weakness and confusion on Trilostane

[Jude]

Hello. My cocker spaniel, Carmel is newly diagnosed with a pituitary tumor. He was put on 100mg of Trilostane 3 weeks ago and is confused and yelps. He seems weaker than ever. Any thoughts on what mght be causing this?
Thanks.

[Altira]

Hi... I'm really not qualified to answer this but I'm sure someone here who is will be by soon. Is this the only medication you are giving your dog? I think that maybe a rather high dose of trilostane. Check back again soon...

[StarDeb55]

Could you tell us how much your Cocker weighs? Trilo dosage is based on weight & this seems like an absolutely huge dose for the average size Cocker. Technical reps at Dechra, the trilo manufacturer, have been contacted by several of our members, & now are verbally recommending a starting dose of 1mg. /lb. If your baby is of average weight, let's say 25-30 lbs., the max dose would be 30 mg. Univ. of California at Davis vet school has developed their own trilo dosing protocol which is even lower at 1 mg/kg. If I assume a weight of 30 lbs which is 13.6 kg, the max trilo dose would be about 15 mg.

Based on what you have posted about the symptoms you are seeing, I'm very concerned that your baby may have had too much trilo. When was the last dose that you gave, & was it the full 100 mg. Do you have any prednisone on hand? Pred is the rescue medicine when any of our baby's have had too much medication, whether it's trilostane or lysodren. I would go ahead & give the prednisone, then notify your vet that your pup needs to be seen ASAP, like tomorrow. If you don't have any pred, I would strongly suggest that you contact your vet, if possible, to let them know what you are seeing. If you can't get in touch with your vet, I think it would probably be a good idea to go to an emergency clinic. Too much of either medication can have serious effects on the electrolytes, sodium & potassium levels, which can have very serious consequences.

We normally have a lot of questions for new members, but I'm very concerned about your baby at the moment. Let's address what's going on now, then we get more of her medical history when she/he is feeling better.

Please keep us posted.

Debbie

I forgot, when you see a vet, whether it's your vet or you go to an ER clinic, it's going to be very important that your Cocker's electrolyte levels be checked.

[littleone1]

I also think that the dosage is too high. Debbie gave you real good advice. Corky started at 1mg per pound, and didn't experience any of the issues Carmel has. I wouldn't give Carmel any more Trilo, and would also have a blood chemistry panel and a stim test done ASAP.

Terri

[zoesmom]

Sorry for the circumstances that brought you here. That dose - 100 mg -- seems high for a cocker. My first question would be: What does he/she weigh? Beyond that, those are not the signs you'd expect to see if the trilostane has dropped the cortisol too low. Other than maybe the weakness. But they are definitely a concern.

We ask lots of questions around here. Starting with his initial symptoms that led to the diagnosis. What did you see and what made the vet suspect cushings. Second, what tests were done to diagnosis cushings? Usually, a vet is tipped off by the results on general labwork - which is being done for dental or just as a senior wellness check. There will be certain elevated enzymes and a few other things. And then that is what usually causes the vet to suggest an LDDS test (8 hour with 3 blood draws) and/or possibly (though it's not the preferred diagnostic test anymore) an ACTH test (2 hour blood test with 2 blood draws). That can be followed by an abdominal ultrasound, to determine which kind of cushings it is (pituitary or adrenal), especially if the LDDS test results did not give that indication. That's not always done, but it is generally a good way to follow up. So which of these things were done for Carmel and do you have the results for any of these? If not, it's a good idea (we all learned to do it) to ask for copies of all test results and keep in a file at home. Ya' never know when you might have to see an emergency clinic vet and it's good to have that info to take with you in the case of cushings dogs.

If Carmel has been on trilostane for 3 weeks, did your vet do an ACTH test at 10-14 days after starting the med. That is the standard protocol for monitoring how a dog is doing on a particular dose. If so, please post those results too. So any additional information you can give us, on the above, that will make it easier to offer some opinions as to what may be going on. But, in the meantime, I would not be giving any more trilostane until this can be sorted out. Is your vet a gp vet or a specialist (IMS)? Did he give you any prednisone - as a counter to too much trilostane? Sue

PS - Has Carmel had any loose stools, loss of appetite, vomiting, lethargy?

[labblab]

Everyone has already given you some great feedback and asked some excellent questions. I just have a couple more questions to add in an effort to identify how urgently serious your dog's situation is. Is Carmel currently eating and drinking normally? How about any vomiting or diarrhea? If you are not seeing any of these problems, then my guess would be that Carmel's cortisol has not dropped to a point that requires emergency intervention. But I totally agree with the advice to discontinue the trilostane until you've had the chance to report Carmel's behavior and your concerns to your vet tomorrow. And I, too, will be really anxious to learn more about Carmel's entire health and testing history...

Marianne

P.S. I hadn't noticed Sue's P.S. when I was typing my reply, so I apologize for the duplication of questions!

