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View Full Version : Ketoconazole treatment, what to expect?



BarkAtNoon
01-20-2016, 03:22 PM
My dog is being treated with ketoconazole, just wondering what sort of things I should expect? Thanks very much.

Harley PoMMom
01-20-2016, 03:41 PM
Hi and welcome to you and your furbaby!

Sorry for the reasons that brought you here but glad you found us. It would help a lot if you could get copies of the tests that were done on your dog and post all abnormal values here along with the reference ranges and units of measurement...e.g..ALT 150 U/L (5-50)...Thanks! We are especially interested in the results from all tests that were performed to diagnose your dog's Cushing's.

Does your furbaby have any other health issues? Is s/he taking any herbs/supplements/medications? What symptoms did your furbaby have that led you or your vet to test for Cushing's in the first place?

Cushing's is one the most difficult diseases to get a confirmed diagnosis for, and unfortunately it is often misdiagnosed. Other non-adrenal illnesses, such as diabetes and thyroid problems, do share some of the same symptoms as Cushing's and should be ruled out.

The two preferred medications prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, so I am puzzled as to why your sweet furbaby was started on Ketoconazole. Ketoconazole is rarely used for Cushing's any longer due to it's lack of efficacy and it's adverse effect on a dog's liver which is already being overtaxed from Cushing's.

I'm including part of a post from one of our staff members regarding Ketoconazole:

Moving on to the ketoconazole, I checked with an endocrinologist specialist, Dr. David Bruyette, who has been very helpful with answering some questions for us here. We are just not that familiar with ketoconazole treatment, so I wanted to get some guidance from him. He has confirmed that it is an older treatment that preceded trilostane and as Lori has said above, in countries where trilostane is available, trilo is now prescribed more often because it is effective for more dogs and carries less risks of side effects such as the liver dangers associated with keto.

Keto treatment does require the same ACTH monitoring as does trilostane and Lyosdren because cortisol can be driven too low, but you do not have the same worries about electrolytes (potassium and sodium levels) going too low with keto because it does not affect aldosterone production (another adrenal hormone) in the same way as do trilostane and Lysodren. The trade-off, though, is that you have to watch the liver values very closely with keto due to the potential for liver damage. As far as the ACTH monitoring, you are looking for the same 1-5 ug/dl post-ACTH range as for Lysodren.

Marianne



Please know we will help in any way we can, so do not hesitate to ask all the questions you want.

Hugs, Lori

Kincsem
01-20-2016, 06:05 PM
As was said above this is a very unusual medicine! Perhaps your vet is stuck in the dark ages. Maybe showing him/her this article would be in order: http://www.veterinaryplace.com/dog-medicine/ketoconazole-for-dogs/, it says ketoconazole can even cause liver failure in dogs with Cushing's :eek:

Well wishes to your furbaby! x

labblab
01-20-2016, 07:42 PM
Hello and welcome from me, too! As you've probably gathered, we don't have many dogs here who are actively being treated with ketoconazole. However, there may be a specific reason why your vet feels as though it is a good choice in your dog's situation. So the more details you can tell us about, the more helpful we can be to you.

We're very glad you've found us, and look forward to learning more about you two! :) :)

Marianne

BarkAtNoon
01-20-2016, 08:02 PM
Hi and welcome to you and your furbaby!

Sorry for the reasons that brought you here but glad you found us. It would help a lot if you could get copies of the tests that were done on your dog and post all abnormal values here along with the reference ranges and units of measurement...e.g..ALT 150 U/L (5-50)...Thanks! We are especially interested in the results from all tests that were performed to diagnose your dog's Cushing's.

Does your furbaby have any other health issues? Is s/he taking any herbs/supplements/medications? What symptoms did your furbaby have that led you or your vet to test for Cushing's in the first place?

Cushing's is one the most difficult diseases to get a confirmed diagnosis for, and unfortunately it is often misdiagnosed. Other non-adrenal illnesses, such as diabetes and thyroid problems, do share some of the same symptoms as Cushing's and should be ruled out.

The two preferred medications prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, so I am puzzled as to why your sweet furbaby was started on Ketoconazole. Ketoconazole is rarely used for Cushing's any longer due to it's lack of efficacy and it's adverse effect on a dog's liver which is already being overtaxed from Cushing's.

I'm including part of a post from one of our staff members regarding Ketoconazole:



Please know we will help in any way we can, so do not hesitate to ask all the questions you want.

Hugs, Lori

Thanks for the advice everyone. No supplements but I would love for any suggestions, I have Prime on Amazon so I can get any helpful supplements very quickly. My dog can't take Lysodren so from what I gather the only option is Vetoryl or ketoconazole, and I think it might be because of her kidneys they want to avoid Vetoryl.

ALT was 42 U/L (range is 0 to 25). I will get a copy of the full results.

Urine testing and blood testing was used for diagnosis. Pretty concerned about the ketoconazole now hmm...

Harley PoMMom
01-20-2016, 10:00 PM
I wanted to provide you with a link to an (inactive) member's thread who had some success treating their dog with keto and here it is ;) : http://www.k9cushings.com/forum/showthread.php?t=620&highlight=Ketoconazole&page=13

Hugs, Lori

molly muffin
01-22-2016, 07:56 PM
I don't have any experience with keto, but did want to say hello and welcome to the forum.

How is your dog doing on the keto? Are they doing any follow up testing to see how it is working?