New here, just started trilostane, dosing questions..Angus (8 y/o American Bulldog)

[Angus' Dad]

Hi everybody,
My name is Mike, my wife Amy and I are proud adoptive parents of a 100lb American Bulldog, Angus. Angus is officially cushinoid, and started a dose of 60 mg once a day. I have been searching the internet on trilostane and it seems to me the initial dose should be much higher, possibly 3-5 times higher? Is it at all typical for a vet to start at such a low dose? I like my vet and do not have a reason to distrust him, but naturally we don't want angus' recovery halted in any way. Short history, Angus is almost 8, adopted at just over 6. Drinking, urinating, and muscle loss have been with us for over a year, more recently large loss of hair and development of sores/infections, and slow healing prompted vet visits. First allergies were suspected, doc gave prednisone and antiboitics for 10 days. Changed food, eliminated grains, treats, switched to hypoallergenic products. No response, sores developed worse, some starting on their own, one started as a scrape, and another was a reaction to frontline which he had dozens of times before with no problems. Another round of antibiotics and steroids, and suspected autoimmune problems. tested with biopsy, negative for autoimmune and very high in calcium. At this point cushings was suspected and low dose test scheduled. I researched internet on cushings and found that angus has just about every symptom, most we attributed to old age and possible thyroid. He has been on 4 pills of .5 thyroxine a day for over a year as well, with recent testing showing still low thyroid. Thanks for any help, you all seem like such nice people!

[mytil]

Hi you three, welcome to our site.

From the weight you mentioned it looks like the dose is low, but a lot start out low. I know others with direct experience with Trilostane will be chiming in shortly.

Can you let us know when you started giving the Trilostane?

Also post those test results that confirmed cushing's.

I am wondering maybe your vet wanted to start low given the thyroid condition. How much experience does your vet have with Cushpups and Trilostane? (treating any others for example)

Terry

[Harley PoMMom]

Hi Mike and Amy, and welcome to you and Angus from me and my boy, Harley. I am so sorry for the circumstances that brought you here but glad you found this forum...we will help you and Angus in any way we can.

We tend to ask a lot of questions from our new members, not because we are nosy but the more information we know about your precious furbaby the better our feedback will be, ok?

You say Angus was on steroids, steroids can lead to a type of Cushing's known as Iatrogenic Cushing's. Iatrogenic Cushing's has the same symptoms as the conventional Cushing's. Also, steroids will skew Cushing's diagnostic tests. Could you give us the exact time-lines of the steroid use?

If Angus does have Cushing's and you are treating with Trilostane, then with his weight of 100 lbs, 60 mgs of Trilostane does seem to be a good starting dose.

The most recent recommendation of Dechra, the company that makes Vetoryl, is to start dogs off using a formula of 1 mg. per pound.

Something you could do is contact Dr Allen and talk to him directly and then ask your vet to do the same. Dr Allen is one of Dechra's technical representatives in their Kansas office and he is a vet. Many members have contacted Dr Allen and he has always been so nice.

http://www.dechra-us.com/Default.aspx?ID=365


The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

Check out the Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
) it has a lot of helpful information.

Love and hugs,
Lori

[Angus' Dad]

Hey thanks for the quick responses. I have read of the steroids induced cushings, one dose started oct 12 and the other dec 20. injection of azium and prednisone pills, starting at 2 a day, than 1 a day, than every other day for a total of 10 days maybe. same both times. i doubt that is the cause though because all symptoms were present before and got neither better or worse after each round. We started trilostine only yesterday morning(saturday) so he's had 2 pills so far. I'm not sure on the experience of the vet with this condition but he did say he's seen it alot. He also has told me more than once over these past few diagnosis that he is consulting with specialists as well. I was not offered the exact test results and did not think to ask, do most vets routinely give them? the vet is young but so far we've been seeing him numerous times for a year and a half and I can't say he's done anything I disagreed with or that didn't jive with my own googling. I would like to say I trust him. He did also mention experience with lysodren pre-trilostane being available and did seem to know the subject matter rather well. I am curious though about the small chance of a cancerous adrenal tumor, what is the protocol for checking that? also one other symptom angus has is leaky plumbing, always a drip or two and yellow stains down the insides of his legs. any experience with this as a cushings symptom or just general aging? I am wondering because i was hoping it might go away with the treatment..?

