Help with medicating - trilostane

[Mswisher]

We've been very lucky in that we started doing yearly blood panels when Kaia turned 9 so when her ALT and ALP levels spiked this year we were able to react very quickly. She had minimal symptoms, most of which we had put down to her advancing age.

The vet prescribed Vetoryl (trilostane) and we started noticing a difference pretty quickly.

The problem I'm having is that she's extremely adept at not taking pills. No matter what I hide it in she can lick or chew off and spit the pill out moments or hours later. We are currently doing the push to the back of her tongue and hold her mouth until she swallows and while it works it usually ends with someone in tears.

I asked the vet about opening the capsules and mixing with food and he recommends against it, but I've seen in older posts here people talking about editing the doses by giving half a capsule which seems to indicate that the outer covering is not necessary so I'm looking for real experiences. I know the vet had to research an answer and I'm not sure he grasped just how horrible the dosing process has been for us so he may have erred on the side of I don't know so this is safe.

Please tell me you have opened capsules for years and dosage has worked out correctly.

Thanks,

[Squirt's Mom]

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[Squirt's Mom]

Now in response to your question - your vet is absolutely correct. The capsules should never be opened for any reason. The outer coating does serve a very specific purpose and that is to make sure the drug is activated in the correct part of the body. By opening the capsule and dumping the content in the food, the drug is exposed to digestive enzymes in the mouth first which is not where the drug was designed to start breaking down. So you will lose effectiveness. ;)

I do understand your dilemma and stress very well. I have a 5 lb Pom mix who has COPD and when we first started having to give pills she turned into a monster that was half Bengal tiger and half Moray eel! :D But a friend on FB told me about a pill dough that worked like a charm. I still had to hold her mouth open and poke it down her throat but the dough kept her from tasting the pill, feeling the capsule coating, and it apparently tastes and smells enticing enough that it kept her from coming unglued. We had a very special routine - I held her with her back to my stomach while she was on the stove top (on a towel ;) ), I opened her mouth, poked the pill, then immediately carried her to my bed for bites (treats). Before long she was coming to me to remind me it was pill time because she wanted those treats! :p I'm not sure how large Kaia is but you might try this method. We did this for months - then I had surgery and my pet sitter started giving it to her wrapped in some of her raw rabbit food and the little huzzy gobbled it right up! :rolleyes: She still does so we no longer have to do the stove-n-poke routine....but she still wants her bites! ;)

Here is a link to the dough we use (you can google and find other places to buy it) - https://www.amazon.com/Vetoquinol-429022-Pill-Wrap/dp/B00701NED2

We have also used this brand and it works as well - https://www.amazon.com/Tomlyn-Pill-Masker-Original-Dog-Cat/dp/B006HO8URI

Glad to have you and Kaia join our little family and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[Harley PoMMom]

Hi and welcome to you and Kaia!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

You really do not want to open them capsules up and try to split the powder. First, it is not a good idea to expose yourself directly to the chemical. And secondly, there is no way in which you can be precisely dividing the active ingredient. The capsules are a combination of Trilostane (the active chemical), and also a "filler." They are intended to be swallowed whole, and the contents absorbed only after they've reached the dog's stomach. When you open and divide the capsules beforehand, you may be ending up with most of the active chemical in one half, and most of the filler in the other.

You can get the Trilostane in a liquid suspension (which may make it easier to administer the Trilostane) by purchasing it from a reputable compounding pharmacy, such as Diamondback, many of our members use this pharmacy to have their dog's medications compounded. I would ask the vet about this and in the meantime I'm including a link to their website so you can check them out. http://www.diamondbackdrugs.com/free-pet-med-quote/?gclid=CNn3gOS6ls4CFcNahgodrxYAdQ

I do have some questions regarding your precious girl and your answers to those questions will allow us to provide you with more meaningful feedback, ok? Could you get copies of all tests that were done on Kaia and post those values that are abnormal. With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. What diagnostic test/s for Cushing's were performed and could you post those results? Does Kaia display any of these common Cushing's symptoms: increased drinking/urinating, a ravenous appetite, skin/hair issues, pot-bellied appearance, exercise intolerance, and difficulty or unable to go up steps or jump on furniture? Does your girl have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Is she taking any supplements, medications or herbs? How much does Kaia weigh? And what dose of Trilostane has the vet prescribed for her?

