Can someone please help me with Trilostane?

[BrendaW]

Hi. I'm brand new here and my baby girl Sophie (12 year old poodle) has just been diagnosed with Cushing's Disease. :(

The vet has given her Trilostane at 57 mg. She weighs around 20 pounds (overweight, I know). I know very little about Cushing's and Trilostane but this sounds like a high dosage to me, based on what I'm reading. Does this dosage sound right to you?

There are several things that have happened and I'm becoming paranoid and a little scared. :( I don't want to hurt my dog!

Please help me if you can. I need to start her on this medicine today. Thank you!!!

[labblab]

Hello and welcome! If I were you, I would be feeling very worried about that dose, too. It is much higher than I would be comfortable with starting out on. Here is the U.S. Product Insert for brandname Vetoryl, and you will see that their initial dosing chart recommends a capsule no larger than 30 mg. for your dog's weight. This is even a larger dose than would be currently recommended by most specialists who have revised their initial dosing formula downwards in recent years to a range that is closer to 1 mg. per pound, or even less.

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

Since your vet has prescribed a 57 mg. capsule, this means it has to be a compounded trilostane product. It also means that the compounder could prepare a custom dose of any size for your dog (other than the exact dosage found in the brandname Vetoryl capsules). So for your dog, you could easily get a dose of 19 mg. or 21 mg., which would correspond more directly to the 1 mg. per pound formula.

If it were me, I would not start giving the trilostane until you can talk to your vet and request that your dog be started on a lower dose. There is really no reason why your vet should not agree. The worst that would come of it is that it may take a bit longer to get your dog regulated, and the dose may end up needing to be increased after all. But if so, our experience here is that dogs are less likely to suffer ill effects when they are started out on lower doses and increased gradually, if need be.

Can you tell us more about your dog's overall medical history and Cushing's diagnostics? This will help us give you even more meaningful feedback. Thanks!

Marianne

[BrendaW]

Thank you, Marianne! You do not know how much I appreciate the feedback!!!

Last month, Sophie was diagnosed with diabetes (which scared me to death) but then I noticed that her fur was coming out and asked her vet to check for Cushing's. (I know nothing about Cushing's. I just googled her symptoms and figured that's what she had.) They did a test where they kept her for 4 hours. I am pretty sure they injected her with something and then kept testing her blood for results. The results came back high on the scale (the vet's words) for Cushing's. He said he would start her off on a small dose of Trilostane since she's a small dog. But 57mg doesn't seem like a small dose to me.

Since it was a Friday that I picked up the medicine and the vet isn't open on the weekend, I decided to wait until today (Monday) to start it, just in case she reacted badly to it.

The vet's office isn't a very good one (they are overworked!), but I'm in a small town and that's about all I have to choose from. I will call them as soon as they open but I don't expect them to be very cooperative. :(

Thank you again for your response!!!

[mytil]

Hi and welcome from me as well.

Firstly, here is a link to our sister site - http://www.k9diabetes.com/forum/. I would encourage you to join as well since your girl has been diagnosed with diabetes.

Is her diabetes under control?

When you get the chance, please list out all the tests (and the results) performed to diagnose Cushings's. You mentioned a 4 hour test above - an ACTH most probably. I will tell you one test does not confirm Cushing's.

Keep us posted
Terry

[BrendaW]

Hi Terry. Thank you for the response!

I have found the k9diabetes site and it was absolutely wonderful in helping me with Sophie's diabetes. I'm so grateful for it!

I think her diabetes is somewhat under control. The vet said not to check it at home (ha!) but to bring her in if her symptoms of excessive drinking/urinating came back. I did get a monitor anyway and learned how to check it at home, but I don't do it often. Should I be checking it often? I don't check it unless she's not acting right somehow.

She has only had the one test to check for Cushing's. The vet did not share any information with me about her test results so I have no clue. :( Her symptoms are diabetes (I had her tested for this because of excessive drinking, urinating), fur loss, panting, getting overheated, polyps/moles, pot bellied, stiff legs. That's how I found the Cushing's information online and asked that she be tested.

