vetoryl tablets

[madcow]

My dog has been diagnosed with Vetoryl tablets. They are costing me £120 for 30 tablets per month. I am insured fortunatly but what I need to ask is why oh why are they so expensive.
If I had not got insurance my poor dog would die, so how does the average Joe in the street manage to pay for them. If they can;t then the dog suffers.
I hope I make sence!

[labblab]

Hello and welcome!

From what you have written, I am guessing that you live in the U.K. First off, we would love to know more about your dog and how your dog is doing on the Vetoryl treatment. We do have many other members here who are using Vetoryl (trilostane) with success, so I hope that your dog is doing well, too!

As to the expense...right now, Vetoryl is the only brandname form of veterinary trilostane that is sold anywhere in the world. The distribution rights are owned by a company named Dechra, which is headquartered there in the U.K. as well. Here in the U.S., pharmaceutical regulations may be somewhat different than they are there in the U.K. But here, pharmaceutical manufacturers who produce new drugs that receive governmental approval (through the U.S. Food and Drug Administration or "FDA") are allowed to market them without competition for a specific period of time. The theory behind this is to allow them to recover their costs associated with the years of research, development, and testing that went into forumulating the drug (and to encourage them to keep developing other new drugs). However, at the end of that time period, other approved drug manufacturers are permitted to market competitive "generic" copies of the brandname drug, and this usually results in a reduction in price. Right now in the U.S., though, we are still within that time period in which Dechra has exclusive marketing rights.

One current lower-priced alternative here in the U.S. is the option to purchase "compounded" trilostane from individual pharmacies (not drug manufacturers) who each prepare their own individual version of the drug. These compounding pharmacies are not selling trilostane in the exact same dosage strength as Vetoryl. And the FDA is embroiled in ongoing litigation which challenges the legality of compounded versions being sold at all unless brandname Vetoryl is used as the basis for the formulations.

Having said all this, I do not know what the comparable U.K. regulations would be. However, I do believe that there is a veterinary formulary in place in the U.K., and that veterinarians must limit their prescribing to drugs that have been placed on that formulary (such as brandname Vetoryl). I don't know whether there is also a mechanism in place whereby lower-priced generic (or compounded) forms of trilostane can ever be offered. This would be a good question to ask your vet.

Sorry for the long-winded answer, and once again -- welcome!

Marianne

[littleone1]

Corky and I also want to welcome you.

I don't have anything to add to what Marianne has posted. Corky takes compounded Trilostane. I recently paid $90 for 180 capsules, which is a 60 day supply. When he was just getting one dose a day, I paid $25 for a 30 day supply.

Terri

[madcow]

Gosh I must be a loon lol Diagnosed with Vetoryl Tablets :D. I meant Cushings and been perscribed. My brain must be on training for somebody else :eek:

Right Sallys story is quite long. She has been through so much in the last 6 months bless her.

Sally is an 8yr old Staff I rescued from somebody 18mths ago.

Last November we had her spayed and some small little lumps which had appeared on her under carriage biopsed whilst she was having the operation.

Lumps came back as cancerous growths and two weeks later she went bk in for a mamory strip.

Over the next few weeks during xmas and the new year we were back and forward to the vets for dressings. Wounds not healing due to being spayed so they left wound open.

Anyhow at long last weeks later she was without dressings. This was February this year :rolleyes:!!

In March I took her for her booster and was concerned, as her hair had not returned from her operation and she was drinking heaps and very lagging on her walks. Occational accident at night and scavaging through bin bags :rolleyes:.

Relief vet took one look at her and said she looked a typical Cushings case :(. Back in we go for bloods which came back possitive test.

We are now on Month two of Vetoryl 120mg dose. We are now perked up loads. Drinking less. No more accidents.

The vets did offer to scan her Adrenals etc. But declined did not want to put her through this.

She is a terriffic dog. We all love her to pieces!

Second bloods told us she was stable on this dose. Next bloods will be in 3 months time.

[labblab]

Goodness, you and Sally have indeed been through a lot! I am so glad to hear that she is responding so well to the Vetoryl. She is a lucky girl to have been rescued by your family, and I hope that all will be smooth sailing from this point onward.

We will love it if you will continue to update us as to how Sally is doing.

Continued best wishes,
Marianne

[Squirt's Mom]

Hi and welcome to you and Sally! :)

You are an angel for adopting her and giving her such a good home! In this country (US), many folks look down on Staffords and Pits because they do not understand them - they only know the horror stories they have been told. Some don't even know they are different breeds - they look alike! I had a Pitty and she was the sweetest girl but people would be afraid of her just because of her looks and breed. :rolleyes: Sally is a lucky girl to have you on her side!

I'm glad you found us and look forward to learning more about you both as time passes. You are off to a good start but we will be her anytime should you have a question...or just want to talk.

