Sofi allergic to Trilostane after 2 years with no problems!

[JML]

Sofi, our 11 year old (ESS) English Springer Spaniel, was diagnosed with Cushings almost 3 years ago. After labs and imaging Sofi was prescribed 24mg of Trilostane twice daily along with 10mg of Benazepril once with dinner.

The vet never adjusted her Trilostane and she seemed fine for the 2 years. Then she started not eating, was lethargic and spacey. We tried giving her one 24 mg a day, still no joy. Finally we found 24mg every 48 hours worked for awhile, but the third 48 hr dose and she would relapse again.

During all this we visited the vet multiple times and the ultimate statement was - "This is very unusual, for a dog who has been controlled with Trilostane."

Frustrated we took Sofi to a "specialist" and $$$ later this vet said basically the same thing. We asked and received a lower dose of 10mg and tried twice a day, then once a day and now the magic dosage is 24mg every 72 hours.

Please if anyone has advice or suggestions let us know. I am terrified that Sofi is not getting enough medicine to hold the Cushings at bay, but it is torture to see her dilapidated by the Trilo. She does not show robust symptoms of Cushings - drinking massive water, etc. even after no Trilo for 5 days. However we are diligent about every 72 hours as we are constantly concerned when she starts to drink just a little more water.

After 2 to 3 days without trilostane Sofi is much more vibrant, eats with gusto, wants to take walks and is more alert. Then we give her the trilostane and the next day she doesn't want to eat and sleeps.

We would appreciate some direction. Thanks John

[labblab]

Hello John, and welcome to you and Sofi. I'm afraid I only have a moment to post right now, but wanted to tell you I've moved your thread to our main discussion forum so that more of our members are likely to have the chance to read and respond.

Turning to Sofi, I am feeling very worried because you are not mentioning any monitoring blood tests in conjunction with Sofi's trilostane treatment. During these past two years, have her cortisol levels and blood chemistries been checked, especially in conjunction with these dosing changes? It is not safe to rely solely on outward appearances when making decisions about dosing, because internal lab changes can precede more serious consequences from over or under dosing.

Please let us know whether any monitoring tests have been performed, as well as the results. Also, can you tell us why the benazepril has been prescribed? There are some specific cautions about combining ACE inhibitors like benazepril with trilostane because of possible cumulative adverse effects on blood chemistries and renal perfusion, so there is added importance to checking blood work regularly.

Thanks so much for this additional info,
Marianne

[Renee]

Jumping in here to second Marianne. It scares me to think that none of the monitoring testing has been done.

Can you confirm if any ACTH stimulation tests have been done?

[JML]

Yes Sofi was monitored with lab work over the whole period of time. We even had labs done when she was off Trilo for up to 10 days.


I have to run right now and will post some of the lab work soon and respond about the Benazapril

There were no alarm bells for any of the labs that I can recall. The latest labs were when we went to to see specialist, March 2, 2016.

My concern is when we give her Trilo she is completely miserable and when she is off for a day or so we have our happy, tail wagging ( not much of a tail ) affectionate dog back. It is all about quality of life. Do we have a miserable dog on Trilo or what?

Are there any other options than Trilostane??? We are at our wits end and not getting any real feedback from vets.

Thanks, John

[judymaggie]

John -- there is another alternative to trilostane. It is Lysodren. My vet was only familiar with Lysodren so that is what my dog was started on -- unfortunately, it did not control her cortisol levels so we switched to trilostane. If switching from one drug to the other, there does need to be at least a month's time before starting the second drug. It is also a good idea to do an ACTH right before starting the new drug so that an accurate baseline can be obtained. Here is a link to some info about Lysodren from our "Helpful Resources" section:

http://www.k9cushings.com/forum/showthread.php?t=181

You will see in this post that there is a loading phase with Lysodren and then a maintenance dose is given. My Abbie loaded without any issues although I will say it was a bit nerve wracking and I'm sure she was not thrilled that I was watching her every move!

[molly muffin]

I think much depends on what your monitoring results where. You should not be below 1.5ug POST ACTH. The test should be conducted approximately 4 - 6 hours after giving medication with food to be an accurate result.
We look forward to seeing what those ACTH results where when you get a chance to post them.
Has there been anything else high or low in her labs? What about in urinalysis?

Welcome to the forum.

[kanga]

Wow, this sounds so tough :( Good luck.