I'm going to call as soon as the vet's office opens. I'm sad to say that I'm paranoid about this office making mistakes due to being overworked.

[labblab]

Hi Brenda, just to muddy the waters further :o, I wanted to add that it can be very hard to distinguish between diabetes and Cushing's as far as symptoms go because there is such an overlap between the two disorders. Also, diabetes can skew the blood tests that are used to diagnose Cushing's so that a dog may register a "positive" when it is really only the diabetes that is at play. For this reason, we have read that some experienced endocrinologists recommend waiting to test/treat Cushing's until you've had a chance to see whether the diabetic treatment can be well-regulated and on its own ends up resolving the symptoms.

In Sophie's case, however, it does sound as though she is experiencing skin and coat changes that are more typical of Cushing's than diabetes, so it may well be the case that the Cushing's diagnosis is accurate. But you may still find this article interesting:

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

Assuming the Cushing's diagnosis *is* accurate, one other point to note is that most endocrinologists seem to recommend that diabetic dogs be dosed twice daily with trilostane rather than once in the morning alone. This is to try to keep the dog's cortisol level at as consistent a level as possible throughout an entire 24-hour time period. In dosing twice daily, you are splitting the once daily dose in half rather than doubling it, however. So in Sophie's case you might opt to start with approx. 10 mg. twice daily instead of approx. 20 mg. once daily.

I am really sorry that it does not sound as though you are receiving very knowledgeable vet advice, because the combination of diabetes and Cushing's can be challenging. We do have several members who are managing both quite successfully, but I sure wish you had some other veterinary options to consider. :o

Marianne

[BrendaW]

Marianne, that is interesting regarding the diabetes/Cushing's overlap. Since we put Sophie on insulin, her thirst/urinating has become so much better. Not once since then has she had an accident in the house. Her fur looks really bad though. It's like someone has taken strips of duct tape and just pulled off big swaths of it. :( Also, her skin is discolored.

I called the vet at 8am and left a message with the receptionist. I'm waiting on a call back.

Thanks for your help!!!

[Trixie]

Hi and welcome to the board. I am not able to comment about the diabetes but I will add that I also think your dose is too high.
My dog started on a very low dose twice a day last March. We tweaked the dose for months before landing on a total of 28mg per day. I think starting low and moving up if needed is a much better and safer way to start on Trilostane.
I"m wondering how your vet landed on a dose of 57mg? Just seems like a strange number unrelated to her weight or anything else.
I would not proceed with the higher dose if I were you. Why take a chance with side effects, especially since you are noticing improvement on a few symptoms with the start of insulin.
I agree with Marianne that a starting dose of 10mg 2x a day would be a conservative and safe dose which could do the trick if Cushing's is a positive diagnosis. You can always move up if needed but no sense putting your dog in any danger with too high a dose. Hopefully your vet will agree.

Barbara

[molly muffin]

Hi and welcome from me too. What happened when you contacted the vets office? Did they get back to you? Did they agree to go with the lower dose of trilostane? There really isn't an reason to not start with the recommended dosage that I can see.
I hope that everything is going okay.

Sharlene and Molly Muffin

[BrendaW]

Hi and welcome to the board. I am not able to comment about the diabetes but I will add that I also think your dose is too high.
My dog started on a very low dose twice a day last March. We tweaked the dose for months before landing on a total of 28mg per day. I think starting low and moving up if needed is a much better and safer way to start on Trilostane.
I"m wondering how your vet landed on a dose of 57mg? Just seems like a strange number unrelated to her weight or anything else.
I would not proceed with the higher dose if I were you. Why take a chance with side effects, especially since you are noticing improvement on a few symptoms with the start of insulin.
I agree with Marianne that a starting dose of 10mg 2x a day would be a conservative and safe dose which could do the trick if Cushing's is a positive diagnosis. You can always move up if needed but no sense putting your dog in any danger with too high a dose. Hopefully your vet will agree.