Hugs,
Leslie and the gang

[madcow]

About 6 months ago our Sally was diagnosed with Cushings. I did not want her mucked about with scans. They were offered to me but left it be.
Sally is on Vetroyl 120mg daily
She has had her 1st 3 months bloods done this week and they have come back on the low side. The vet is cutting the dose down after I have finished this packet of tablets, then possibly after her next bloods stopping her meds. They also want her to take a supplement to help with her joints.
Does this mean that they can't do anymore for her and the meds are not working? I know I should have asked the vet but was scared what she was going to say :confused:
Sally has lost some weight lately which is a good thing, due to new pup keeping her more active bless. She seems fine and full life but tires very quickly on her walks.
Please can someone advise
Thanks for reading. Sorry for the waffle!

[Harley PoMMom]

Hi and welcome to you and Sally!

I was wondering if you could provide us with additional information about your girl, because the more we know about Sally the better our feedback will be, ok?

Could you post the results of the Cushing test/s and any abnormalities in her bloodwork. How much does Sally weigh? Is she on any other herbs/supplements/medicines?

Please know we will help you in any way we can so do not hesitate to ask us any and all questions.

Here are links with information about Trilostane/Vetoryl: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf) and Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
)

Love and hugs,
Lori

[addy]

Hi and Welcome from me as well,

Lori has given you a good start. When is the next test?
Sometimes if a Vetoryl dose is too high the pup's cortisol may drop below the desired range and then medication is stopped for a period of time and restarted at a lower dose. That does not mean the vet is giving up on the pup. Perhaps your vet is saying she is borderline?

Without test results we can only assume or make guesses as to what may be going on. It would be so helpful if you could post any test results.

Take a deep breath. You have come to a very special place with caring, supportive people who have gone through or are going through the Cushings journey.

Hugs,
Addy

[Squirt's Mom]

Mornin'!

I merged your latest post with Sally's original thread. We like to keep all the info on each pup in one place; that way it is easier to keep up with the history and look back if needed.

Hugs,
Leslie and the gang

[madcow]

Sally is doing very well on Vetyrol. I live in the Uk so we don't get a print out of bloods.
All I know her last bloods done this week was bordering on the low side. The vet said just above the 50 mark what ever that is.
I am going to start her on Seraquin supplement to help her joints.
Sally now weighs 19.5kg she has last loads due to unable to exercise in January to Breast cancer operation.
She has been through the mill and back my poor baby.

[zoesmom]

Hi and welcome to you and Sally -

Her weight converts to about 44 lbs, in US speak. And if she really was at 50 mark (which means just under 2 ug/dl), then she is borderline. But 120 mg for her weight was kinda high as a starting dose. A slight break from the vetoryl might be a good idea at this point - maybe a few days to a week before restarting at a much lower dose. For her size, something like 30 mg would make more sense (and certainly no more than 60mg) as many dogs continue to have their cortisol drop in the first 30 - 60 days, even longer. Then after doing another ACTH to see how that's working, you can always adjust the dose up if necessary. You just don't want her to slip any lower and end up in an addisonian crisis (from too low cortisol). When my cushings dog first started vetoryl, the recommended dosing ranges wwere much higher than what vets are recommending today. And Zoe did have trouble - started at 180 mg and after two bad starts and several dose reductions, she was finally able to tolerate only 40 mg. Over the coming months, after her body adjusted to the med, we did have to push her dose back up. But as we've learned here, thru many dogs' experiences, the safest and best approach is to start LOW and then work them up slowly to higher doses, if needed.

I'm also concerned about your vet's testing schedule. They should have the first ACTH after going on the drug within the 10-14 day range. And then the second should be done 30 days after that. It's important to closely monitor them in the beginning of tx, to avoid any problems of too low cortisol. After the second test at 30 days, then you can usually go to testing every 3 months. If I've misunderstood the timing, sorry. But just want to make sure you understand the proper testing protocol so that Sally doesn't run into any more serious problems. So any time there's a dose change - like now - it's like starting over. In other words, you need to retest at the 10-14 day mark and then at 30 days and then back to every 3 mos, assuming the numbers are ok.. What dose is your vet recommending for Sally now? Sue

[madcow]

Sally was tested 1st off for Cushings, Then had another test 1 month later to see if she was stable on the drug, then was testing every three months. So it was her 1st 3 month test if you get my drift.
Sorry if I confused you.

[jani]

I was told by my vet that the cheapest place to buy Trilostane is Roadrunner Pharmacy in Arizona. The number is 877-518-4589.
I think Trilostane hastened the growth of my dogs tumor on her pituitary and turned her micro into a macro adenoma.......but i guess this doesn’t happen to everyone. http://www.roadrunnerpharmacy.com/
I gave Maisie a supplement called Relora and I feel like this helped her symptoms tremendously. You get it at health food stores. But I guess check with your doctor first. I kind of wish I only gave Maisie the Relora and other natural remedies to keep her comfortable.

