth or 10mcg/kg every 24hrs

    I get mine compounded from Wedgewood pharmacy. The concentration is 100mcg/ml. I give 0.9ml or 900mcg daily because Maverick is 20lb. It is pricey, $135 per bottle with shipping. It lasts a little over a month.


    I am giving 10mcg/kg daily
     
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  24. Jadi & Tiffany

    Jadi & Tiffany Member

    Joined:
    Mar 5, 2017
    Hi there,
    My cat Tiffany has been on Cabergoline, liquid form,
    Hi there,

    This is my experience with the Cabergoline drug:
    My cat, Tiffany has been on Cabergoline liquid form, compounded at Diamondback Pharmacy in Scottsdale, AZ. She is on .26ml daily and is 14 pounds. This has been a miracle drug for her. She was on 16 units of levermir 2x daily when we started and is now at 5.5u. We saw our playful, purry cat return after about 2 weeks into it. This drug is not a cure, but definitely has helped her live a better quality of life. My vet is also quite happy with her progress.

    Jadi & Tiffany
     
    Last edited: Jan 29, 2018
  25. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Nothing like HOPE to put a smile on a face.
    Thanks.
     
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  26. Mom2Maverick

    Mom2Maverick Member

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    Dec 15, 2016
    I am thrilled to hear Tiffany is still doing well!
     
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  27. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    My vet has been busy reading articles quoting Stijn Niessen at RVC from 2016 and 2017.
    She said he says cabergoline doesn’t work, nor is he in favor of radiation therapy.
    He promotes hypophysectomy. Of course, he is cofounder of the hypophysectomy center at RVC.
    My vet is encouraging me to investigate the surgery.

    I started Yum on cabergoline yesterday. 45mcg per day in a compounded liquid, mixed into food. There's a chance she threw up a bit of it, but a civvie is also throwing up around the house so not sure.

    My vet suggested that some vets in the US believe IGF-1 just goes up with blood glucose. Has anyone else heard that?
    Maybe acromegaly isn’t well accepted as a cause of diabetes in the US.

    Just a thought: some veterinary research student should mine this forum for data on cats with acromegaly.
     
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  28. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    I got a copy of Yum's IGF-1 and IAA test. It has 2 sentences:
    "The serum concentration of insulin-like growth factor 1 (IGF1) is increased and is a likely differential diagnosis. Are there physical changes that are consistent with acromegaly? It is recognized that increases in this hormone may occur as a metabolic response to diabetes mellitus in some cats, but this result is clearly higher than what would be expected in that latter scenario"

    I guess that validates my vet's saying that sometimes IGF-1 goes up with blood glucose.
     
  29. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    IGF-1 competes with insulin at the cellular level. When the pituitary gland outputs excess IGF-1, we have to dose additional insulin to overcome the IGF-1.

    I'm not sure I agree with that statement that IGF-1 goes up with BG. You could have a an example cat which has high IGF-1, but has not eaten a lot of food. So excess BG would not accompany the high level of IGF-1.

    Excess BG occurs because there is insufficient insulin for the body to absorb it. So the body pushes more glucose into the bloodstream, then it gets filtered out by the kidneys.

    There is no surprise that your vet is pushing hypophysectomy if he started some clinic which focuses on that. There was a recent case in the Acro forum of a lady who had a hypophysectomy done on her kitteh. The results were 100% cure of the diabetes (and IGF-1). That was in the last 12 months.

    From my participation on the forum here in the last 18 months or so, it seems many vets are inexperienced with diabetes. Very few of them seem to really know about Acromegaly. There are a lot of things that can go wrong with a cat, so maybe Acromegaly is considered an edge case.

    I hope the Cabergoline works for Yum.
     
  30. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Re my earlier question re IGF-1 being elevated in all cats with diabetes:
    In a 2015 paper by Scudder on Paseriotide I see the statement:
    "A previous study indicating that diabetic cats treated with insulin long term have increased serum IGF‐1 concentrations compared with diabetic cats receiving insulin treatment over shorter periods of time."

    Yum has mild diarrhea today, possibly from the 3 doses of cabergoline.
     
  31. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    That is an interesting quote from the paper. Did they mention the IGF-1 levels associated with the observation? The other component of this - is that 20-30% of all diabetic cats have Acro. So it would need to be correlated with that as well. I know you are quoting from a paper, but maybe they didn't include all the pertinent content.