Barbara

Thank you for your response. I have no idea how he came up with 57 mg. :(


Hi and welcome from me too. What happened when you contacted the vets office? Did they get back to you? Did they agree to go with the lower dose of trilostane? There really isn't an reason to not start with the recommended dosage that I can see.
I hope that everything is going okay.

Sharlene and Molly Muffin

Thank you for the welcome. The vet finally called back that evening and said yes, that is the correct dosage to go with. I started giving her the medicine on Wednesday morning. She seemed to do ok for a couple of days but she started throwing up this evening. :(

I will just have to keep an eye on her, I guess. :( Other than throwing up, are there any other signs I should be aware of?

Thank you all for your kind responses and the nice welcome. I truly appreciate it! :)

[Harley PoMMom]

Diarrhea, lethargy, not drinking...can all be signs of cortisol going too low. Since she is vomiting, I am worried that her cortisol might have dropped too low. Do you have any prednisone on hand?

Very important: do not give any more doses of Trilostane, ok?

Hugs, Lori

[molly muffin]

um, I'm sorry, he said 57mg is the correct dosage to go with? I'm sorry, but if he said that he is incorrect and this is when we see problems, so many times. There is a reason that the manufacturer even says, no more than 30mg to start with. It is a dangerous drug in the hands of inexperienced vets. :(

Throwing up is a sign of overdosing, and no more vetroyl/trilostane should be given. You should call your vet and tell him that she is throwing up. Is there a 24 hour vet clinic available in case things get worse over night?

Is she wobbly? Lethargic? still throwing up? Not eating?

Sharlene and Molly Muffin

[BrendaW]

Diarrhea, lethargy, not drinking...can all be signs of cortisol going too low. Since she is vomiting, I am worried that her cortisol might have dropped too low. Do you have any prednisone on hand?

Very important: do not give any more doses of Trilostane, ok?

Hugs, Lori

Oh goodness. I didn't know I would need prednisone?? What is prednisone? She is definitely lethargic, but that's not a new thing for her. I'm not sure about the diarrhea, but I will look. She is drinking but she won't eat her evening meal.

I won't give any more Trilostane then. Should I call the vet in the morning? I'm nervous now!

[BrendaW]

um, I'm sorry, he said 57mg is the correct dosage to go with? I'm sorry, but if he said that he is incorrect and this is when we see problems, so many times. There is a reason that the manufacturer even says, no more than 30mg to start with. It is a dangerous drug in the hands of inexperienced vets. :(

Throwing up is a sign of overdosing, and no more vetroyl/trilostane should be given. You should call your vet and tell him that she is throwing up. Is there a 24 hour vet clinic available in case things get worse over night?

Is she wobbly? Lethargic? still throwing up? Not eating?

Sharlene and Molly Muffin

Wobbly, yes. Not eating, yes. She's not throwing up right now. I will FOR SURE hold the Trilostane and call the vet in the morning. There's no 24 hour clinic here.

[Harley PoMMom]

Prednisone is a synthetic corticosteroid drug that is given when a dog's cortisol goes too low. Prednisone mimics cortisol in a dog's body.

Trilostane does leave a dog's system pretty quickly so just with-holding the Trilostane should help. If the vomiting continues she should see a vet ASAP.

Also, she will need to be put on a lower dose, I think I seen where she weighs 20 lbs, right? So at 20 lbs, no more than 20 mg of Trilostane.

[BrendaW]

Prednisone is a synthetic corticosteroid drug that is given when a dog's cortisol goes too low. Prednisone mimics cortisol in a dog's body.

Trilostane does leave a dog's system pretty quickly so just with-holding the Trilostane should help. If the vomiting continues she should see a vet ASAP.

Also, she will need to be put on a lower dose, I think I seen where she weighs 20 lbs, right? So at 20 lbs, no more than 20 mg of Trilostane.

