Cabergoline as a possible treatment for acrocats: discussion

Wendy&Neko

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A trial has been underway for a while by the Royal Veterinary Clinic, to use the drug cabergoline to help our acrocats. Here is my first post on it. Since then, we've had a few acrocats try the drug, and even had one here, Marvin go OTJ! The results of the RVC study are supposed to be out shortly, and if anyone finds the paper or link to the paper, please add it to the discussion. Christopher Scudder is the lead researcher at RVC. Paul @Bronx's dad listed some early trial results in this post. I also found another trial done in South America, where another acro went off insulin.
Pharmalogical treatment with cabergoline in three cats with acromegaly, to be published in Revista Colombiana de Ciencias Pecuarias (RCCP). Cats on that trial were dosed every other day vs. every day on the RVC trial. One of those three cats also went OTJ.

My purpose in starting this post is as a discussion place of experiences, doses, possible side effects, or other information that might be useful to anyone considering trying cabergoline for their kitty. I am including some random selection from other discussions/posts. @Marvin's Mom - Nat, @Beenie, @Adrian and Chino, @Bronx's dad , please add your thoughts and experiences. @Jadi & Tiffany and @Karen & Lily are also looking into this.

A quote on current RVC dosing: "We are currently only managing the trial in the UK but have been in contact with others outside the UK who wish to try it. We use a starting dose of cabergoline of 10 micrograms per kilogram by mouth once daily. It seems to have a slow onset of action, unlike pasireotide which has a rapid onset of action. The have been monitoring diabetic control as we would do any other diabetic cat (mainly monitoring clinical signs such as thirst, urination, appetite and body weight but also using fructosamine testing) and also monitoring the IGF1 levels. Our time schedule for the IGF1 testing is after 1 month, 3 months and 6 months of receiving the medication.

The main possible side effects of the medication are gastrointestinal upset such as reduced appetite and diarrhoea. I think some cats have experienced reduced appetite but not to the extent of requiring to discontinue to drug. I have known one cat that did need four days of hospitalisation due to pancreatitis and I do not know if this was drug induced or not. If this medication has been ineffective then when the drug is discontinued, I recommended weaning the medication over three weeks to avoid a syndrome described in people as dopamine agonist withdrawal syndrome. I do not know if this happens in cats and have yet to see any signs that it happens. I also recommend that women who are pregnant or hoping to get pregnant do not handle the medication as it is known to cause abortion in cats."

So far, everyone using the drug is getting it compounded into liquid format.

We do not know much about long term effects of this drug, and it is a drug that may have to be used for the life of the cat.

There is a lot we don't know about the use of this drug. In Marvin's case, the impacts and dose reductions came very quickly, 3 weeks after starting the drug. In the South American study, they were still seeing improvments between 3 and 6 months after starting the trial.
 
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This thread is a wonderful idea Wendy and it will be good to have as much information about members using cabergoline as possible all in one place. There could be some valuable information gained by having this compiled thread. Bookmarked this thread!! :bighug::bighug:
 
This is interesting. It looks like all 3 cats in the study showed a response in the first 4 weeks when they were only getting 10 µg/kg every 72 hours:

An oral dose of 10 µg/Kg Cbg every 72 hours (Wanke et al., 2002)
was prescribed, maintaining the same doses of insulin (Case 1: 7 U/cat, Case 2: 14 U/cat,
Case 3: 9 U/cat) and their frequency (b.i.d) in each cat. At home, the owners controlled water
consumption, appetite, urination and behavior, and they modified the insulin dose according
to the values of glucose obtained before each application of insulin through a portable
glucometer; additionally, a complete physical examination was performed on each cat, each
week. By the fourth week, there was a partial resolution of clinical signs with glycemias
averaging 15 mmol/L in the three cats, without exceeding 17 mmol/L (IR: 3.8 – 8.3 mmol/L),
with the following b.i.d. insuline/cat dose: 3.5 U (Case 1, previously 7 U), 8 U (Case 2,
previously 14 U) and 5 U (Case 3, previously 9 U)
.

(17 mmol/L = 306 mg/dL)
 
Are there any kitties with HCM taking the drug?
That was one of the reasons I decided not to try the drug, that plus they had no track record yet and Neko had enough on her plate. At the time, Chris didn't think it was that big a worry. But that was over a year ago.
 
