new to this (8 y/o Yorkie)

[Fabuk]

I'm writing from London UK
I have an 8 year old yorkie named Lyra who has confirmed cushings
I originally started her on 10 mg of trilostane per day as she weighs 3.8kgs but after her ATCH test was told by the vet to double the dose.
After only 2 days on 20mgs she got acute pancreatitis (my guess was from the vomiting and diarrhoea brought on by the double dose) and after a four day visit to emerge her meds were stopped.
We resumed the meds end of june and at 10 mg again and as of july 4 her meds went up to 15mg (10mg morning and 5mg eve)
I have just brought her to the vet again as she has had another bout of bloody diarrhoea but because she is still eating and drinking and quite perky they've sent her home with some pain killers, stool firming paste and some antibiotics
Next ATCH test is this thursday but vet recommend that she has no more loose stools before we do the test.
Any of this process sound familiar to anyone?
Is it coincidence that the dosage up and pancreatitis (which the vet thinks she might have again but not as bad) happen at the same time or am I seeing a side effect of the meds?
HELP!

Fabuk

[Harley PoMMom]

Hi Fabuk,

Welcome to you and Lyra, sorry for the reasons that brought you here but so glad you found us.

I am worried about Lyra, especially with her having bloody diarrhea and pancreatitis. When a dog is being treated for Cushing's and shows signs of not feeling well the Cushing's medication should not be given until the dog is feeling like their normal self, so if this were me, I would stop giving the Trilostane for right now. How is Lyra feeling and acting right now?

Could you get a copy of Lyra's ACTH stimulation test results and post them here? With Trilostane an ACTH stimulation test is performed within 10-14 days after treatment, 30 days after treatment and also at 90 days. Generally the Trilostane dosage is not adjusted until the the 30 day mark because the dog's cortisol can continue to drift downward for the first 30 days after treatment is started, so I am quite concerned about Lyra's vet's knowledge with Cushing's and the treatment protocols.

How was Lyra's pancreatitis diagnosed? Has the vet discussed with you how to manage her pancreatitis, such as feeding her a low-fat diet and giving her small meals through out the day? Is Lyra pancreatitis going to be monitored with spec cPL tests?

Please know we are here for you both, so do ask all the questions you want, ok? ;)

Hugs, Lori

[Fabuk]

She was originally diagnosed in May and began on 10mg of trilostane then, after the first 10 days she had an ACTH test showing that the cortisol levels had dropped but very very little but I wasn't comfortable upping her meds until the next test as I had already read about several side effects with using trilostane.
The Acute pancretaitis attack that happened in June was after only two days of upping her dosage to 20mg per day which I did think was too much for her as she only weighs 3.8 kgs
But I spoke to a vet in canada as well (where I'm originally from ) who said that this was not too much for a dog her size and that dosage levels are dependant on how much the dog specifically needs.
Her pancreatitis was confirmed by both blood test and X-ray and she was hospitalised for 4 days. During which time her meds were stopped completely.
She then began again on 10 mg and was upped to 15mg once we had sourced the 5mg tablets from Dechra.
She was on this dosage for 10 days with no side effects at all and I started to notice definite decrease in her drinking and urinating.
on day 11 she had bad diarrhoea again but was still very spritely and hungry (which the last time she was not)
I took her to the vets and another blood test revealed pancreatitis again. Albeit a very mild case as apart from diarrhoea nothing else had changed much.
The following day was her scheduled ACTH test and that happened as planned and she was sent home with some probiotics and pain relief as she did not require fluid therapy.
She is now very spritely and eating normally as we await for the test results.
She has not had a bowel movement in about 2 and a half days which the vets have checked on and believe that due to her recent diet of plain chicken and rice (to stop the diarrhoea) there isn't very much in her colon to excrete yet.
I will post the results for all to see when i get them.
I wasn't aware that cortisol levels can continue to drop on the same level for 30 days so should they say she needs her meds upped again I will discuss this further with the team of vets looking after her.

Thank you so much for your info so far. I think this forum is very informative.

Fabuk.

[Fabuk]

Hello all!
Was wondering if anyone knows of anywhere you can easily get 5mg trilostane tablets in the UK.
Im in London and it seems to be very difficult to get them and now my lil girl is doing really well on her 15mg a day dosage
Any help would be great.