Thank you! I will ask the vet about keeping prednisone on hand. Yes, she weighs 20 pounds. I was really surprised he wanted to start her out so high. When we first discussed it he said 1mg per pound. That's why the 57mg confused me! I really wish I had a better relationship with this vet. :(

[Harley PoMMom]

I really wish I had a better relationship with this vet. :(

Finding a vet that will work with you as a team player can be so darn hard to find. :(:mad: And sometimes that kind of relationship just doesn't happen for various reasons, so in times like that one has to be the voice for their furbaby, and I do know how uncomfortable that can make one feel.

We're here for you and your sweet girl.

[BrendaW]

Finding a vet that will work with you as a team player can be so darn hard to find. :(:mad: And sometimes that kind of relationship just doesn't happen for various reasons, so in times like that one has to be the voice for their furbaby, and I do know how uncomfortable that can make one feel.

We're here for you and your sweet girl.

You are so right! My sweet girl is the most important thing. And thank you so much, this board is a God send! :)

[molly muffin]

Hopefully she'll improve over night, but none in the morning and the vet needs to cut that dosage big time. He was right before when he said 1mg per 1lb, then blew it with this 57mg. grrrrr

I know you will sort him out though. :) Vets are there to help you and your furbaby. I know my vet wanted to start at 30mg, and my internal medicine specialist later said no that was too much. She is 19lbs.

Lori, do you think they need an acth test in the morning? Usually after a vomiting, the recommendation is that before starting back in on a lower dosage, you check to see where the cortisol is currently at. Especially with signs of a low drop.

Hang in there.
Sharlene and Molly Muffin

[Harley PoMMom]

Lori, do you think they need an acth test in the morning? Usually after a vomiting, the recommendation is that before starting back in on a lower dosage, you check to see where the cortisol is currently at. Especially with signs of a low drop.



If this were me, I would definitely want to have a complete ACTH stim test done. I know how expensive those ACTH tests can be, so I would at least have a resting cortisol done.

[molly muffin]

Good point, at the bare minimum a resting cortisol and preferably a full ACTH (but yea those are expensive)
Another thing we always talk about on here and see so much is that every dog is different and one reason to start out low is because you never know how a dog will react to Any medication. Some are quite a bit more sensitive to drugs than others. Some feel quite ill if their cortisol drop to low too fast too. We've seen big dogs end up on low dosages and little dogs end up on big doses, but you never know that going in unfortunately. None of the dogs ever seem to read the manuals. :)

sharlene and molly muffin

[BrendaW]

Hopefully she'll improve over night, but none in the morning and the vet needs to cut that dosage big time. He was right before when he said 1mg per 1lb, then blew it with this 57mg. grrrrr

I know you will sort him out though. :) Vets are there to help you and your furbaby. I know my vet wanted to start at 30mg, and my internal medicine specialist later said no that was too much. She is 19lbs.

Lori, do you think they need an acth test in the morning? Usually after a vomiting, the recommendation is that before starting back in on a lower dosage, you check to see where the cortisol is currently at. Especially with signs of a low drop.

Hang in there.
Sharlene and Molly Muffin


If this were me, I would definitely want to have a complete ACTH stim test done. I know how expensive those ACTH tests can be, so I would at least have a resting cortisol done.


Good point, at the bare minimum a resting cortisol and preferably a full ACTH (but yea those are expensive)
Another thing we always talk about on here and see so much is that every dog is different and one reason to start out low is because you never know how a dog will react to Any medication. Some are quite a bit more sensitive to drugs than others. Some feel quite ill if their cortisol drop to low too fast too. We've seen big dogs end up on low dosages and little dogs end up on big doses, but you never know that going in unfortunately. None of the dogs ever seem to read the manuals. :)

sharlene and molly muffin

Thank you both! I will call first thing in the morning. Thankfully, she seems to be doing better now, just a little weak. Hopefully, she will be even better in the morning. Thanks again for all the help and the support! :)

[molly muffin]

That's what we are here for, to support you on this journey that none of us every wanted to be on.

