Brutus, Cushings and Diabetes

[paradyne64]

Hello,
I am new here. I have a 12 year old dachshund named Brutus who is diabetic and has Cushing’s. He is on insulin with twice daily injections of 3 units. Blood sugar is controlled. Started Vetoryl about 8 months ago. He is up to 50 mg twice a day and according to his last ACTH Stim, the dosage is prefect. He is reacting well to the Vetoryl, his pot belly is gone and his hair is growing again. I was hoping to go to 60 mg twice a day to cut the cost, but vet said no this would be too much. As Vetoryl only comes in 10, 30, 60, 120 mg packages, a 50 mg twice a day dosage requires four 10 mg and two 30 mg packages a month. Vet said going back to 40 mg twice a day is not good either. Vet offered to go to 30 MG three times a day, but with insulin shots required twice a day with food, this will not work, since Vetoryl also requires food to be absorbed correctly.

Does 50mg twice a day seem like a normal dose for a 25 pound diabetic dog?

Anyone know of any other options? I have gone to mail order Vetoryl which is less than my local vet’s cost, but still it comes in at $275 a month.

Brutus has also has been getting UTI’s, mainly e coli infections, and now is also on a 6 week antibiotic treatment.

Thank you for any suggestions you may have.
Don

[labblab]

Hello, Don, and welcome to you and Brutus! It is such good news that he seems to be responding well to both the insulin and the trilostane. If you are interested, we have a sister forum that is dedicated to the care and support of diabetic dogs; we have several members who belong to both groups: http://k9diabetes.com/forum.

I can surely understand the financial burden associated with Brutus' current Vetoryl dose. In answer to your question re: whether or not his current dose is normal, there really is no "normal" dose once you are beyond the initial treatment phase. Initial dosage amounts are based strictly upon weight, but after treatment is begun, subsequent dosing changes are based upon monitoring ACTH results and clinical improvement. Since the drug is metabolized differently by each individual dog, there can be wide variations in the amount that is required, to the extent that a very large dog may need a smaller daily dose than a very small dog. So if you could get us the actual numbers for Brutus' monitoring ACTH tests, that would be great. That will give us the best idea as to the advisability of any dosing changes.

If you stick with the 50 mg. twice daily, however, one possible option would be to shift from brandname Vetoryl to a compounded trilostane product. Compounded trilostane is custom-made by individual pharmacies, and can be prepared in any dose needed by a patient other than the standard Vetoryl doses. Some vets are reluctant to prescribe compounded trilostane because the products are not FDA-approved and there have been some research warnings about comparable effectiveness. However, we have had many members through the years who have been very satisfied with compounded products, and for whom they have been a life-saver due to cost and/or the ability to prepare doses that simply are not available using Vetoryl capsules.

I believe the cost of compounded 50 mg. capsules would be significantly less than what you are paying for your combo of Vetoryl capsules. If you and your vet wish to pursue this option, it is important to make sure that you use a reputable compounder. One such compounder used frequently by our members is Diamondback Drugs, located in Arizona. If you are interested in pricing and other info, you can contact them through their internet website: http://diamondbackdrugs.com

Once again, welcome to you and Brutus. I'm sure other folks will also be by soon to check in with you. :)

Marianne

[LauraA]

I have been using trilostane for about a year and a half now without a problem. You really need to make sure the compounding pharmacy you use is a reputable one though. By getting the compounded version of Vetoryl you get get any strength you want and as I buy it 100 tablets at a time it is way cheaper than getting just 30 tablets of the named brand.

[paradyne64]

Thank you all for the replies. Vet said he let Brutus use compounded trilostane as a last option but did say the 50 MG of Vetoryl would not be the same as 50 mg of compounded trilostane. But it may come to that. It would also be nice to have Brutus on 1 pill instead of the current 3 Vetoryl pills twice a day.

[Squirt's Mom]

FYI, the active ingredient in Vetoryl, the ingredient that makes Vetoryl work, IS Trilostane. ;)

[labblab]

Yes, as long as a reputable compounder prepares the product, there should be no difference in the effective ingredient nor the dosage.

Marianne

[molly muffin]

I have never used vetroyl and only use trilostane so far with my dog. If i had problems with control, then I would probably do the vetroyl, but so far so good. It's key to use a good compounding pharmacy and when you do there shouldn't be any difference.

I remember one vet telling a member that vetroyl is absorbed better, but I haven't noticed any problems with that issue.

It is worth a try for sure. Even if you had to go up a bit with trilostane, then it would still be cheaper than using the brand name vetroyl.

[molly muffin]

I forgot that I did want to mention that with a diabetic dog, you want to do twice a day dosing, not once a day. It's important to keep their cortisol as level throughout the day as possible. I don't think you'd need to do three doses though.

[paradyne64]

Thank you all. I contacted Diamondback and it is $70 for sixty 50 mg compounded trilostane capsules compared to $275 for the same amount of Vetoryl mail order or $335 local.