Fabuk

[labblab]

Brandname Vetoryl is not made in a capsule smaller than 10 mg. So unfortunately, you will need to have a specialty pharmacy repackage Vetoryl capsules for you, or instead compound capsules from raw trilostane. How had you been getting the 5mg. tablets previously? We do have compounding pharmacies here in the U.S. that can fill individual prescriptions for virtually any size dose, but I don't know whether you can import a U.S. drug of this type into England.

Marianne

[Fabuk]

I actually got the 5 mg from Dechra from my vet but now it seems like it's becoming an issue and she needs to have no more than 15 mg a day...
The search continues

[labblab]

Hmmm...this is very interesting, because Dechra is not publicly marketing 5 mg. capsules at this stage. Here's a link to their U.K. website, and as you'll see, there are no 5 mg. capsules listed:

http://www.dechra.eu/Topmenu/Pharmaceutical-Products/Products.aspx?pcatid=PRIMARY4&catid=PROPGRP50&fid=PROPFIELD618

I know they've been talking about getting approval for a smaller dose such as this for a while. So maybe you were getting the capsules for a short time as some sort of clinical trial or something?

Many of our American members use this U.S. internet compounding pharmacy. You might try contacting them just to see whether they know about any similar options in England.

http://www.diamondbackdrugs.com

Marianne

[Callie's mom]

The liquid my Vet has me using from Diamondback in AZ, USA can be adjusted to any miniscule amount needed/wanted. I have had to bring my dog's initial dosage way down due to a bad reaction and this is very easy to do with the liquid. Good luck. I will be visiting your country in 3 weeks for vacation and am looking forward to it :)

[Fabuk]

Thank you for your responses… All very helpful.
At the moment though I'm dealing with another bout of pancreatitis. This is becoming quite normal for us as she's become very sensitive since the cushings developed.
She's eating and drinking and thanks to the meds actually quite normal but yesterday and today she's not a happy girl.
Its pain killers white rice and boiled chicken for a while. Any suggestions are welcome.

[molly muffin]

Oh poor baby. Pancreatis is so rough on them.

Sharlene and Molly muffin

[Harley PoMMom]

Several of us had to deal with our furbabys having pancreatitis and it can be challenging. Feeding several small meals throughout the day is important. Dogs that are prone to recurrent attacks of pancreatitis do better when fed diets that are low in fat. Keeping a dog hydrated aids in the recovery from pancreatitis.

I am providing you with a link to an article that I have found very informative regarding canine pancreatitis, it is a long article but a good read.: Diagnosing andtreating pancreatitis (https://www.idexx.com/pdf/en_us/smallanimal/education/diagnosing-treating-pancreatitis-roundtable.pdf)

I am sure others that have dealt or are dealing with pancreatitis will be along to share their advice as well. Hoping Lyra's pancreatitis resolves itself quickly, and that she feels much better soon.

Hugs, Lori

[Fabuk]

So the newest issue is getting my hands on the 5mg tablets again which Dechra has apparently sent as they did before but now I'm entering the first day of only giving her 10mg instead of 15 mg. … we are hoping that the 5mg tablets will arrive soon but in the meantime i hope that she will be fine on the 10 mg for at least a couple of days… should I have upped the dose to 20mg instead of leaving her at 10mg? what are your thoughts on this?

Fabuk

[labblab]

Fabuk, when you say "tablets" do you truly mean a tablet instead of a capsule? Vetoryl is only marketed in capsule form. I am still really puzzled about the source of these 5 mg. doses. In addition to wondering about their form, do they come in a blisterpack or instead a bottle? Is Dechra actually written somewhere on the packaging?

And no, if it were me, I would dose at 10 mg. rather than 20 mg. until the new meds arrive. When in doubt, it is usually always safer to underdose rather than to risk overdose.

Marianne

[Fabuk]

thanks for the advice, it's what I actually was thinking as well…
Yes Dechra did send the first batch of blister pack capsules… The box they came in is Dechra and they are apparently sending more but have a back log of requests so I'm anxious that they might take a while… The last ACTH test showed that her levels were high before the test but then went to normal after the injection which told the vets that the 15 mg probably is the best for her right now.. incase her cortisol levels continue to drift downward…
fingers tightly crossed the 5mg show up soon.