Let us know how things are going. We're a bunch of worry wart mother hens.
Hope both of you and can get some rest and have a good night.

Sharlene and Molly Muffin

[BrendaW]

That's what we are here for, to support you on this journey that none of us every wanted to be on.

Let us know how things are going. We're a bunch of worry wart mother hens.
Hope both of you and can get some rest and have a good night.

Sharlene and Molly Muffin

Thank you. I hope you have a good night as well!

[Meg_Elizabeth]

Loose stools or incontinence if the dose is too high.

[tarpola79]

Hi. I'm brand new here and my baby girl Sophie (12 year old poodle) has just been diagnosed with Cushing's Disease. :(

The vet has given her Trilostane at 57 mg. She weighs around 20 pounds (overweight, I know). I know very little about Cushing's and Trilostane but this sounds like a high dosage to me, based on what I'm reading. Does this dosage sound right to you?

There are several things that have happened and I'm becoming paranoid and a little scared. :( I don't want to hurt my dog!

Please help me if you can. I need to start her on this medicine today. Thank you!!!

This amount seems WAY too high. My dog was diagnosed with Cushing's last June (Michigan State Vet Clinic) and they got him regulated on 10mg of Trilostane twice a day. He's been having some issues lately and so they did another ACTH stim test and his cortisol level was too low. So they reduced his Trilostane to 5mg twice a day. He is a min poodle and weighs 16 lbs. I would not give him that high a dosage. I would get a second opinion.

[Harley PoMMom]

Just popping in to see how you and Sophie are making out, let us know as soon as you can. ;)

Hugs, Lori

[BrendaW]

Loose stools or incontinence if the dose is too high.

I'm not sure she has either of those, but she sure threw up a lot!


This amount seems WAY too high. My dog was diagnosed with Cushing's last June (Michigan State Vet Clinic) and they got him regulated on 10mg of Trilostane twice a day. He's been having some issues lately and so they did another ACTH stim test and his cortisol level was too low. So they reduced his Trilostane to 5mg twice a day. He is a min poodle and weighs 16 lbs. I would not give him that high a dosage. I would get a second opinion.

Sophie is a min poodle too. I hope your baby is better!


Just popping in to see how you and Sophie are making out, let us know as soon as you can. ;)

Hugs, Lori

Thank you for checking on us!

Sophie threw up a lot on Friday night. I held the Trilostane and called the vet Saturday morning. I actually have a better relationship with the on-call vet who I got to speak with. I told her the symptoms Sophie was having and she suggested we add an anti-nausea drug to the Trilostane. :( I told her I was reading that the dosage was too high and asked if we could lower it. She looked it up in her drug book while I was talking to her and said no, that's the right dosage for a 20lb dog. Looking back, I wonder if her drug book is out of date? She suggested that perhaps I was confusing pounds with kilograms in figuring the dosage. Also, due to the possibility that something else could have been causing the nausea (food, etc.), we agreed to hold the Trilostane until today (Monday) and restart it. Sophie's symptoms went away when I stopped the Trilostane and if she has nausea again I will ask politely that her dose be lowered. If they refuse, I will take her out of town to another vet.

Thank you all again for being here for us with all of this!

[Renee]

She looked it up in her drug book? Wow. It seems to me that Dechra is quite clear about dosing, with 1 mg per 1 lb as the starting dosage. Even though you are using compounded trilostane, the vet should still be able to at least access Dechra's product materials, or do a little more research than just reading a drug book.

[BrendaW]

She looked it up in her drug book? Wow. It seems to me that Dechra is quite clear about dosing, with 1 mg per 1 lb as the starting dosage. Even though you are using compounded trilostane, the vet should still be able to at least access Dechra's product materials, or do a little more research than just reading a drug book.

You know, they never even gave me a patient insert with this medicine. It says C-Trilostane 57mg. There's no mention of Dechra on the label. Just Pet Health Pharmacy.

[Junior's Mom]

Please do not restart the trilostane. That dose is 3 times more than it should be to start. Our fur babies have only us to speak for them, you must insist to your vet that you want no more than 20 mg.