    Sorry that Yum has diarrhea. In the 2000 timeframe we had Squeaky. She would get diarrhea and run thru the house with it coming out. Just really a bad deal all around.
     
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  32. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Bwahaha. Made me laugh. What we do for our cats.
     
  33. MJW

    MJW Well-Known Member

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    The American Cancer Society has a pdf about treating pituitary tumors.

    https://www.cancer.org/content/dam/CRC/PDF/Public/8791.00.pdf

    It says cabergoline is very successful at treating prolactin secreting tumors, usually making surgery unnecessary.
    It is not as successful at treating growth hormone secreting tumors.

    "Dopamine agonists: Drugs like cabergoline or bromocriptine can reduce growth hormone levels in about 1 out of 3 patients. But higher doses are needed for these tumors than for prolactinomas, and some patients have trouble with the side effects they can cause (discussed above). An advantage of these drugs is that they can be taken as a pill. "

    Hey. 1 out of 3 is something. It doesn't say if cbg reduces tumor size when it does reduce growth hormone levels.
     
  34. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    That is an interesting find. For the low cost of the cabergoline, it is worth the probability that it can resolve the growth hormone levels.
     
  35. Beenie (GA)

    Beenie (GA) Well-Known Member

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    May 3, 2017
    So glad to hear Tiff is doing well !! :bighug:

    I'm a fan of Cabergoline. It was reducing Beenie's insulin needs and she was dropping down the dose ladder. I feel it is so worth a try for Acro cats based on cost and the success I've seen here. Not a cure but us it was getting and keeping my girl in healing numbers.
     
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  36. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    @Bronx's dad
    Your spreadsheet says you started Bronx at .4ml then upped him to .8ml cabergoline once a day.
    Was the .8ml 10mcg/kg? I'm not sure they are all compounded at the same mcg per ml, and I don't know Bronx's weight.
    Thanks!
     
  37. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    Bronx was about 17-18lbs and yes, we doubled to .8ml which is 10mcg/kg. We started at .4ml (5mcg/kg) which is half the dose that most kitties start at now.
     
  38. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    His chart does suggest that he might have been responding to it.
    It's interesting that the cats in Argentina responded to that dose delivered just every 72 hours. I will ask my vet what the medical argument would be for longer or shorter intervals between doses. The longer interval makes me think of terror strategies where they strike, wait for recovery to start, then strike again.
    Has Bronx's polyphagia subsided with his BG coming under control and/or lower insulin dose?
    Yum's polyphagia/polydipsia seem to fluctuate in real time with her BG.
    I guess there are 2 sources though: the BG and the mitogenic stuff.
     
  39. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    Yes, his hunger is under control now that his numbers are lower. It was hard keeping up with him this time last year, he was eating insane amounts of food. The acro also makes them hungry, they think they are like a growing teenager.
     
  40. Marvin's Mom - Nat

    Marvin's Mom - Nat Well-Known Member

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    I can only speak for myself, I worked with Chris at RVC unofficially for my Marvin, and cabergoline was a miracle for him too. He has been off insulin since July I think.... and still doing well. Went from a cat who's quality of life was about done, he could barely walk due to neuropathie caused by diabetes, he could climb in his litter box, the 5 P's were no longer there.... 5 weeks after cabergoline and support from here, he was off insulin, normal range, eating, showing attitude again ... He is still improving, neuropathie is almost gone, he plays, purrs, grooms, pee and poop in litter box and oh ya his coat is super soft now (must be the oil wendy told me to add to his food).... the only thing he hasn't done is jump, not sure if he can or he thinks he can't. Cabergoline is not a cure, but helps to manage acromegaly.
     
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  41. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    There is evidence it can reduce the tumor size in some humans. So not a full cure, but a partial cure.
    I remember when you joined the forum, when Yum was a simple diabetic, with no suspicion of acromegaly. You were debating putting Marvin down. Marvin's miracle was a wonderful story to watch unfold.
     
  42. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Chris Scudder of RVC didn't mention Marvin's case in his rather negative 9/17 abstract on cabergoline testing. Was that just because Marvin wasn't officially part of the study? Did Marvin inspire the study?
     
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  43. Marvin's Mom - Nat

    Marvin's Mom - Nat Well-Known Member

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    He wasn't on the study officially, however Chris had asked me if he could mention Marvin at the conference this summer and asked for some pictures. I haven't seen the study abstract. I had checked a few times but haven't found it.
     
  44. MJW

    MJW Well-Known Member

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    Mom2Maverick posted it above on Dec. 6. Chris Scudder was the first author.
     
