Side effect Vetoryl

[Suzanne]

My dog Lola was recently diagnosed with Cushings. She has probably had it for a couple of years because she has been drinking a lot and of course peeing. The last 6 months it really ramped up, waking up at night to drink and then having accidents. Other symptoms, panting, anxiety, pot belly, muscle wasting.
She had a low dose Dex test pre-3.8
4h 3.1, 8 hr 3.8
She was started on Vetoryl 10 mg twice a day. She weighs 12.72 lbs.
After 4 days she woke up and threw up a couple of times, took her to the vet. Labs were Ok, maybe a little dehydrated. I should say her fluid intake had started to decrease and not eating as much.
The vet had me hold the drug for 5 days and then I restarted at 10 per day. Now after 3 days she woke up and theme up again.
I'm frustrated and worried she won't be able to tolerate this med. This time her fluid intake has only slightly changed.
Has anyone had this problem? She is seeing her Local vet today. The diagnoses and treatment was started by a a specialist 45 min away but she is on vacation.

[Harley PoMMom]

Hi and welcome to you and Lola!

I am sorry Lola is having a rough time right now, and hopefully once we all put our heads together we can figure out what's going on.

Dechra's recent published literature recommends a starting dose of 1mg per pound of a dog's weight. That 10 mg twice a day just may have been too much for her. Did the vet check Lola's cortisol before the Vetoryl was restarted at 10 mg once a day? If this was not done I am concerned that Lola's cortisol may have dropped too low and she now needs some prednisone to supplement that low cortisol level.

The vomiting is worrisome, and with out the knowledge of results from a recent ACTH stimulation test, all we can do is guess at what is causing the vomiting, because it could be that her cortisol is too low or it could be that she is having some gastric problems with the Vetoryl. Is she having any diarrhea? How is her appetite?


Those results you posted are from a low-dose dexamethasone suppression (LDDS) test and are indicative to Cushing's, however they do not distinguish if the Cushing's is the adrenal or pituitary type. Were any other tests performed to diagnose the Cushing's? Was an CBC/Chemistry blood panel done and if so could you post all abnormal levels? Was an urinalysis done, and if so, could you post those findings too? Is Lola taking any other herbs/supplements/medications? Does she have any other health issues?

If she is still vomiting, if this were me, I would with hold the Vetoryl until an ACTH stimulation test is done.

Looking forward to hearing more about sweet Lola.

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

I agree with Lori, I would want an ACTH test to see if that 20mg was too much for her and if she has recovered enough to be on the medication right now.

Vomiting is most often caused by too high of a dose.

[Suzanne]

Thank you for responding. Last week when she threw up, they were going to do a ACTH but my car broke down (clutch)on the way there and we never made it. That night she was eating and drinking.I went the next day but by then I had held 3 doses. The did a serum cortisol, which was 5.5. Her a chem 25. Everything was normal except her Bun which was 67 mg/do and her potassium which was 6.1 Molly/L.
I held the Trilostane from Tues eve until Sunday when she started back to her Cushings symptoms again. Started at 10 mg per day instead of twice a day.
She was doing OK on the 10 mg until this morning when she woke early and threw up about a 2tbs of white foamy secretions. Same as last week. Almost the same exact time. Took her to her local vet who did more blood work which was OK again except for the bun being slightly elevated. Now she will restart at 5mg per day. The vet had some compounded med.
I feel much better with my local vet. She is about 10 min from my house. After being on it for a week she will run the ACTH test.

When she was being worked up they did chemistries, urine which was all normal. I don't think they did a CBC. She did have an ultrasound and both adrenals are enlarged.
So far the bill for the work-up, low dose dex test, 2 visits for vomiting, I'm up to $2000 not counting the $200 for a month of Trilostane 10 mg twice a day. She hasn't even had her ACTH test yet and I understand that expensive. Ugh..my poor little girl. She had her left eye removed about 6 months ago after battling a corneal ulcer that wouldn't heal and just kept getting worse. 2-4 visits a week with the ophthalmologist. In retrospect, it was probably the Cushings that was causing it to not heal properly. I feel bad. I should have really pushed to have her excessive drinking worked up way back. it just wasn't that bad at the time and she has had blood work that never showed any abnormality.

[Harley PoMMom]

Thank you for responding. Last week when she threw up, they were going to do a ACTH but my car broke down (clutch)on the way there and we never made it. That night she was eating and drinking.I went the next day but by then I had held 3 doses. The did a serum cortisol, which was 5.5.

Could you clarify something for me? When they did the "serum cortisol" did they inject a stimulating agent and after a hour take blood? If her cortisol was 5.5 ug/dl after not having 3 doses of Vetoryl, I'm a bit worried.

[Jed's Mom]

Hello to You and Lola

My dog, since he was a pup, would get sick that white foamy/bile A LOT. I found that a lot of dogs do this when they have empty stomachs and the acids make them feel sick. Add in all of the water they drink and I think it makes it worse..at least for Jed it did. I started feeding Jed 3x a day and giving him a small treat before bed. I also give him 10mg omeprazole in the mornings. This seems to be working..no more vomiting, unless he skips meals.

[Suzanne]

Thanks, my vet also thought the early morning vomiting episodes was related to acid and an empty stomach. So, she was started on Pepcid and a snack before bed. I also feed her 3 times a day and she is doing well. Restarted the Trilostane at 5mg per day, tolerated that so she has been on 10 mg per day for a few days and is scheduled for a ACTH next week. Haven't noticed a big change in the amount of water she drinks but her energy is good and she is more interactive, more herself. Feel like she is making some progress. Everyone is so great and helpful.

[molly muffin]

Is the ACTH test this week?

I always give molly a little bit of something right before bed. For the last couple years it has been her milk thistle and her glucomine treats, which she loves and she doesn't have as many upset stomach issues in the mornings as she use to. So sounds like you are on the right track with that.