[Harley PoMMom]

Trilostane is the active ingredient in Vetoryl. Dechra is the manufacturer of brandname Vetoryl.

When you have some time on your hands and want some good reads our Resource thread has a wealth of information regarding Cushing's, but for right now here's a handy link for Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) and Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

According to Dechra's product insert if a dog weighs =10lbs to <22lbs they should get no more than 30mg of Trilostane.

A pharmacy is not allowed to compound Trilostane in a dose that brandname Vetoryl comes in, Vetoryl is offered in 10mg, 30mg, 60mg, and 120mg doses, so if one needs a 10mg dose, the pharmacy can compound either 9mg or 11mg.

Hugs, Lori

[molly muffin]

At 20lbs on 57mg, she is getting almost 3.0mg per Lb!!!!! (it is actually 2.85mg)
I think your vet needs to get a new drug book . Perhaps either her or you should contact Dechra directly. Especially your vet since they seem to have very little knowledge of the drug they are administering.

We wouldn't be such nags about it if we hadn't seen very bad results from starting to high in other dogs. :(

Sharlene and Molly Muffin

[goldengirl88]

Just happened to look in this thread. OMG are you serious with that dosage? Please stop with that amount of Trilostane before something happens to your dog. What happened to 25 or 27mg? Your vet actually told you the dog needs this much? I would be looking some where else if it were me. Please so not give your dog this amount of Vetoryl. Call Dechra and they will help you 866-307-0789. They will start a file on your dog and advise you of what to do here. I am so sorry a vet told you to do this. Blessings
Patti

[labblab]

Brenda, just to muddy things for you a bit more, Dechra's Product Insert for Vetoryl does actually contain a written initial dosage range of 1-3 mg. per pound. So technically, the dose your vet has prescribed is within the very top end of that written dosing range. However, as Lori has just mentioned, the chart in that very same Insert recommends a starting dose of 30 mg. for a dog that weighs 20 pounds. But both the written range and the chart reflect recommendations that were in effect back at the time that Vetoryl was first approved by the FDA. In actual clinical practice since that time, specialists have come to prefer initial doses at the lowest end of the dosing range rather than at the highest. And in more recent literature, Dechra themselves recommend starting lower rather than higher.

I want to give you this history so that you will understand the context if your vet continues to maintain that 57 mg. is the "right" dose. But over and above what the printed range says, your vet ought to be responsive to the effect the drug is having on your dog. A dog that is vomiting and unwell should not continue with the drug at an unchanged dose, no matter where you started. That is just crazy and a recipe for serious consequences of overdosing.

Marianne

[Squirt's Mom]

You know, they never even gave me a patient insert with this medicine. It says C-Trilostane 57mg. There's no mention of Dechra on the label. Just Pet Health Pharmacy.

Another little tidbit - the "C" means the medicine was compounded. Any time you see "Trilostane" it is a compounded Vetoryl, which is the brand name by Dechra and only comes in specific doses in even increments like 10mg, 30mg, etc. - any dose size other than the ones Dechra makes are compounded. Pet Health Pharmacy IS a veterinary compounding pharmacy in Youngtown, AZ.

How is your baby this morning? I hope she is better and so sorry you are having such a difficult time.
Hugs,
Leslie and the gang

[doxiesrock912]

Brenda,
We use Trilostane. Daisy's numbers indicated that we should use 2mg per pound when we first began treatment. This didn't work out well and we had to start much lower and work our way up over time.

Regardless of what the numbers show, please ask the vet to start at 1mg per pound and work up. You'll avoid a lot of worry by doing this.

Also, dosing twice a day works better for many dogs.

[Junior's Mom]

Hi Brenda. I'm worried because we haven't heard from you in a few days. Did you re-start the trilostane? How is you dog doing?

[flynnandian]

my dog ian weighs about 30 pound [14 kg] and does very well on only 30 mg vetoryl. so please listen to all the experts on this forum and start low!