Can a dog overdose on Vetoryl

[Nanoo]

I am so glad to find this forum Our dog Shablu was diagnosed with Cushing about a month ago. When first diagnosed her cortisol blood level was at 117 - 263. after 2 weeks of being on Vetoryl her levels went down to 40. I am concerned about the dosage of Vetoryl she is getting. We have been told to give her 1 30mg capsule 2 times a day. Is it possible to overdose? What are the signs if so. She, at times seems much better but there are times like tonight where she seems worse than ever. Tonight she has throw up,is panting very heavy and does not want to move. We have been reading up on diet for cushings and for the most part she has been on a good diet for cushings She has been on a raw diet for just over a year and gave now cut out all grains, carbs and extra organ meat. I am very worried about the way she is tonight

[mytil]

Hi and welcome to our site.

I have just a sec but, Yes a dog's cortisol level can fall much too low which is a very dangerous situation.

Please tell us how much your Shablu weighs.

There has been a change in the recommended starting dosage to approx. 1 mg/pound - please read through this link -- http://www.k9cushings.com/forum/showthread.php?t=185.

If you Shablu is vomiting and showing signs of being lethargic I would stop the Vetoryl and contact your vet. Another ACTH test may need to be performed as well as having the electrolytes checked.

The number 40 you mentioned, was that the result of the most recent ACTH test? There are letter beside this number (ug/dl, nmol for example), please post those along with the referenced recommended range.

Keep us posted
Terry

[dew_nay]

The starting dosage is very very very important. You can read here for the recommended starting dosage:http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Starting dose is 2mg per KG.

I read a lot of cases when they start at the high dosage, that is when they encountered adverse reaction. The worst is the dogs get into addison which needs immediate vet attention. So if your dog isn't eating, feeling lethagic, bring your dog in to the vet for a check.

And having said that, some vets are quite inexperience with treating cushing and does not have a good knowledge on using the drug Vetoryl. For example, my vet probably do not have much experience. At first, she recommended using 15mg daily for my dog weighing about 3kg. That is 5mg per KG which is way over the starting dose.

That was when I pointed out to her that I am not comfortable with the dosage she prescribed. Now she recommended 6mg per day, which is about 2mg per KG. I have yet to start treatment yet, but I think I will start soon. Fingers crossed.

[labblab]

Yes, a dog can definitely overdose on trilostane and your description of your dog's test result and behavior has me extremely worried. If Shablu's post-ACTH result of 40 was reported in units of nmol/L (1.4 ug/dL), her cortisol had already fallen too low at that time and the Vetoryl should have been discontinued, at least temporarily, and the dose lowered. If she has continued on that same dose for another two weeks, she may now be in a serious condition requiring medical intervention.

As Terry says, no more Vetoryl and she should be assessed by a vet as quickly as possible. When cortisol and aldosterone levels fall too low and the balance of sodium/potassium is thrown off, the condition can become life-threatening. Shablu may need supplemental fluids and medications to stabilize her. By any chance, did your vet give you any prednisone to give her in a crisis?

Please do take her in to be seen, and let us know what you find out, OK?

Marianne

[Squirt's Mom]

How is your baby today? If she is not any better, please please please get her to a vet or hospital asap for an ACTH and to have her electrolytes checked. Please.

Let us hear from you when you can!
Hugs,
Leslie and the gang

[molly muffin]

Hello and welcome to the forum. I'm glad you found us.

It sounds like Shablu has already gone too low at 40nmol. Never give medication to a dog that is vomiting, diarrhea, won't eat, wobbly standing. Get an ACTH done immediately along with electrolytes and do not start medication (and then only at a lower dose) until symptoms return and a follow up ACTH shows that levels have again risen.

This is very important for Shablu's health.

Here is a link to the new dosing protocols:
http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Please print out and take to your vet.

How is Shablu today?

[Nanoo]

Shablu is much better today. Full of energy and eating well. She had her first peeing accident last night she could not make it outside and ended up going in our elevator Poor girl. Shablu weighs about 35 pounds .
Her last results are biochemistry.
Urea (Bun) Ref- 3.2 -11.0 momol/l
Creatinine 74 44-133 umol/L
Total protein :77 ref 55-77 g/l
Albumin 42 ref 27-39 g/l
Globulin 35. 24- 40 g/l
A/g ratio 1.2 0.7 -1.5
Alt 67. 18-121 iu/l
Alp 181 5-160
Hematology
White cell 12.5 4.9-17.6 x10e9/l rbc 8.1 hemoglobin 230 hematocrit 0.60 men corp vol 74 mean corp hgb 28.6 Mchc 386 rdw 12.8 platelets 634.