[zoesmom]

Sally was tested 1st off for Cushings, Then had another test 1 month later to see if she was stable on the drug, then was testing every three months. So it was her 1st 3 month test if you get my drift.
Sorry if I confused you.

So that's what worries me. She wasn't tested at two weeks into tx. So I would highly recommend that now, with this dose change, that she be retested with an ACTH, no later than two weeks from now. You didn't mention what her new dose is? If it's 60 mg or higher, I would retest at 10 days in - presuming she has no bad reaction or indication of low cortisol before that time.

Just watch her very closely for any sign of her cortisol dropping too low - that woud be loss of appetite, loose stools, lethargy and can progress to extreme weakness, vomiting, diarrhea. A dog who is going addisonian with not enough cortisol in its system may still drink excessively so it's these other signs you need to watch for. I don't suppose your vet gave you any prednisone to keep at home. It's a steroid which mimics the dog's natural cortisol and in the event of any signs of low cortisol, it can be given and the dog should start to feel better within a couple of hours and until you can get them to the vet. Sue

PS - I've never heard of Relora, but natural remedies are not going to do the trick with cushings. If it's a supplement, then it might lend some support to a cush dog's system in some way, but the natural remedies do not lower the excess cortisol that is the cause of cushings and its long-term damage to the body. Vetoryl is one of the two drugs that will effectively lower the cortisol - and is still the only drug available to those in the UK - see Marianne's explanation near the top of thread - on why we can get compounded trilostane (same as vetoryl) here in the States.

[Spiceysmum]

Hi,
To answer your question about the cost of Vetoryl, they are available to buy online in the UK with a prescription from your vet. A month's supply of 120mg would be approx £60 but as you have insurance it doesn't really matter.

I know UK vets don't usually give out test results but it is possible if you have a good relationship with them.

I too thought that 120mg was a high dose for her weight and if the last results were low it is unusual for them to keep her on the same dose just to finish the packet as she could go even lower.

Linda

[zoesmom]

Good catch, Linda. I saw that but forgot it - the comment about finishing out Sally's current pack of vetoryl. That makes me even more concerned. She should not continue to take 120 mg. - for even another day. If that means she'll miss a few days until you can get your hands on some lower dose capsules, then so be it. That would be a good idea at this point anyway - a few days break from the meds. But please do not give her any more of those 120's. PLEASE! I know your only option for vetoryl is 30 or 60 mg, but you can adjust their doses up or down using the above plus 10 mg caps - which I think are available to those in the UK???? Somebody will know - maybe Linda? Sue

[Spiceysmum]

Yes, 10mg capsules are available in the UK as well as the 30 and 60mg so the dose could be adjusted to make any amount which can prove expensive but as you are insured it would be ok. Linda

[madcow]

Hi
My Sally was diagnosed with Cushings in March this year. I have noticed over the last two months under her tail as gone pure white and on top of her tail she is loosing her hair (or rather gone very thin)

Also what causes the pot belly effect with Cushing's :confused:

[addy]

Hi and Welcome,

I am glad you found us and we will share what we can and help in whatever way you need.

Cushings can cause hair loss and thinning skin, pups may develop what is called a "rat's tail". It is my understanding the pot belly is from loss of muscle and redistribution of fat.

Hypothyroidism can cause some of the same symptoms in a dog so you need to make sure you are dealing with Cushings.

My pup, Zoe, is just starting to regrow hair on her tail. She lost all of her undercoat and it is now starting to regrow with treatment. I waited a year to treat her until her symptoms were stronger as hers were mostly skin/coat issues, then we progressed to hind legs weakness, then having accidents in the house and needing to go out more. I waited a year to start treating her.

What tests were done to diagnose your pup?

Hugs,
Addy

[madcow]

Sally had Breast cancer and was mamory stripped last Nov. Her hair never grew back. When I took her for her boosters in March she was still hairless and pot bellyed. (bare in mind she has had 3 ops)
Locum vet took bloods which varified Cushings. She was on 120mg of Vetroyl which have been reduced now to 90mg after recent blood tests. She is also on Serequin for her joints which is helping immensley.

She is very sluggish on walks and pants excessive in the car. I don't understand why she excessive pants on the car though!

[addy]

How much does Sally weigh? Do you know the results of her last ACTH test? Could you post them? If your vet reduced her Trilostane dosage, her numbers probably were low. It takes some fooling around to get them on the right dose. The hair can take awhile to regrow. Cush pups can overheat easily. Maybe she is getting too hot in the car. My Zoe will pant in the car if it is warmish outside, she overheats in the car easily. Otherwise, panting was not one of the Cush symptoms she had.