[Bichonluver3]

Welcome from Chloe & me as well. You are certainly in the right place. There are folks here, as you can see, who are extremely knowledgeable and will help you every step of the way. The rest of us will be here to support you and Carmel.
Hugs to you and a big tummy rub for Carmel.
Carrol & Chloe

[Jude]

Thank you all for the advice. I am now concerned about the dosage that the vet put him on. He is 38 lbs. We were told he had pituitary type Cushings. I had originally told the vet, time and time again, of my concern about his non-stop crying for food and subsequent weight gain. He was unable to jump and started to get cysts all over. (He was 43 lbs a few months back). After Carmel started urinating frequently, the vet finally decided to do blood and urine tests and kept him for 8 hours. He did a follow up blood test in mid-Feb and his levels were apparently fine. Over the last 2 weeks, he has become a different dog. He has urinated in the house, goes outside and poops on the porch or goes and lays down in the snow. Now we have to go outside with him at all times or he gets confused. He is pooping frequently, but no vomiting or loose stools. He just finished antibiotics for an upper respiratory infection which he has never previously had.

Carmel was always one to know how to relax and now he can't seem to get comfortable. Keeps getting up and relocating. Right now he is yelping non-stop at nothing in particular. His eyes are bloodshot as well. He has had hypothyroidism for the past 2 years and is 12 years old. We cannot let this little guy leave us just yet. We lost our 24 year old son on Labor Day and Carmel was his dog. It would be unbearable to lose him now. Thanks again for your input.
Will ask the vet for his labs.
Jude

[mytil]

I agree also to stop giving Trilostane and have a talk with your vet and if you are still not comfortable with the treatment, please find another vet or seek a specialist's advise.

Also I agree his electrolytes need to be checked as well.

Terry

[Isnthebeautiful]

hi
my Bob is 46lbs and on 300 mg a day BUT he crept up to that over an 8 month period! Your initial daily dose is way high.Anyway,just repeating what others have said!
I think we are all anxious to hear how you get on
jo

[Altira]

Praying for you. You lost a 24 year old son? I'm so sorry!!!

[Cushpup]

Thank you all for the advice. I am now concerned about the dosage that the vet put him on. He is 38 lbs. We were told he had pituitary type Cushings. I had originally told the vet, time and time again, of my concern about his non-stop crying for food and subsequent weight gain. He was unable to jump and started to get cysts all over. (He was 43 lbs a few months back). After Carmel started urinating frequently, the vet finally decided to do blood and urine tests and kept him for 8 hours. He did a follow up blood test in mid-Feb and his levels were apparently fine. Over the last 2 weeks, he has become a different dog. He has urinated in the house, goes outside and poops on the porch or goes and lays down in the snow. Now we have to go outside with him at all times or he gets confused. He is pooping frequently, but no vomiting or loose stools. He just finished antibiotics for an upper respiratory infection which he has never previously had.

Carmel was always one to know how to relax and now he can't seem to get comfortable. Keeps getting up and relocating. Right now he is yelping non-stop at nothing in particular. His eyes are bloodshot as well. He has had hypothyroidism for the past 2 years and is 12 years old. We cannot let this little guy leave us just yet. We lost our 24 year old son on Labor Day and Carmel was his dog. It would be unbearable to lose him now. Thanks again for your input.
Will ask the vet for his labs.
Jude

So sorry about your son.

I don't have any experience with a dog "being confused", sorry.

Not sure what is going on, but my dog was being treated for Thyroid and Cushings, and she had some strange adjustments.

When dogs are placed on Trilostane many times you will see the Creatinine and the BUN elevated. This means that the kidneys are adjusting to the Trilo. This affects how the Soloxine (Thyroid med) is filtered thru the kidneys. For my dog, it seemed that because the kidneys didn't function that well during the Trilo loading period ( a month or so), I had to decrease the Soloxine ( I cut the regular dose in half)for a while until she was ok on Trilo. Once she was ok and the kidneys adjusted to the Trilo and were functioning normally, again(not compromised), I gave her the normal Soloxine dose.

I'm wondering if your dog isn't experiencing too much thyroid medication, as your trying to load your pooch on Trilo, because the kidneys are adjusting, and so the normal Thyroid dose is too high. It's a tricky balance before everything falls into place. Definitely talk to your Vet and check the kidneys and thyroid. Remember it's always best to check the Thyroid 4-5 hours after dosing and do the same in the future.

The antibiotics can cause a quicker stool push (some dogs get diarrhea because the good bacteria is being washed out), and so can the thyroid working too fast (too much Thyroid meds), as it speeds up the system. Placing a dog on Trilostane (this lowers cortisone-the feeling good stuff) can cause all sorts of pain to come out, and so can a hyperthyroid. Your dog may have a difficult time to get comfortable because he's in pain. Some Cushing/Thyroid dogs get hot, and like cool places. I kept my house cooler for my dog, as she fell into that category.

After the 14 day ACTH test I had a chemistry profile, cortisol level with Thyroid done in 30 and 60 days post Trilo/Soloxine dosing. Everything was normalized by the 2nd bloodwork. Hope this helps.

[Squirt's Mom]

Hi Jude,

How is Carmel doing?

Hugs,
Leslie and the gang