That was one of the reasons I decided not to try the drug, that plus they had no track record yet and Neko had enough on her plate. At the time, Chris didn't think it was that big a worry. But that was over a year ago.
Ok. Thanks. I think doing what we're doing with his insulin is all we can handle right now...and he's doing OK esp when he dips under the 300 mark. Breathing, heart rate, appetite, etc all improves at the mark. Green is no longer our goal. Solid days of yellows is what we're shooting for....literally. o_O
 
Maximizing time under renal threshold is a better goal. Acromegaly by itself is hard on kidneys, without the added complication of high blood sugar. When I made the decision on cabergoline, Neko had CKD, HCM and lymphoma to deal with. And lots of meds.
 
I sent in Buddy's sample's to MSU today for testing. I did the leg work, but with info I received from Susan G & Jimmy G. My vet did the blood work and when I find out the results, I am to let her know so she can write a script.

I find it very promising that some kitty's were able to cut back on their insulin. This was a very good idea to start this thread.
 
My Cabergoline from Diamond Back Pharmacy just came today. I am reading as much as I can and do not see at this point what we possibly have to lose. Based on these studies do you think I should still give a dose every day? And, since it is in liquid, is it okay to mix with a little food when giving it to her? Anything else that you all can tell me before I begin would be great. (How often should I test...?) @Wendy&Neko @Marvin's Mom - Nat @Bronx

My vet seriously is in uncharted territory, so any help, advice that you can give me is appreciated!!
 
I mix it with her AMPS LC snack. She gobbles it all right up. I know Nat gave it straight from the syringe. Beenie doesn't like to be "forced" to take meds so I had asked the pharmacy if mixing it in with food would be ok and they said sure. I'm giving it every day based on what the RVC did and hope for the best.

Best of luck to you and can't wait to cheer you on your journey:bighug:
 
Amethyst was just diagnosed 9/19/2017 her number is 100 Can she be put on Cabergoline with her ASTHMA and GLAUCOMA??
I am not sure, maybe. I would check with your vet or pharmacist to see if there is known reaction with the other meds she is on. I doubt there would be, but I think the pharmacist should be able to look into it. Again it probably would be based on human reaction.
 
My Cabergoline from Diamond Back Pharmacy just came today. I am reading as much as I can and do not see at this point what we possibly have to lose. Based on these studies do you think I should still give a dose every day? And, since it is in liquid, is it okay to mix with a little food when giving it to her? Anything else that you all can tell me before I begin would be great. (How often should I test...?) @Wendy&Neko @Marvin's Mom - Nat @Bronx

My vet seriously is in uncharted territory, so any help, advice that you can give me is appreciated!!
Well I can only speak for me, but I would give it to her every day... mind you I maybe a bit bias... also compounded meds are typically only good for 30 days. So you would lose effectiveness of the med, since I assume you got enough for one month based on daily dose
 
When Dr Bonnie called me tonight I asked her about medication. She said there was none!! I just left a message for her and told her about the Cabergoline and do not know if she will put Amethyst on it or not?
 
When Dr Bonnie called me tonight I asked her about medication. She said there was none!! I just left a message for her and told her about the Cabergoline and do not know if she will put Amethyst on it or not?
Most vets do not know about this drug. It's being trialed by RVC, so it is still experimental. My vet agreed to try it out for Marvin, as we figured we had nothing to lose. so you may need to educate her. The researcher at RVC had offered to talk to my vet if my vet wanted that. In my case my vet didn't call as I had the dosing information. However I think others here may have had their vet contact RVC for information. Not sure. @Beenie @Bronx's dad
 
I am very curious. Has RVC offered any explanation for the reasons behind so many kitties developing pituitary tumours? My GA kitty was not Acro...he was Cushing's but still caused by a pituitary tumour. With such a large percentage of kitties being diagnosed as acro ( and it may even be higher because of under-diagnosing) I wonder if RVC has done any research into possible environmental/nutritional/??? causes...what is behind this "epidemic"?

Sorry if this is a bit off topic. :oops:
 
I don't think its off topic at all. I came on board here in May and there is an up tick on kitties getting tested and so far any cat that has gotten tested has come back positive. I too wonder why??
 
I don't think its off topic at all. I came on board here in May and there is an up tick on kitties getting tested and so far any cat that has gotten tested has come back positive. I too wonder why??


Thanks Michelle. My question does not relate to cabergoline as such, but more so to what is causing such a large % of kitties to develop these pituitary tumours. Maybe there is no research done or no answers, but if there is perhaps people could be proactive in using approaches that may help prevent this. Probably too involved a question to get answers to, but still I wonder if there is something in blood work/hormone testing that could predict the likelihood of this developing before it actually happens, or meds that could control the body processes that lead to these tumours forming.
 