Could you tell us the tests you had done to diagnosis Sally? Do you have copies of the results? If we know these things we can sometimes help you more as we have a clearer understanding of your pup's health.

Hugs,
Addy

[Squirt's Mom]

MODERATOR NOTE - I have merged your newest post about hair loss causes with Sally's original thread. We like to keep all info about each pup in one thread. That way it is easier to keep up with the history and look back if needed. If you would like to change the title of Sally's thread so it is more easily recognizable for you, just let one of the mods or admins know and we will gladly take care of that for you.

[madcow]

I don't get given Sallys test results. I live in the Uk. Yes her levels were low hence the drop in strengh of tablets.

[madcow]

Sally weighs 19kg

[addy]

Hi,

Okay I understand and read through your previous posts.

Do you know when Sally will have another test done to check her cortisol levels?

Sometimes, a dog's hair will get worse before it gets better. Zoe's did.

Sometimes they can still be hypothyroid which does not resolve when we treat their Cushings and need to be treated for that as well. Was Sally ever tested for that?

Hugs,
Addy

[Harley PoMMom]

Dr. Tim Allen, a vet tech from Dechra's Kansas office, verbally recommends a starting dose of Vetoryl at 1mg per pound. UC Davis protocol suggest an even lower starting dose of 1mg per kg. With starting Sally at 120mg and now at 90mg this dosage just seems too high to me. With Sally weighing 14kg (41.8lbs) according to Dr. Allen the starting dose should have been 42mg and UC Davis would have had started her even lower at 14mg.

How is Sally eating and drinking, is she lethargic, any vomiting or diarrhea? Any one of these symptoms could mean that her cortisol is too low and this would need to be addressed.

I am very concerned about your sweet girl, so please keep us posted.

Love and hugs,
Lori

[madcow]

Sally weighs 19K she used to be over 20K when she was 1st diagnosed. (she has lost a bit o weight :D)

She is next due in for bloods in November. No diarrhea, or vomiting he stools are A ok. Just this hairloss has suddenly appeared :confused:

[addy]

Me again,

I am a bit worried too about her cortisol which is why I asked when Sally is due for her next stim. We have another pup, Penny, who started on a huge dose and is now down to 10mgs once per day. I don't want to worry you, just concerned that sometimes when these pups start out on a big dose they can get sensitive to the drug. Penny grew hair on her too high dose and then blew her coat when her dose was lowered.

You might want to read about Penny

http://www.k9cushings.com/forum/showthread.php?t=2984

Hang in there,
Addy

[Cyn719]

Hi I am Pennys mom - the one Addy mentioned - Penny has Cushings and we found out when she was 8 and started treatment at 11 - She will be 12 in November she is on Vetroyl and she is 82 lbs - she started out on 60 mg and her counts went up so my vet (not knowing anything about the drug) pushed the dose to 120 mg - well with that Pennys numbers dropped so low she went into Addisions Crisis - now DON'T get alarmed I just want you to know my story - not thats its going to happen to Sally but you need to be aware - What did I do? Came on this forum and talked to people like Addy and ALL the other knowledgeable fantastic people on here at 1100pm and they told me what to do because Penny was very sick - they stayed by my side and they are the reason Penny is here today!! So this is to tell you to watch your dog carefully - sounds like you are:) Prior to the meds Penny had the rat tail - lost her coat - drank tons of water - had to go to the bathroom more - increased appetite - pot belly - and constant panting - then we gave her the meds and her coat came back - drinking went to normal - eating normal - panting got better - still has her pot belly - now Penny is only on 10 mg and blew her coat again like Addy said - the higher dose kept her coat but way to much meds for her - just watch the dog closely - If its too much med you will see the dog lose interest in eating - drinking - wanting to do anything she normally does - lethargic - thats how Penny got - just layed down and didnt want to be bothered - do you have predisone for emergencies like this? I had to give Penny predisone the night she was very sick and stop the vetroyl and continue the predisone for a week or so then back on the Vetroyl -- Again dont get alarmed but you need to know what could and could not happen - the other Cush Angels on this forum know alot more about the disease that I do and will always be here for you (I do know alot now by posting with them and going through what I experienced with Penny -- I wanted to share my story because I used high does of the Vetroyl that was way to much for Penny - like I said every dog is different - Also I spoke to Dr Allen the vet for Dechra and he was so helpful when it came to the correct dose - a phone call to him may be a good idea. His email address is tim.allen@dechra.com -- I cannot find his toll free number at the moment - another member may beable to give it to you -- if not I will search for it -- He answers immediately - he helped with the correct dose - Hang in there - you are doing a great job with Sally - any questions I am here!:)