She has also just had her second surgery to remove a malignant mast cell stage 2 tumor The first was 1 year ago. She I a rescue ( 8 years old ) and we've had her for 2 years now.
I hope this is the info you needed if not let me know what other info I should add There is just so may # s. On this paper.

[molly muffin]

Hello, you only really need to post the abnormal (out of range) results Anything within range is fine.
None of that looks very bad.
What I don't see is the ACTH test. Which has a base and a post result.

Like this as an example:
pre (base or 0 hr) 40nmol
1 hour or post - 110 nmol

This would have been the monitoring ACTH after being on the 60mg of vetroyl was given.

I don't see where you mentioned how much she weighs, did I miss that?

The numbers are important as you want to know if she is really going low, or if she is having cortisol drop withdrawal, which can make them feel awful but not normally cause vomiting.

Did you get vetroyl today or withhold it?

Oh poor baby. Well she tried to hold it I'm sure.

[Nanoo]

Hi He is about 37 pounds.



8 hours 4 hours Interpretation

28 nmol/l Not applicable Normal
28-41 nmol/l Not applicable Inconclusive
41 nmol/l 59% base line
Or 41 nmol/l. Consistent with pituitary dependent

[mytil]

I am glad she is doing better today. Did you stop giving her the Vetoryl?

Thank for supplying the numbers. If this ACTH test was the most recent then your Shablu cortisol levels have fallen low. My conversions are underlined. By the way, was this the ACTH test that was performed to diagnose Cushing's OR one to monitor AFTER giving her the Vetoryl at the 14 day mark?

28 nmol/l Not applicable Normal (1.01 ug/dl)

28-41 nmol/l Not applicable Inconclusive
41 nmol/l 59% base line
Or 41 nmol/l. Consistent with pituitary dependent (1.48 ug/dl)

The manufacturer recommends this:


Post-ACTH serum cortisol
<1.45 μg/dL (Shablu was close enough with the 1.48)(<40 nmol/L) and clinically well (Shablu did not show signs of being clinically well)
Stop VETORYL Capsules for
3-7 days depending on the
severity of the clinical signs
and then
return to Day 1
at lower dose
Terry

[labblab]

8 hours 4 hours Interpretation

28 nmol/l Not applicable Normal
28-41 nmol/l Not applicable Inconclusive
41 nmol/l 59% base line
Or 41 nmol/l. Consistent with pituitary dependent

I am thinking these are actually the results of an initial diagnostic LDDS test rather than a more recent monitoring ACTH stimulation test. Can you double-check the date of this test? The LDDS has three blood draws, including a baseline and then subsequent draws at 4 hours and 8 hours. So that's why this looks like a LDDS. But as written, I having a hard time making sense of these results. Are you certain there were no other numbers or text included?

However, turning back to monitoring testing, the ACTH test should have had two numbers as Sharlene described. The LDDS cannot be used to monitor cortisol levels after treatment has begun, so it is really important for you to confirm whether ACTH stimulation testing has been done, and what the actual numbers were.

Hang in there -- we'll get to the bottom of this yet!!

Marianne

[Squirt's Mom]

That doesn't read like the results of the blood draws but rather the interpretation supplied by the lab. :confused::confused::confused:

[budindian]

I'm fairly new here but yes your baby can overdose on Vetoryl. My dog was diagnosed and started on 60mg per day after the second day I came home my baby could not get up, was shaking uncontrollably , couldn't get up to go to the bathroom went where he was laying, he had never done that. It went on all night, I stopped the Vetoryl and it took about a week but he slowly got better.
You have come to the right place, I don't give advice but I read everything I can and the people that have been here for a while know what they are talking about and have helped me tremendously. I can't say enough good about the moderators. Just keep asking questions, checking in and reading what they say.

[Nanoo]

She is now on her second day of no meds but does not seem to be doing well this morning. The test results were after the 14 days of meds.

[labblab]

In what way is she not doing well? At this point, if you have any doubt at all as to whether or not she is OK, I think she needs to be seen by a vet. If her cortisol has been driven too low, she may need supplemental medication and perhaps IV fluid to normalize her blood chemistries.

I still cannot make sense of that lab result because as Leslie says, it looks as though all that was written down was the way the lab would interpret different test results. It does not give Shablu's actual numbers on the test. But the more serious problem is that it really does look like a diagnostic LDDS test. If this is what was performed two weeks into treatment, it is the wrong test and the results are meaningless in terms of deciding whether or not she is on the right dose, or has been overdosed. An ACTH stimulation test must be performed to gain that information.

If it was me, I would take Shablu in to the vet as soon as possible and insist that they perform an ACTH stimulation test and also check her blood chemistries.

Marianne

[Squirt's Mom]

We are not getting enough info or answers to our questions to be able to help you much. :(:(:( I hope your baby is ok. Please let us know when you can.