Positive for Acromegaly, questions about Cabergoline and talking to my vet

Hi all

I recently received Midas'(12 years old, approx 13.4 lbs) test results from Michigan State University:
IGF-1: 329
IAA: 38


I am going to be talking to my vet soon about Cabergoline. I know from previous discussions about Acromegaly that my vet is not aware of Cabergoline.


Questions:

1) Other than the JFMS study from January 2022, are there any other studies or information I can provide to my vet?

2) How can I help my vet determine amount and frequency of the dose? I'm not seeing solid info on this online.

3) Below are Midas' health issues and current medications. Considering this, is anyone aware of any problems he might have taking Cabergoline?

Medications:

Methigel (a urinary acidifier)- He had two urinary tract blockages about 10 years ago.

Albuterol- Takes as needed for asthma. First given October 2021. Used it about 6 weeks and didn't need it again until recently.

Glargine- Diagnosed diabetic December 2021


Thanks!

 

1. There is a paper by RVC but I probably wouldn't show that one to your vet. They essentially concluded it didn't help, but it was a short term study.

2. Unfortunately there isn't a ton of info regarding cabergoline for acro cats. The papers out there used 5-10mcg/kg, daily or every other day. I think most people here start at 10mcg/kg every other day, then if after a few weeks there's no progress, try daily.

3. You can check the known drug interactions for cats, but I fear you won't find a whole lot. I have been basing things off the drug interactions in humans, which are much more widely studied. While humans are not cats, it's at least a starting point. Methionine (methigel active ingredient) seems to work counter to cabergoline in terms of lactation (one of cabergoline's primary uses in cats). This study is quite old, but seems to indicate a possible link between methionine and increased growth hormone - https://academic.oup.com/jcem/article-abstract/72/5/982/2653401?redirectedFrom=fulltext

I am no vet/organic chemist/biologist, so I could not tell you whether the form of methionine matters.

 

There is an older study that the JFMS study, but it's an early one by the same researchers. Plus the small scale RVC study Melissa mentioned. There is a small section in case study 2 of the paper in this link that talks about options for treatments for acromegaly:
(2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism

As Melissa said, most kitties here have started out on 10mcg/kg daily. RVC started out with 5mcg/kg originally and found it wasn't enough. Some cats have GI issues as a result of starting cabergoline, and go to every other day dosing for a while. In other words, there is some element of Every Cat Is Different in dosing approach.

We do have at least on cat here, Amethyst, who has been on cabergoline for years, and has asthma. Now that Midas is on low carb wet food, his urinary blockage issues should be less of a problem. As for insulin type, we've had some cats take cabergoline on both Lantus/glargine and Levemir. More on Levemir as it seems higher doses cats to better on it, plus it doesn't have the sting factor that glargine with it's acid base has. Many of the members who have used cabergoline have posted on this thread:
Cabergoline as a possible treatment for acrocats: discussion