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  45. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    It is in post 109 above
    They only used 6 cats in the study. So not statistically significant. Too bad they didn't do 20 or 30 cats. Probably just too much work.
     
  46. MJW

    MJW Well-Known Member

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    Yum is a bit lethargic today, so I've been googling cabergoline side effects in humans. Almost all the articles describe it as a long lasting drug, usually prescribed to be taken twice a week. Hmmm. I am still worrying over the dosing frequency differences between the Argentine abstract and the RVC abstract. At very large doses it can cause heart valve problems in humans.
    I think I also read it can lower blood pressure, but not dramatically.
     
  47. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Yum's respiratory rate has been elevated (dyspnea). It was high 40's to low 50's yesterday. This morning it is mid 30's.
    Mid 30's is high for a resting cat, but not an emergency.
    I read dyspnea can be a side effect of cabergoline in 1% to 10% of humans.
    Has anyone else had side effects?
    Yum doesn't seem to feel great.
    I think I will cut her back to every other day as a trial. The cats in Argentina took the cabergoline once every 48 hours.
    [I have been writing 3 days, but on a more careful reread, it is 2 days.]
    It is considered a long acting drug.
     
    Last edited: Feb 18, 2018
    Reason for edit: wrong dose frequency typed
  48. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Sorry, don't know about Cabergoline. However, Leo is on Leukeran (chemo) which is typically one of the following doses:
    - small dose every other day
    - or larger dose every 10 days

    He is responding well. So my vet called an internist, and they recommended moving him to every third day. Just using this as an example. Some adjustments can be made depending on the patient's response - for some drugs.
     
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  49. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    I contacted RVC about cabergoline.
    I will post more later. Chris says cabergoline only works in a few cats.
    He did have success combining it with octreotide (a somatostatin analogue which does not work well on its own in cats). It's a combination used for humans.
     
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  50. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    CSU did a study on the use of octreotide with acrocats. Somewhere on this forum is a link to the study. Interesting that the combination might work better.
     
  51. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Yes. I had read that octreotide doesn't hit the dominant somatostatin (?) receptors in cats. Looks like the one two punch to the dopamine AND non dominant somatostatin (?) receptors is more successful. Makes sense.
    He didn't give me dosing information. I sent a follow up email but I have not heard back yet. I guess the CSU study or other studies would give dosing information. Yum seems so far to be responding to the cabergoline on its own.
    Chris said he saw no difference between the 10mcg/kg dose and the 15mcg/kg dose. (I thought he tested 5mcg and 10 mcg, not 15 mcg?)
    All these drugs have side effects.
    I'm thinking I might drop down to the every other day 10 mcg/kg dosing of the study out of Argentina.
    She is very sleepy. I have to figure out her QOL on the drug, assuming it is working.
    I wonder if side effects depend on whether or not the drug is working.
    I need to go through the threads here again and look for comments on side effects.
     
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  52. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Just for interest, I looked up the cost of octreotide. :eek: This is for humans, so it might be less for cat sized doses.
     
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  53. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I can't imagine paying $1,000 or $6,000 per month for something besides a house. And lots of listed side effects too.
     
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  54. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    @Wendy&Neko @JeffJ

    It's listed as $224 or $234 at Walgreens for what looks like a 1 month prescription for humans.
    A vet could probably buy it wholesale for less.
     
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  55. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Here is the email from Chris Scudder where he mentions octreotide.

    Hi,
    Thank you for your email.
    I have come to the conclusion that only a small proportion of acromegalic cats respond to cabergoline in my experience, and did not find a better response if cats were receiving 10mcg/kg/day or 15 mcg/kg/day.
    With regard to side effects, in humans there is a low risk of heart valve disease, and only seems to occur on much higher doses than the doses I have used for cats. Nonetheless, if there is worry about her breathing then a chest xray and heart ultrasound could be considered because hcm is common in cats, and it seems acromegalic cats are more at risk of heart failure than cats without acromegaly regardless of their therapy. This risk only seems to go away after hypophysectomy. I did have one cat go into heart failure in my study after 2.5 months, again I do not know of this was due to cabergoline or being acromegalic.
    If you struggle to get control using cabergoline alone, you could add in octreotide and give them both together. I have only done this in one cat so far but it worked well when they did not respond to cabergoline as a stand alone drug.
    I always recommend high protein diets, to keep acro cats lean and active to also aid diabetic control.
    I hope this helps,
    Bw
    Chris
     
    Last edited: Feb 26, 2018
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  56. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Interesting. I wonder what he used as the octreotide dose.
     
