12 yr.old Boston w/ Cushing's -60mg Trilostane?

[hukull1]

Hello

My 12 yr old Boston Terrier, Hukull, has been diagnosed with Cushing's. The vet prescribed 30mg Trilostane 2x/day. I'm a little nervous about this dose because it seems a little high. Anyone else have a dog around 15-16lbs prescribed this much? I just gave him his first dose tonight. Any advise will be appreciated. :confused:

[Harley PoMMom]

Hi and welcome!

Although I am not a vet, starting out at 30mg of Trilostane to be given twice a day to a dog weighing 15-16 lbs seems too high to me.

Some members have talked to a vet tech named Dr. Allen that works at Dechra's Kansas office and he recommends starting out at 1mg per lb.

UC-Davis recommends a starting dose of 1 mg/kg once daily.

Here is a link to the files on Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
)

What you could do is contact Dr. Allen and talk to him directly and then ask your vet to do the same: http://www.dechra-us.com/Default.aspx?ID=365

Could you tell us what test/s were done to confirm Hukull's Cushing's and could you post those results here, please.

What symptoms led you or your vet to test Hukull for Cushing's in the first place?

Please know we are here for you so ask all the questions you want.

Love and hugs,
Lori

[labblab]

Hello and welcome,

I agree with Lori that a total of 60 mg. a day is a MUCH higher starting dose than is recommended by any initial dosing protocol with which I am familiar :(. For a dog weighing 15 pounds, a 60 mg. daily total would work out to 4 mg. per pound, which exceeds even the highest end of Dechra's published dosing range. Here is a link to the U.S. Product Insert for Vetoryl (brandname trilostane):

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

As you will see, the published dosing range is 1-3 mg. per pound, and the dosing chart lists a TOTAL daily dose of 30 mg. for a dog of Hukull's size. In instances where twice daily dosing is required due to symptom rebound later in the day, the protocol advises increasing the daily total only incrementally and dividing it into two doses, rather than doubling the dose.

Having said that, as Lori has already written, the technical representatives at Dechra are verbally advising pet owners and vets to begin at the very lowest end of that published dosing range: at 1 mg. per pound. So for Hukull, if twice daily dosing was indicated, it would be more in the range of 10 mg. twice daily.

As Lori says, we are not vets. But I heartily endorse her recommendation that you ask to speak to Dr. Allen or one of the other technical representatives at Dechra. They are veterinarians who are up-to-date on the most current dosing recommendations, and they are happy to speak to owners and vets via the telephone or email. Unfortunately, I am not sure whether they are available over the weekend. So if you have any doubts about the dose that has been prescribed for Hukull, you may want to wait until Monday to discuss the appropriate dose in greater detail with both Dechra and your vet. If not, please monitor Hukull very, very carefully for symptoms of trilostane overdosing! You will find related warnings and cautions in that product insert.

Marianne

[hukull1]

Thanks for your responses! Funny you should ask what prompted my vet to test for Cushing's.... it was me! Huk was having various symptoms such as increased urination, hair loss, thinning of the skin, etc., however, when I took him to the vet they would only do blood and urine tests. Afterwards they at first determined that he probably had a urinary tract infection and prescribed antibiotics. This would only help temporarily then his increased urination symptoms would return. After bringing him to the vet a second time, they again did blood tests and found that he had abnormal kidney and liver values. A third test showed elevated liver enzymes which then prompted the vet to do an ultrasound to determine if a tumor was present on his liver. Of course there was no tumor and my gut was telling me they were missing the big picture. After doing my own research I called the vet and insisted they test Huk for Cushing's Disease.

The test I believe they ran was the low dexamethasone suppression test which overwhelmingly indicated Cushing's Disease. I don't have the test values but I will get them when I call and inquire about the dosage.

So basically, $2000 later, I am the one who diagnosed my dog! I also initially brought up the fact that I thought the dosage prescribed seemed a little high but decided to go with it anyway. The medication came in 30mg capsules, do you think it's possible to open the capsules and only use half? Maybe buy empty capsules and split them? I just hate to waste it and would like to continue the Trilostane therapy. Thanks again! - Amanda

[labblab]

Unfortunately, no, Dechra specifically advises against owners opening and dividing the contents of Vetoryl capsules. This warning is included in the Product Insert:


Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

One alternative may be for you to check to see whether there is a compounding pharmacy near you. If so, they may be willing to "repackage" your existing capsules into smaller doses for a charge that would be less than the cost of new medication. For future reference, however, we always advise newbies to initially buy their trilostane in relatively small dosage units so as to permit greater dosing flexibility during the first couple of months when dosing changes are the most likely.