I sure am sorry for the reasons that brought you here but so glad you found us and we will help in any way we can...hang in there ok ;)

Hugs, Lori

[Mswisher]

So I looked up the dough you were talking about and decided it looked a lot like a new cheese I just bought for myself (spreadable Brie, delicious) and so I tried it. OMG not only did it work she wanted more.

So pill issues covered.

Kaia is a 10 yr old boxer(ish) We're pretty sure that there is something else in there but she was a rescue so we're not sure, but she is tiny for a boxer.

We lost our older boxer in November to a spinal tumour so when she started sleeping on the floor instead of our bed and not playing as much we just put it down to sadness. She didn't gain weight or get the pot belly but she did go from a free feeder who rarely had an empty bowl to eating all of her meals as soon as they were available, and we did have some accidents when I was at work but I'd been laid off at the same time Mojo died so again we put it down to being out of practice.

We get annual blood work done, we started a couple years ago when Mojo first got sick and did Kaia's as well just to be safe. So glad we did.

The first clue something was wrong was when he sent me this years results... and last years.

2015 ALT 49, ALP 61 - Smack in the middle of normal
2016 ALT 127, ALP 371- ALT close to normal, ALP not even close.

We did the LDDS testing right away.
0hr - 98
4hr Dex - 80
8hr Dex - 53

And followed that with X-rays to verify that there is no tumour. And as an added bonus no sign of any of the bone issues that her brother had. Other than Cushings she's in excellent health.

Right before her annual vet appointment we rescued two puppies so she is currently taking Dolpac and Apo-Sulfatrim to ensure she doesn't get the critters they brought along and she's also taking Heartguard for Heartworm and Bravecto (the cause of our pill problem - apparently it tastes vile) for fleas and ticks.
She is about 50lbs and is taking 120mg of Vetoryl once daily. Other than getting it into her she's had no issues with it although the shaking I read about as a side effect she's been doing since shortly after we lost her brother. Started off in new situations (alone in the car and by alone I mean the only dog, meeting new people etc) and before we got the diagnosis we'd decided that we had messed up by comforting her and that now she was doing it for attention as it was occurring more often.

She's only been on Vetoryl for 8 days so I can't say for sure if it's decreased but her other symptoms are. She's jumping on the bed again, actually played with the puppies for the first time yesterday and has been running around again. Odd to see this as a benefit, but she's skipping meals again too. She's not 100% yet but it's a huge improvement.

http://imgur.com/PTBQwFU

Nap time. Kaia is the tan brindle on the floor, the puppies are boxer/lab mix and are Lexi (f) tan and Tucker (m) dark brindle.

[molly muffin]

The manufacturer now has a recommended starting dose to the low end, which is 1mg/1lb, since Kaias dose started about a bit over 2mg/1lb, keep an eye on her as you don't want the cortisol to go too low either. Any signs of vomiting, diarrhea, excessive lethargy, won't eat, won't drink, can't stand and immediately stop the vetroyl and get an ACTH w/electrolytes to check levels.

This is just a precautionary note so you'll know what to watch for. You can expect levels to continue to drop for 30 days at least on the same dose.

When you get your ACTH to check her levels you are looking for a Post level of 1.5ug - 5ug with up to 9.0ug if symptoms are controlled.

Your brain will be full of numbers, but in no time, this all becomes second nature to know and be able to rattle off.

Oh what a cute family. So are they becoming friends?

Glad the cheese worked! I agree I picked up some of that spreadable brie the other day and oh man, it is yummy. Haven't tried it with my dog but now it will be a possible if she gets finicky of her chicken.

[Squirt's Mom]

So glad the Brie helped and the added fat will also help the drug absorb better so YAY all the way around!

Kroger here has a garlic and herb Brie that my youngest grandson and I simply LOVE! Anytime he is here and we need to go to the store that comes home with us and Mimi gains another 5 lbs. :p