Vetoryl to control symptoms

[Carhan]

Can anyone tell me the highest dose of Vetoryl that can be given to control Cushings symptoms? Thank you.

[Squirt's Mom]

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[Squirt's Mom]

Vetoryl dose is dependent on many things but weight of the dog to start with. Can you give us a bit more info on your baby?

[Harley PoMMom]

Hi and welcome to you and your furbaby,

I have manually approved your membership so please just ignore the validation email that was sent by k9cushing's.

Like Leslie has mentioned we need to know more about your furbaby. Could you tell us more about your furbaby? We love details!

Hugs, Lori

[Carhan]

Ellie is one of my rescue babies,so age unknown. She came to me 18 months ago and was diagnosed about six months after. She's a ? MalteseX, so I've only really known her as a sickly furbaby. Gradually increased her Vetoryl to 30 mgs a day over last eight months. And for about a month she was more active than she's ever been. But then symptoms started returning. I gave an extra 10 mgms alternate days with minimal response, the every day. She's slightly improved, less drinking, peeing and some weight gain. But nowhere near how she was when she was at her best. I regularly check the SG of her urine and it's still not within the 'normal' range.

[Squirt's Mom]

Honey, this is a very, very powerful drug that needs to be used according to a very specific protocol. The dose should never, ever be changed without an ACTH showing where the cortisol is currently. When was her last ACTH?

How much does she weigh? (critical info)

How was she originally diagnosed with Cushing's, which tests were done?

Could you get the results, actual numbers, of those tests and post them here? Than would help us a great deal.

Have diabetes, hypothyroidism, liver, kidney disease and other possible issues been ruled out?

Does she have any other health issues you are aware of?

Is she on any other meds, supplements or herbs?

[Carhan]

She was, of course, diagnosed only after having tests over a period of three months when the ACTH showed excessively elevated (and initially hardly responsive to medication) cortisol levels. And after all other options and co morbidities were excluded.
She demonstrated thinning hair and skin. Weight loss, excessive drinking,urination and a voracious appetite. Had a pot belly. Skin lesions. No glucosuria on testing.

Her weight is currently 6.30kgs. It was previously maximum 6.50kgs. And pre diagnosis 5.70.
She lost 0.5 kgs over the weeks preceding the vetoryl increase. And since the last vetoryl dose increase her weight has increased slightly.

I'll post results of last cortisol results later today.

Her last test was due two weeks ago. Unfortunately, the medication needed for the test was not available in the country at that time. Or since.

In view of her diagnosis, prognosis and general condition, and with my vets agreement, I chose to take the path of determining the dose of medication dependant on the general well being and contentment of Ellie along with weekly urine testing.

With ACTH testing at regular intervals.

Initially, the dose was very variable (both in amount and timing ie bd or od dosing) as her appetite diminished and I wouldn't give on an empty stomach, due to the toxicity of the medication.

She has fish oil supplements.

I was just curious as to maximum dosage.

Our next vet appointment is in one weeks time.

[Dixie'sMom]

Hello and welcome to you and your furbaby. I would just like to say that I am fairly new to having a cushpup, but I have been trying very hard to educate myself and learn all I can. With that said, I'm not sure that there is a correct answer to your question of "What is the maximum dosage?" The manufacturer makes 120 mg tabs for larger dogs of course, and for those that need higher than that, they add either 10 mg tabs or 30 mg tabs to get to the proper dosage.

In your case and with a fairly small dog, the maximum dosage would be whatever your vet feels is enough medicine that the Cushings should be under control, without putting your pet in danger. My vet told me that some dogs do not respond to the Trilostane/Vetoryl and she may need to be switched to Lysodren. Luckily my dog's symptoms are under better control with Vetoryl. Not perfect because she will always continue to have the disease... but better and I am grateful for that.

I also remember reading one story where one pup's cortisol had actually gone too low, but was asymptomatic and it wasn't discovered until testing. That situation could have easily been fatal. Luckily everything turned out ok. So if the members of this forum appear overly cautious, it is only because they care about you and your pet. They can and will be a tremendous help to you if you let them.

Best of luck to you and your baby and I look forward to getting to know you.

[molly muffin]

Dosage depends usually on cortisol levels.

One thing that can be done is a resting cortisol baseline level to find out what that is, which will make sure she doesn't go too low. Electrolytes can also be tested. This has been used when the agent for a full ACTH is not available. I think that it can be ordered in, as one of our members vet was finally able to get it in the UK.
With a maltese, can you tell what the ALKP is as they often seem to have gall bladder sludge too and the ALKP goes up very high if they do. (in the thousands)

Sharlene and molly muffin

[Carhan]

Thank you. I was advised to titrating to Vetoryl 40 mgs od which Ellie tolerates and which worked until recently. Not sure if trying 20mgms bd would have a better effect. Or a change. I will ask next week. And will also ask re the ALKP. Also re the resting cortisol levels. Not sure why this wasn't done last time.
I have watched for an Addisonian crisis, but hadn't realised that it could be a symptomatic.
Such a worry when all seemed to be going so well only to have her condition reverse and not respond as well as it could.

[molly muffin]

There is never anything easy about cushings, but when you find a good dose that controls the symptoms without any sign of cortisol going too low, then you can often stay at that dose for quite a while and they can live a good life. It's just getting there that can be confounding.

Sharlene and molly muffin

[Carhan]

I've been advised that I can use a compounded form of vetoryl. It's a third of the price of vetoryl. Does anyone else use a compounding pharmacist?

[Squirt's Mom]

Many here do. Check out Diamondback Drugs out of Arizona if you are in the US - that is the compounding pharmacy most here use and they get a good rating consistently.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about compounded drugs into Ellie’s original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

FYI - 3rd note in a row from me....just so you see them all. ;)

In looking back thru Ellie's thread, I see we never heard from you about the test results. Did you get those numbers? Would you mind posting them here for us. It would help a great deal to see at least the last few ACTHs that have been done to monitor treatment.

[Carhan]

Thank you. I'm in Australia and have just learned of a local compounding pharmacist

[Carhan]

Thank you. I'm in Australia and have just learned of a local compounding pharmacist. I hope my vet doesn't go bankrupt as I won't be buying from the surgery in future!!
Ellie is doing remarkably well. She is eating well, playing, coat is shiny and not sparse and weight is stable. On vetoryl 30mgs od.
Urine SG is good, no glucosuria
Will find last results. And post tomorrow. They were elevated. I asked if the lab had made a mistake. Next test in a few months.
But at this stage, I will continue to give the 30 mgs as she is stable generally.
I have also made recent enquiries about homeopathic preparations.

[westcoastflea1]

I've been advised that I can use a compounded form of vetoryl. It's a third of the price of vetoryl. Does anyone else use a compounding pharmacist?
both of my vets have specifically told me to use vetoryl from the manufacturer (decha) only, not to use anything compounded by any other company