Compounded trilostane - Good or bad?

[jasonhbaum]

Hello. My 8 year-old boxer Sophia has Pituitary Dependent Cushing's. She weighs 57-60lbs and the vet would like to start her on 30mg of Vetoryl - twice a day. The cost of the Vetroyl will run approximately $110/month for 60 count of 30mg. I could get a 60 count of 29mg or 31mg compounded trilostane from Diamondback Pharmacy for $40. I asked the vet about using the compounded version and she gave me the official AVMA statement on why not to use a compounded drug. My question is has anyone had a bad experience with a compounded version of trilostane? The price difference is considerable. It seems like there are a lot of people on this site that have used the compounded versions. How did you get your vet to agree to use a compounded trilostane over the brand name Vetoryl?

[littleone1]

Hi and welcome from Corky and me.

Corky has been taking compounded Trilostane for a little over a year now. He hasn't had any problems with it. I also get it at Diamondback. Corky started on a lower dose than the brand name offered. His IMS had no problems having him take compounded Trilo. Even when his dosage had to be increased and at one time he would have been able to get the 30mg Vetoryl, his IMS had him taking 20 and 11mg BID.

Terri

[lulusmom]

I have two cushdogs, both of whom treated with Trilostane for two years. When they first started treatment, Vetoryl was not yet approved in the U.S. and at that time, Dechra did not make small enough doses for my dogs. Because of their wee size, their Trilostane had to be compounded and I too purchased directly from Diamondback. They both did very well on the compounded version.

[apollo6]

Apollo takes compounded Trilostane. But I think there may be some confusion as to what compounding means. Apollo was on 10mg and is now on 12.5 mg compounded liquid. He gets it once a day not 10 in morning and 2.5 in afternoon. The only reason we upped the medication slightly was to see if it would help with his hind leg stiffness and weakness due to muscle wasting from Cushing.He is doing fine with it. His legs have not improved .
But taking twice a day may help the effects of Trilostane do it's job better, since I was told the medication can lose it's effect after 12 hours .
May want some more input on this and even email the vet at Decha?vetoryl-trilostane about this.
Sonja and Apollo.

[zoesmom]

My Zoe first took the Dechra brandname vetoryl (back when we still had to order it from the UK) for about 2 years and then later, the compounded trilostane, for another two years. I didn't notice any difference. We got the compounded from pethealthpharmacy.com in AZ. These are their current prices for some higher dosages, so the 30 mg has to be considerably less.

30 caps x 63 mg = $34.65 (they have to do something other than 60 mg, because that's the Vetoryl strength, so that's how they get around it = I'm sure it will be the same for the 30 mg - probably have to get 31 mg or some such)
30 caps x 75 mg = $37.
30 caps x 90 mg = $40.65

You have to call them for prices as they don't put them online, but you can get their phone # from their website.They have great customer service, too. Initial order requires a hard copy of the prescription or else they'll call your vet. And they didn't require payment up front for orders under $100. When order arrives, you can simply go online and pay for it with a credit card.

As far as the vet, Zoe's care was fattening up our clinic's till quite nicely (plus, I did get her cheapers meds from them) so our IMS never gave me any problem about getting the trilostane elsewhere. Maybe if you say the only way you can afford to treat is by buying the compounded trilo and could you please get an rx because the best price is online. ;) Sue

[labblab]

Jason, is your vet asking that you purchase the Vetoryl only from him/her? If so, it's true that you can probably buy the Vetoryl more cheaply from an internet pharmacy and hopefully your vet will give you an Rx in order to do so.

But I'm guessing that the issue may be a different one -- that your vet wants you to use brandname Vetoryl (from whatever source) instead of a compounded version of trilostane? Right now there is a lot of controversy about that issue, relating to both human and veterinary medication. Here are a couple of articles that may give you some context for the veterinary debate:

http://news.vin.com/VINNews.aspx?articleId=14392

http://news.vin.com/VINNews.aspx?articleId=14399

For reasons that may be clearer after reading those articles, one year ago the FDA sent letters to veterinarians (and pharmacists) warning them that the FDA considers it illegal to prescribe or dispense compounded trilostane except in very limited circumstances:

http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm182038.htm

As you can see from your reading here, some vets are continuing to prescribe compounded trilostane for their patients, regardless. But we have other members whose vets are choosing to solely prescribe brandname Vetoryl. I surely understand the financial burden associated with having to buy the brandname product (if you can believe it, at one time my own Cushpup was daily taking 240 mg. of a brandname trilostane product! :eek: :eek:). But I just wanted you to be aware of the broader issues beyond expense that may be affecting your vet's prescribing decision.

Marianne

[jasonhbaum]

Thank you for the information. The IMS suggested buying the Vetoryl from Wedgewood Pharmacy. They actually wanted $160/month for 60-30mg capsules. I found it thru ValleyVet for $110/month. Sophia is to take 30mg 2x/day. I think I will try the Vetoryl for awhile and if necessary I will go to the compounded version.
After reading some of the articles, I feel it comes down to money in the end like everything else. Not money I am willing to use for my pup, but the bigger picture with the FDA and pharmacy companies.

[labblab]

I think I will try the Vetoryl for awhile and if necessary I will go to the compounded version.

I personally think that's a good strategy. If my dog was beginning trilostane therapy and prescribed a dose that is readily available in brand form and affordable to me for at least a while, I would prefer to start on it. Once my dog was stabilized on a dose, if the brand form was just too expensive for me -- at that time I'd investigate switching to a compounded version. But for me personally, that way I'd feel more secure that any initial issues with dosing and response were not being caused by irregularities in the medication. Plus, that way I'd have a basis for comparison. If my dog had been stabilized on a particular dose of Vetoryl, and then continued to do equally well on a compounded version -- that would also give me greater peace of mind that the compounded med was performing as desired.

Marianne

[Annie's Mom]

The vet I was using when my Annie was first diagnosed with Cushings refused to prescribe compound Trilostane. The more I read, the more I inquired; from a cost standpoint, it is a significant difference. I asked: "If my dog needed a very small dose, I would have to go with compound, so what is the difference if she needs 60 mg?" The vet did not have a sound answer for me, other than "the FDA says...", so I switched vets -- to one that has many cushings patients and all of the owners choose compound Trilostane, and most all get it from Diamondback. Annie has been on compound from Diamondback for 9 months and I feel it is equal to the name brand. I have found Diamondback to be quick and efficient and cost effective (one shipping price, no matter the size of the order).

All the best to you and your pup!
Barb

[kaiabug]

Hi there... My Boston Terrier was recently diagonosed with Cushings and we started her on the Vetoryl Trilostane about 4 months ago. Prior to the drug, she was going downhill fast and we had prepared ourselves for the worst. However, the Vetoryl has proven to be our little miracle! For the first 2 months, there wasn't much of a change, but that third month was amazing! She has grown back so much of her hair and muscle, that I am still in awe over the improvement. We purchased it through valley vet as well and I too cringe each month when I see that $110 charge, but I just wanted to let you know that, at least for us, it's been worth every penny.

[Jennyrose]

My senior chihuahua was diagnosed with Cushings disease about 6 years ago, on her very first vet visit after we adopted/rescued her. Vetoryl was not permitted for use in the states at that time we had to go the Trilostane route, we have used Roadrunner Pharmacy *the only one that compounded it at the time* since her diagnosis and have had great results, we have not tried the "name brand" because there was no need to even after it was approved for use here.