[Angus' Dad]

oh,, also scheduled for the 2 hour test at 14 days of trilostane..
in addition angus has a badly cracked tooth, the big front one on the bottom, vet says it needs to come out but wants to get stabalized first, not sure if that might affect dosing as well. thanks again and sorry for all the sloppy grammer!

[lulusmom]

Hi Mike and Amy. Welcome to the forum.

Yes, 60mg does sound to be low for a 100lb dog but one thing we've learned is that no two dogs react the same and it's always better to go low and slow. Your vet will have a really good idea as to how effective the dosing is when he gets the result of the first acth stimulation test. Make sure you have Angus to the vet 3 to 5 hours after his morning dose of Vetoryl.

Sometimes the low dose dexamethasone suppression test (LDDS) will tell you if the dog has pituitary cushing's but it sounds like this isn't the case with Angus. Your vet should have done additional testing to determine which form of cushing's Angus has. An abdominal ultrasound would be the best way to do this. In addition to allowing your vet to determine if Angus has pituitary or adrenal dependent disease, it will give your vet a good look at the surrounding internal organs.

Please do ask your vet for copies of all testing that was done to diagnose Angus. You paid for these tests and your vet should be happy to provide you with copies. Most of us keep folder with our dog's up to date records in case we need them for possible visits to the ER vet. They also come in handy when we nag you to post results. :D The more information you can give us about Angus, the better equipped we'll be to provide you with the most meaningful feedback.

The circumstances that brought you here are not fun but the good news is that you found us and we'll do everything we can to help you help Angus. It's never wise to place blind faith in your vet when it comes to cushing's. Learn all you can about the disease the drug you are giving Angus so that you can be the best advocates possible for your boy.

Looking forward to seeing the test results.

Glynda

[Angus' Dad]

Hi, yes I will ask for those results on the next visit. So far this is the third day and no reactions of any sort so crossed fingers. What part leads you to think adrenal vs pituary? also is the trilostane the same type of drug as the lysodren in that it kills off part of the adrenal? or does it work in some other way? I saw something that said trilostane is fully reversible when stopped. I am curious about the 'loading phase' vs. maintenance phase. I am assuming by what you guys are saying it is likely his maintenance dose will still be higher than the one a day? Trying to plan for the financial impact...
Angus thanks you for all the help and education!

[lulusmom]

I'm sorry, I didn't mean to say that I thought Angus had adrenal based disease. What I meant was that since you don't know whether Angus has pituitary or adrenal cushing's, the LDDS must not have been consistent with pituitary cushing's.

Trilostane and Lysodren are completely different in their modes of action. Lysodren has a cumulative effect and it erodes the adrenal cortex. Because of it's cumulative effect, prednisone is always prescribed to be used if a dog should show signs that cortisol may be too low. Loading and maintenance applies only to Lysodren. Trilostane is an enzyme blocker that interferes with the synthesis of cortisol. Because it has a short half life, a lot of vets do not feel that prednisone is necessary as a dog will usually rebound rather quickly by simply stopping treatment. You can find a lot of information on both drugs in the Helpful Resource section. Since Angus is being treated with Trilostane, I recommend that you use the links Lori provided so you can familiarize yourself with Trilostane (Vetoryl). You can find information on dosing, proper treatment monitoring, side effects, etc.

Glynda

[Angus' Dad]

gotchya, I had been reading the fda material on the trilostane and thats where i first got concerned about the dosing, so what you said is pretty much what i was thinking but wasn't sure. the vet did say before the low dose test that he just wanted to see if he was cushinoid and go straight to treatment, i think maybe because of his age and condition that surgery would be too much for him? I did not question it or the cancer possibility at the time but plan to ask him on next visit on the 4th, that's when he gets the next test(2 hour).
-Mike, Amy, and Angus Meatball