If it is not possible to get the capsules altered over the weekend and you want to continue dosing, one option might be to cut back to giving Hukull only one 30 mg. dose a day. That would mean dosing him at a rate of 2 mg. per pound, which is higher than Dechra's verbal recommendations, but at least it is in line with their published dosing chart. In that vein, is there a particular reason why your vet wants to start right off with twice daily dosing? Again, per the Product Insert, Dechra's recommendation is to begin with once daily dosing and then subsequently shifting to twice daily dosing only if symptoms rebound within a 24-hour time period (twice daily dosing is also often recommended for diabetic dogs, but I'm assuming that Hukull is not diabetic).

Marianne

[littleone1]

Hi Amanda,

Corky and I also want to welcome you and Hukull.

Marianne and Lori have given you some really good advice. Corky's been taking Trilo for 1 1/2 years now. When he first started taking it, he was almost 24 pounds due to his cushings symptoms. His IMS started him on 20mg with once daily dosing. She started him at the 1mg per pound. I have also talked with Dr. Allen, and he also recommends starting with a lower dosage. The dosage can always be increased if necessary. You'll probably find that the dosage will need to be adjusted until the cortisol level gets stabilized.

I hope everything goes well with Hukull's treatment.

Terri

[Keiko's Mom]

Hi. My dog is 73 pounds and is taking 30mg Vetoryl twice a day.
Toll free number to Dechra is 1-866-933-2472
I have talked to them a few times and so has my vet.

[hukull1]

Thanks for the support everyone! I love this dog soo much. I have decided to go with the 30mg 1x a day for now. I'm going to contact the vet today and try to talk to them about it. I'm also going to try to get his test results to see what you all think. - Amanda

[hukull1]

Oh, one more quick question... After Huk's first 30mg dose, he has had diarrhea. Is that normal and will it subside?

[Keiko's Mom]

Hi. We went with twice a day to keep blood level up over full day. Diarrhea and vomiting are danger signs as far as I understand. Have you changed food or feeding time?

[labblab]

Oh, one more quick question... After Huk's first 30mg dose, he has had diarrhea. Is that normal and will it subside?
Diarrhea is listed by Dechra as one of the most common adverse reactions to Vetoryl. Per that Product Insert link given above:


The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness.

These reactions can result from a sudden lowering of the cortisol level in a dog's body. One of the benefits from starting at a lower dose of medication and slowly working up is to minimize the likelihood of these adverse reactions by allowing the dog's system to adjust to the lowering of the cortisol more gradually. For dogs suffering from cortisol withdrawal, Dechra recommends temporarily stopping the trilostane and restarting at a lower dose.

As Keiko's Mom has said, these symptoms can also signal an even more serious condition -- the situation where the cortisol is lowered to such an extent that the basic body chemistries are thrown out of balance ("Addisonian crisis"). This condition can become life-threatening if not recognized and treated.

After only one dose of trilostane, I would not think that Huk is at immediate risk. But I am glad that you will be speaking with your vet today about Huk's dosing. If he continues to have diarrhea or otherwise appears to be unwell, I would advocate that you stop the trilostane until you can obtain a lower dose.

Marianne

[hukull1]

No change of food or feeding time. The only reason I'm not super alarmed is because he sometimes has diarrhea for no apparent reason. He's my special boy! :o It's wasn't really watery just very loose. (Not to be too descriptive!)

[hukull1]

Thanks guys. I will let you know. Glad to find this forum. Makes me feel better!

[Keiko's Mom]

I've been watching closely to make sure that my dog doesn't get diarrhea. She is used to having bowl of dry food all day long (she would usually eat at 9pm when we ate our dinner). Now I soak about 1/2 cup dry food with water, drain and add 1/4 can of Chef Michaels "pate" food to it. I only do this in the morning for her Vetoryl dose. She has formed stools that are sometimes soft. That lets me know that it's diet and not medicine related. My vet's office doesn't have vetoryl in stock, so I buy my Vetoryl from Drs.Foster and Smith....you can buy by the each capsule without the price being higher.

It costs me $111.00 for 60 each 30mg.
It's $70.55 for 30 each of 60mg, but I couldn't do twice a day dose.