  57. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    He didn't respond to my followup email. I would look at (a) the ratio of feline/human doses for short acting pasireotide;(b)published octreotide alone studies for cats; (c)published cabergoline+octreotide studies for humans.
     
    Last edited: Feb 26, 2018
  58. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Yes, this is interesting. Even recently in 2016 there was not much info on this, which is why we elected for SRT for Leo - which was successful, but expensive.
     
  59. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Yum's response to cabergoline has been miraculous so far. She has gone from a max of 16.75 unit shots of Lantus to less than 3 unit shots in less than 9 days (30 days on cabergoline).
    I wrote up our experience so far in post #18 in the "Yum my acro cat" thread in this forum.
    Best wishes to the other cats here on cabergoline. If your cats aren't responding and you are still set on a drug solution, see the information on adding octreotide to cabergoline in the preceding posts.
     
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  60. Mom2Maverick

    Mom2Maverick Member

    Joined:
    Dec 15, 2016
    That's great for you and Yum. She is so adorable to boot!
    Where was the 15mcg/kg given daily? The RVC?
    Maverick has gained 3lbs since the acro diagnosis. I have only increased insulin maybe by 1 unit and he's fairly well regulated. I had his IGIF redrawn at day 74 and it had increased from 361 to 437. He's been getting 90 mcg Cabergoline and I have since increased to 100mcg Cabergoline daily to adjust for his new weight. My vet discussed increasing to 150mcg daily (15mcg/kg) but I wasn't sure if anyone had done it.
    I would like to see the info on octreotide if anyone has it.
     
  61. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    I don't know why Chris (RVC) referred to 15 mcg/kg in his email to me, while his abstract refers to 5mcg/kg and 10 mcg/kg.
    Yum is 9 to 10 lbs and gets 45 mcg per day, or now every other day.
    I worry about side effects. Has Maverick had any side effects? Diarrhea? Lethargy? I would be afraid to go to 15mcg/kg, but what do I know.
    Yum had some diarrhea when she started the cabergoline, which went away. Unfortunately, I set it off again by feeding her lamb 2 days ago and today we are in major GI trouble. I am worried.
     
  62. Mom2Maverick

    Mom2Maverick Member

    Joined:
    Dec 15, 2016
    Maverick has had no side effects. I wasn't too worried about diarrhea given the extent of his megacolon. The amount of laxatives he receives is enough to make my stomach cramp. I'm sorry the lamb has upset her belly. It's so hard to keep everything balanced.
     
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  63. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    I got an update from RVC on octreotide doses. Also note the reduced (and hence cheaper) pasireotide dose (once a day for short acting). I will post that part in the pasireotide thread.

    As a vet not working within your country / state I cannot prescribe medications. However, I can tell you what I have used in the past, which was a starting dose of 0.05mg or 0.1mg per injection once daily of short acting octreotide (there are long-acting versions also available which I have not yet used). Pasireotide is a very effective treatment in the patients I have used it in, and I used a dose of 0.03mg/kg once daily by subcutaneous injection of the short-acting preparation of pasireotide.


    It is very interesting about your cats family history and I am sorry there have been so many endocrine problems. There are a number of genetic causes of multiple endocrine neoplasia i.e. MEN1 / MEN4 / Carney complex, and if if there are any more endocrine neoplasias in the family line then it might be possible to test for these things (the tests would need to be created but I’m sure this would be possible with the right research group and finances).


    BW



    Chris
    ------------------
    Hi Chris,


    Thank you for your quick response.

    May I post it on the felinediabetes.com forum?


    I had read about the combination of cabergoline and octreotide in humans. It is exciting news that you tested it successfully on a cat. Do you have dosing guidelines? I will look up the price for octreotide. I was thinking of falling back to the short acting Pasireotide if the cabergoline fails. Because the long acting Pasireotide dose for cats is about the same as for humans, it is completely out of the question.


    After several days of reducing my cat’s insulin dose, I believe she is one of the lucky ones responding to the cabergoline. I will probably retest her IGF-1 in the next few weeks. Her mother passed from a rare chemodectoma. Her sister passed on the operating table as an undiagnosed diabetic, with symptoms I now realize may well have been Cushing’s or Acromegaly. My cat may well have some bad genes.


    Thanks again,
     
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