New member Angel - Tremors on trilostane

[MarikaZoll]

My Angel is having the tremors. At least from all this I know that his is "normal" with this symptom, but still, is there nothing I can do. This forum is more than a year old. He just got test. Test number was 1.9. Seems I could bring his dose down a tiny bit. He takes BId 20 times two. Now I am giving him 15 times two. My vet knows less than me. He did not do an electrolyte test. What will that show. I read it here several times. I am feeling helpless.Does dose change sound correct. I guess ideal numbers are 2-6. we are at 1.9. So if we drop the dose a bit the number can come up. Could he be taking just a bit too much and that is why the tremors?

Also his mood is sad. I often think he doesn't feel well yet he will outwalk the other dogs. But never playful anymore. At first when we started meds 9 5 months) he seems mood wise better for a while. Now he look better. HIs body doesn't look swollen. His hair is still missinsg but no more oosing skin. But now he seems depressed or something, yet, he will get up to walk.

any suggestions?

What about potassium supplements.?

Marika Zoll

(Editing note: This new reply was originally posted on another member's thread which has not been active in over a year. This reply has been shifted to create a new thread with greater visibility for this new member.)

[labblab]

Dear Marika,

Welcome to you and Angel, although I am very sorry that you are having these problems. I will come back later to add a more complete reply, but I want to first add a link to the thread to which you had originally posted since it does contain a lot of helpful discussion about members' thoughts and experiences about tremoring episodes among dogs taking trilostane:

"American Bulldog 7yrs PDH Tremors at rest (Vetoryl)" (http://www.k9cushings.com/forum/showthread.php?t=2052)

Also, can you please tell us more about Angel and his health history? How old is he and how much does he weigh? What were his symptoms that originally led you to suspect Cushing's, and what tests were done to diagnose the disease? Sorry for so many questions, but this will help us give you our very best feedback.

Once again, welcome to you and Angel, and I look forward to reading more about your little boy.

Marianne

[labblab]

OK, it's me back again, now with the time to add a couple more thoughts ;). As you saw from my replies in the thread to which you had originally posted, my Cushpup also suffered from tremors across his shoulder blades for a period of time. He later developed neurological problems consistent with an enlarging pituitary tumor, but by that time the tremoring had stopped. So we really have no real basis to think that the tremors were connected. Like Angel, he also was treated with trilostane, but his tremoring actually started before he even started on the medication. So that is also a question mark for us -- whether or not the trilostane exaggerated the problem or whether, again, it was unrelated.

In Angel's case, I do think it is reasonable to wonder whether he would do better with a cortisol level that is somewhat higher than 1.9. It will be interesting to see whether or not the dosing decrease helps with both the tremoring and also his mood.

You've asked about testing the electrolytes. This involves a simple blood test to check the status of basic blood chemistries such as the levels of potassium and sodium. Not only does trilostane lower cortisol, but it also has the potential to lower another adrenal hormone, aldosterone, as well. And if the level of aldosterone is lowered too much, it can interfere with the proper balance of potassium and sodium in the dog's body, creating problems that can become serious. This is why the manufacturers of Vetoryl (brandname Vetoryl) recommend that the electrolytes also be checked every time a dog has an ACTH monitoring test.

After you've had the chance to fill us in with more details about Angel's history, symptoms, and diagnosis, it will be easier for us give you our thoughts about his situation. In the meantime, here's a link to the U.S. Product Insert for Vetoryl. It will supply you with a lot more helpful information about the potential side effects and recommended monitoring protocol associated with trilostane:

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

Marianne

[MarikaZoll]

HI. My dog an this dog sound like one and the same. Extreme weight loss and trembling. Although my dog does not want to eat. ACTH says he is on the right dose. 20mg twice daily. He is a french bulldog. Weighed 37 pounds and now is 24 pounds. I recommend anyone call Dechtra. They were amazing on the phone and recommended stopping! the half life of this drug is about 18 hours. After stopping they are back to zero. Hence, I was told he could restart another drug if necessary soon. I wonder if anyone can elaborate on this. Which other drug? After reading here I wonder if I should just try doing really small doses if you all think that too much would decrease appetite, alhtough even dechtra does not say this. Is is simply a side effect for some dogs. ACTH was good only 1 month ago, already into the weight loss and severe lethargy. I am stumped. What drug. any ideas.:mad:

Moderator's Note: This post was originally made on another member's thread. I have put a copy of it on Angel's thread to give members an update on how Angel is doing.

[StarDeb55]

The other drug option is lysodren. Whoever told you that you could make a switch immediately is not correct. It is strongly recommended that there be a 30 day washout period with no medication, a return of symptoms or both.

Debbie

[labblab]

My Angel is having the tremors. At least from all this I know that his is "normal" with this symptom, but still, is there nothing I can do. This forum is more than a year old. He just got test. Test number was 1.9. Seems I could bring his dose down a tiny bit. He takes BId 20 times two. Now I am giving him 15 times two. My vet knows less than me. He did not do an electrolyte test. What will that show. I read it here several times. I am feeling helpless.Does dose change sound correct. I guess ideal numbers are 2-6. we are at 1.9. So if we drop the dose a bit the number can come up. Could he be taking just a bit too much and that is why the tremors?

Marika, have you done another ACTH test since this one on 9-11 when Angel's result was 1.9? If not, given his behavior and extreme weight loss, I absolutely believe you should follow Dechra's advice and totally stop the trilostane immediately!! In your original September reply that I have quoted above, you said that you were going to decrease the trilostane dose. But if you have not and have continued to dose him at 20 mg. twice daily, it is entirely possible that Angel's cortisol level has now dropped way too low. This can turn into a life-threatening situation very quickly.

You can always start back up again with the trilostane in the future, or even consider switching to Lysodren (another drug used to control excessive cortisol) if need be. But if Angel's cortisol has dropped too low, you HAVE to allow it to first rebound, and that may take days or even weeks. He may even temporarily need some supplemental prednisone in the meantime to help make up for the cortisol he is lacking. And as I mentioned in an earlier reply, he really needs to have his blood chemistries ("electrolytes") checked in addition to the ACTH testing.

Does your vet know how poorly Angel is doing? If not, you need to let him know. If he does know and hasn't advised you to make any changes or perform any testing, then I am sorry but you really need to consult with another vet!! Knowing that a dog has lost 30% of their body weight in a month without intervening or testing in any way is inexcusable!

I am very, very worried about Angel. In my opinion, your very first step is to follow the advice of the Dechra vet and stop the trilostane. Totally stop it. And if he has not had another ACTH test since last month's result of 1.9, I do believe he should be retested immediately or at a minimum, have his electrolytes checked. That only involves a simple, relatively inexpensive blood draw. Please do keep us updated!

Marianne

[frijole]

Hi! I agree with Marianne. If you haven't done another acth the chances are that it is the cortisol that is causing the issues. In other words the drug is working - just the dose was too much and you need to stop until Angel's cortisol is regulated.

Also, what Deb says is true - you cannot just switch drugs. Very dangerous - you need to wash out for 30 days minimum. Hope this helps. Kim