Cabergoline as a possible treatment for acrocats: discussion

Wendy&Neko said:
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.
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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.
 
I can't imagine paying $1,000 or $6,000 per month for something besides a house. And lots of listed side effects too.
 
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
 
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Wendy&Neko said:
Interesting. I wonder what he used as the octreotide dose.
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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.
 
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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.
 
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.
 
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.
 
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.
 
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.
 
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,
 
Hi!!

I am finding this thread a couple years too late, but my kitty was diagnosed two years ago with acromegaly and is now up to 25 units of insulin. Are you all still having success with the use of cabergoline? I was happy to hear it worked for many of your cats and am interesting in suggesting this to my vet. Hope to hear from you all soon. Thanks!!
 
LBS said:
Hi!!

I am finding this thread a couple years too late, but my kitty was diagnosed two years ago with acromegaly and is now up to 25 units of insulin. Are you all still having success with the use of cabergoline? I was happy to hear it worked for many of your cats and am interesting in suggesting this to my vet. Hope to hear from you all soon. Thanks!!
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Hi!

Like Wendy said, quite a few of us. I'd say the majority have seen some sort of decrease in insulin dose, some more than others. And some more quickly than others. But as Wendy also mentioned - it can possibly help with side effects as well (the soft tissue growth, etc).

My cat Mr Kitty is one of the four that have gone completely off insulin - you can see we started it July 1st, and within 2 weeks he was totally off insulin. That is not the norm, and they don't know why some cats see more drastic results than others but think it may relate to size of the tumor (paper Wendy linked - 35% of cats in diabetic remission, 26% of cats with normalized IGF-1).

Most of us started at 5-10 mcg/kg, daily or every other day. The paper Wendy linked was every other day. It seems to take about 6 weeks on average to start to see results.

In my opinion it's worth a try, minimal risk. You'll just need to be diligent about testing BG for if/when it starts to come down and he needs dose reductions.
 
LBS said:
Thanks for the quick responses! Do you know how much it costs? My kitty is 20lbs!
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I get mine from ETHOS Pharmacy in Woburn,Mass. They make it in a Triple Fish oil flavor that Amethyst loves She gets 1.4mg every morning and with shipping it is $62 very reasonable!!:)
 
LBS said:
Thanks for the quick responses! Do you know how much it costs? My kitty is 20lbs!
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It seems to be pretty variable depending where you are. I pay about $40 for 8-0.5 mg pills compounded in chicken flavored liquid, my vet does it in-house. I think a lot of people use Wedgewood pharmacy if you're in the US. Just be sure if it's compounded it's sugar free, and you really have to shake it because it settles fast when trying to draw it into syringe.

How long it last depends on size of cat, dose, and frequency. My cat is about 5.7 kg, so at 10mcg/kg it's 70 doses. Every other day would last me 140 days, so 5-6 months
 
Pamela & Amethyst said:
I get mine from ETHOS Pharmacy in Woburn,Mass.
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Note form their website:

Our pharmacy is currently licensed in Massachusetts and New Hampshire, with more states to come! For your convenience, ask about shipping within each of these states and have your pet’s medications delivered to your door.

Pet Owners with a valid prescription may order medications from other states, but they must pick up in person at an Ethos hospital in either Massachusetts or New Hampshire (we cannot ship outside either state). If you are close enough that this is an option for you, please work with our compounding team to arrange a pick up location and date.
 
Larry and Kitties said:
Note form their website:

Our pharmacy is currently licensed in Massachusetts and New Hampshire, with more states to come! For your convenience, ask about shipping within each of these states and have your pet’s medications delivered to your door.

Pet Owners with a valid prescription may order medications from other states, but they must pick up in person at an Ethos hospital in either Massachusetts or New Hampshire (we cannot ship outside either state). If you are close enough that this is an option for you, please work with our compounding team to arrange a pick up location and date.
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Thank you Larry They are a wonderful Pharmacy!!:)
 
Hi again friends,

I was wondering how long your kitties were on the cabergoline before you started noticing some results? I know one cat was able to come off insulin after taking for only 2 weeks, and I read an article that said it may take up to 6 weeks to notice results. My cat has been on it for 7 weeks now with no drop in insulin needs or improvement in symptoms. I give him 0.5 mls of cabergoline 100mcg/ml once a day. Do we think I need to give it to him twice a day or should I give it more time?