I am very curious. Has RVC offered any explanation for the reasons behind so many kitties developing pituitary tumours? My GA kitty was not Acro...he was Cushing's but still caused by a pituitary tumour. With such a large percentage of kitties being diagnosed as acro ( and it may even be higher because of under-diagnosing) I wonder if RVC has done any research into possible environmental/nutritional/??? causes...what is behind this "epidemic"?

Sorry if this is a bit off topic. :oops:
I was saying the same thing to my husband last night. Maybe it's because I'm more aware now, but it's almost as if Acro is the new hyperthyroidism...a few cats were diagnosed and then an explosion of cats were getting it. Why??Why?? :banghead::banghead:
 
I was saying the same thing to my husband last night. Maybe it's because I'm more aware now, but it's almost as if Acro is the new hyperthyroidism...a few cats were diagnosed and then an explosion of cats were getting it. Why??Why?? :banghead::banghead:
My vet was not looking for Acro, when I asked her about Acro, she said she had not seen it that often. Our vet wanted to increase Buddy's dose till he got to 13u, then change his insulin. I am guessing if a kitty does not have obvious signs of Acro, a doc probably does not think of it. When I suggested taking care of everything, she was willing to do the blood draw and try one of the compounding pharmacys she uses for Cabergoline. She is very busy and does not have a lot of help at this time, I can see where this would be very time consuming, for all of the steps to find out about Acro.

I did get Buddy's Blood work to MSU, they told me that one test would be done today (Wednesday) and I could get the results Friday. Not to be nosy, would anyone mind telling what they pay for a 30 day supply of Cabergoline.
 
I paid about $95 for 37 day supply at the smaller 5ml/kg dose, but Bronx is a big cat. Dosage is weight-dependent.
Buddy, weighs between 13 to 14 lbs, how much does Bronx weigh. Also, I live in a small town in Indiana and I am guessing you live in a bigger town.
 
Buddy, weighs between 13 to 14 lbs, how much does Bronx weigh. Also, I live in a small town in Indiana and I am guessing you live in a bigger town.
He was about 17lbs at that time, we started at the .4ml dose ($95/37 days) and then doubled to .8ml ($190 for 37 days). My north Jersey vet used a compound pharmacy in south Jersey since they had a better price than the local compound pharmacy. Many folks use DiamondBack in AZ for compound meds since they seem to have the best prices, which I didn't know at that time.
 
I read a similar article that stated that was true for hypothyroidism.
It's interesting though...Jimmy has a female sibling who from the time we rescued them was a bit smaller than Jimmy. Looking back Jimmy grew at a faster rate than his sister. His appetite was always bigger too. We lived in a house for the first five years of their life and for the past 6 we have lived in a boat. Jimmy kept growing and eating and Marley stayed essentially the same size. We don't have a typical environment with rugs, curtains sofas and such. But for sure we have dust despite being surrounded by water. Anyway, I think Jimmy was prob just born with it and it was always present albeit slow growing and didn't show symptoms until the excessive drinking and urination at around age 11. Why Jimmy and not Marley? Same environment and same food. Still it just sucks no matter what the cause.
 
He was about 17lbs at that time, we started at the .4ml dose ($95/37 days) and then doubled to .8ml ($190 for 37 days). My north Jersey vet used a compound pharmacy in south Jersey since they had a better price than the local compound pharmacy. Many folks use DiamondBack in AZ for compound meds since they seem to have the best prices, which I didn't know at that time.
Thank you, How is Bronx doing. I saw on a post where you were going to lower his dose.
I paid $69.96 for a 30 day supply.
Thank you, I don't know how I can afford everything. I guess where there is a will, there is a way.
 
I get my script filled locally. You will need your vet to write the script. Do you have a pharmacy locally that does compounding? If not it seems some here use DiamondBack in AZ , here's their website
Thank you I left a message for Animal Pharm they are local no one called me back yet. I will use Diamond Back if I have to. First I have to get her VET on board!!!:oops:
 
Hi Has anyone gotten the Cabergoline in a Tuna Flavor Compound from Diamond Back? What was the price? Thanks:cat:
I'm tagging @Jadi & Tiffany as I believe they just ordered from Diamond Back. Not sure what the shipping charges would be so that will add to it.

So I see you're in MA so I called the compounding pharmacy just now that I used (in NY much closer than AZ) and they ship as well. They'd be happy to assist. Here's their website http://www.crossriverpharmacy.com/

Based on some of prices I seen Cross River is very reasonable, I paid $69
 
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