[labblab]

My curiosity is getting the best of me! I just now called Dechra's U.S. headquarters and they confirmed that 5 mg. capsules are not yet approved nor available for marketing anywhere in the world. They have no idea how you are getting those capsules...:confused:

I am going to send an email to Dechra's U.K. headquarters, but our experience is that they are not very responsive to requests for info from pet owners. Can you ask your vet how he/she has been able to obtain these 5 mg. capsules on your behalf? Is it a special clinical trial of some sort?

Marianne

[molly muffin]

It would be interesting if Dechra won't answer UK member questions but will provide them with 5mg vetroyl capsules.
While in the US, you can talk to them but not get 5 mg vetroyl.

I actually hope that they will expand 5mg throughout the world as it is definitely needed.

Sharlene and Molly muffin

[Budsters Mom]

Will you please post a photo of the box that those 5 mg capsules came in? Maybe open it flat? We are all itching to see it. ;)

Thanks,
Kathy

[labblab]

OK, here's the scoop! ;)

My email to the U.K. generated a callback from the U.S. office, but this time from a more knowledgeable person. She told me that a 5 mg. capsule is indeed available in the U.K., but not through general market channels. It can only be obtained directly from Dechra on a special need basis via vet request. Compounding is not allowed in the U.K., so the 5 mg. cap is being made available to vets in circumstances when conventional dosing strengths simply are not suitable for a dog's needs.

We should not hold our breath here in the U.S., however, because the 5 mg. capsule is a long way away from FDA approval :(. And no, there is no mechanism in place by which it can be imported. So compounding remains the available alternative for unconventional doses here.

But at least the mystery is solved!!

[Budsters Mom]

Thanks for tracking that down Marianne. Great detective work indeed!;)

[molly muffin]

Well darn, that would have been good to have a 5mg available. I wonder if it will be available in other places such as Canada, Australia, New Zealand, where trilostane compounding is not really available or not known about by the general GP vets.

I agree, good sleuthing Marianne!

Sharlene and molly muffin

[Fabuk]

Quick question for all out there...
How often do you find trilostane dosage needs to be upped?
My little one seemed fine on 15 mg for a while but her thirst seems to be coming back...
All answers helpful and welcome

Fabuk

[labblab]

It is not uncommon for trilostane dosages to require tweaking as time goes on. Can you do us a big favor, though, and post the actual ACTH results for the most recent monitoring test (which I believe was performed after the switch to 15 mg.)?

Marianne

[Fabuk]

Her next ATCH test will be a week on Monday so will post the results then. We had a set back as Dechra didn't dispatch her 5mg tabs on time so she went through a two week period on only 10 mg...
Thanks for the advice.

Fabuk

[Fabuk]

Any experiences with trilostane not working as well it did?
My little one gas been upped to 20 mg a day but I'm noticing her drinking quite a bit again... Is this normal? She seemed to he doing really well on 15 mg but then her results showed that her dosage needed to be upped.. How long does it usually take for cortisol levels to drop?

[molly muffin]

What were the results of the ACTH test that showed medication needed to be increased?

Anything up to 9.0ug with symptoms controlled is acceptable. If symptoms are not controlled then you are looking for under 5.0ug for post numbers. Don't go under I think it is 1.5 or 1.8ug on pre or post numbers.

It does happen that sometimes the medication needs to be tweaked. It depends on both numbers and symptoms together.

Sharlene and molly muffin

[Squirt's Mom]

Could you post the results of the latest ACTH that indicated the dose wasn't high enough? Is the drinking the only sign you are seeing come back?

[Fabuk]

I don't have the results on me . I can ask my vet but needless to say that the results indicated that her trilostane needed to go up. What baffles me is that when she was on 15 mg she responded very well for quite a while. Couple of months actually. But since her results and the dosage going up to 20mg she seems to be slipping back to drinking lots, week hind quarters and bigger abdomen. Her hair has been sparse since her initial diagnosis.
I'm feeling that her next results will indicate a higher dose needed again. She only weighs 3.5 kgs.. What can a yorkie that size take before you're in danger?

[molly muffin]

Dosages can go up quite a bit, but everything depends on the numbers and the symptoms.

Also, you want to make sure that nothing else caused the symptoms of drinking/peeing to come back.

So we'll be looking forward to those results.

Sharlene and molly muffin

[jas77450]

Welcome, I nhope your baby feels better soon...pancreatitis is rough.