My vet wasn't knowledgable about this medication, so I am pretty much on my own with trying to figure out what will work best for my cat. I hope you all can help. Thanks!!!!
 
Hi @LBS, could you start your own thread with details of your cat? We'll also need to see a spreadsheet of his blood sugar numbers and a bit more detail on him. Also, his weight (dosing is per weight). The quick answer is that the length of time it takes to see effect varies a lot, based on many things. We seen cats (more than 1) take a couple weeks, some take months.
 
Hi there. It would be a good idea to start your own thread. So much we want to know. Yep, dosing is based on weight. Your dose at that strength “sounds” like it might be low, but we won’t know unless you tell us his weight. Anyway, can you start a new thread as Wendy suggested- in this Acromegaly forum - so you can give us more details. Cabergoline did help my boy.
 
Cabergoline is definitely helping my little girl It has taken some time BUT she has gone down from 40 Units a day to 30 Units a day:cat::) Good Luck!
 
Pamela & Amethyst said:
Cabergoline is definitely helping my little girl It has taken some time BUT she has gone down from 40 Units a day to 30 Units a day:cat::) Good Luck!
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Hi! Do you do Cabergoline daily? My car has been on it for a couple months, every other day . It seems like he feels better than he did prior to going on it, but it hasn't yet helped his insulin dose. I'm wondering if daily Cabergoline would be worth trying, but wanted some input before I mention it to the vet.
Thanks!
Kelly
 
KellyMac said:
Hi! Do you do Cabergoline daily? My car has been on it for a couple months, every other day . It seems like he feels better than he did prior to going on it, but it hasn't yet helped his insulin dose. I'm wondering if daily Cabergoline would be worth trying, but wanted some input before I mention it to the vet.
Thanks!
Kelly
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Hi Yes Amethyst takes hers' everyday in a Triple Fish Flavor She loves it!!
 
Hi all, I was wondering how things are going since you have been trying cabergoline long-term? Have you had improvements in other areas the tumour impacted like neurological symptoms? Any side effects?
 
My cat has been on it for about a year and a half. I didn't notice much in improvement for a few months but spoke to my vet and we switched from every 48 hours to every 24 hours for dosing. His insulin dosage steadily decreased. He went from needing max 15u , 2x daily of insulin to around 6u. It all depends what I give him based on where his numbers are at but that was a steady place for a while. He's recently been going back up in insulin needs, so I think he needs some blood work done to see if something else has popped up, but I truly don't think he'd have the quality of life he has had since starting the cabergoline if we didn't. I haven't noticed any side effects at any point in using it, even after increasing the dosage frequency.
-Kelly
 
KellyMac said:
My cat has been on it for about a year and a half. I didn't notice much in improvement for a few months but spoke to my vet and we switched from every 48 hours to every 24 hours for dosing. His insulin dosage steadily decreased. He went from needing max 15u , 2x daily of insulin to around 6u. It all depends what I give him based on where his numbers are at but that was a steady place for a while. He's recently been going back up in insulin needs, so I think he needs some blood work done to see if something else has popped up, but I truly don't think he'd have the quality of life he has had since starting the cabergoline if we didn't. I haven't noticed any side effects at any point in using it, even after increasing the dosage frequency.
-Kelly
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Thank you for the reply. How quickly after switching to 24hrs did it help? Did you see any other improvements in demeanor, behaviour?
 
Renee2602 said:
Thank you for the reply. How quickly after switching to 24hrs did it help? Did you see any other improvements in demeanor, behaviour?
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It was a gradual decrease for sure to get him all the way to 6ish, but I just checked my logbook and within a month he was down about a unit and a half, held there for about four months, then had another stretch where his numbers were getting real good so I lowered again. And it patterned like that until about two months ago where I've been increasing slowly again. Unfortunately I only do a physical logbook. Regarding his behavior he's been fairly consistent throughout his whole diagnosis. He hasn't changed much in that regard so it's difficult to give a concrete answer about that
 
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