Trilostane For Cushings

[a2743]

Our 10 year old Golden was diagnosed with cushings and the Vet put him on Trilostane 60 MG two pills a day. Now after about 5 weeks on the medicine he was tested to see how his body was reacting to the meds. We were told to stop giving the meds immediately his adrenal gland has crashed and hope it comes back. If not he is in real trouble. Has anyone had anything like this happen to them. Any other comments would be appreciated.

[spdd]

see next post,

[spdd]

Hi and welcome to the forum. There are many experts on here that will guide you through this. They will want to see a report of the tests that were made to diagnose the cushings from your vet. They will also want to know the weight of your pup as medication strength is based on their weight. It is Thanksgiving here in Canada today, so you may not get a reply tonight from the Canadian experts, however someone with plenty of expertise will be along later tonight, or tomorrow for sure to help you. My experience here has been wonderful, and we all know that a lot of veterinarians are not experienced enough in cushings diagnosis or proper medication doses, so please pay attention to what they will say. They saved my dogs life on here, no thanks to 3 vets and 1 almost killed him. You are in the right place here. I believe the medication you were giving is far too high especially given twice a day. Symptoms your dog was having would be good to know before taking medication and certainly would be interesting to know his behaviour after taking it for 5 weeks.
The starting dose recommendation by Dechra is 1-3mg per pound, once a day...and usually the lower dose, at least in my case we started with and can be tweaked upward from there.

[Harley PoMMom]

Hi and welcome to you and your boy,

It is critical that when a dog's cortisol drops too low that they are given some kind of a glucocorticoid replacement such as prednisone, is your boy getting this? Also, were his electrolytes checked? If not, I would suggest having that done too just to make sure that there is not an imbalance in the electrolytes.

Could you get a copy of his recent ACTH stimulation test and post those results here?

How is your boy acting? Is he eating and drinking normally? Any vomiting or diarrhea?

Hugs, Lori

[dsbailey]

Welcome,

Sorry your boy is not doing well. You can read my thread at http://www.k9cushings.com/forum/showthread.php?t=7962&highlight=lolita. We had a similar start to treatment.

There are a bunch of read flags in the treatment of your boy. I know I'm repeating some of Lori's and SPDD's advice because they're spot on and it needs repeating.


First, unless he weighs 120 lbs the dosage is too much to start with.


Second, he should have had an ACTH Test as per Dechra protocol between 10 and 14 days to avoid what has happened.


Third, the vet should have insisted your boy come back in for an electrolyte test as soon as possible, it's relatively inexpensive. If anything is out of balance he should be given appropriate treatment including possibly prednisone.

If your boy is doing horribly and it were my girl I'd give her prednisone tonight. When my girl crashed at 60 lbs my vet told me to give her 5 mg prednisone and another 5 mg if that didn't help after a few hours. He said it would not hurt and only help. I'm not a vet just relaying my personal experience.

I'd run him to the vet first thing in the morning and get the electrolytes checked. The second thing I would do if it was your vets idea to wait 5 weeks or your boy doesn't weigh at least 120 lbs is find a new vet to properly treat your boy for cushings.

My girl weighs 57 lbs and has stabilized on 30 mg once per day. With all that being said I hope I've not overstepped. Your boy with a little intervention should be just fine and should be able to be restarted at a lower dose sooner than later. My girl bounced back in a few days and was restarted after a week as per protocol. It's been noted that larger dogs sometimes need a lower dosage per pound than small dogs.

Here's a link to the Dechra documentation. Section 3 is the protocol that should have been followed. http://www.dechra-us.com/Admin/Public/DWSDownload.aspx?File=%2fFiles%2fFiles%2fSupportMa terialDownloads%2fus%2f01TB-VET50030-0615.pdf

There will be others here that will offer some great advice and help you get things straightened out. Most of them have a better bedside manner than myself. :rolleyes:

Darrell and Lolita

[Budsters Mom]

Okay, I am no expert, but I see red flags waving all over this!:eek::eek::eek: I don't normally do this, but no one is here right now, so you've got me. Others will be along shortly.

First of all, Darrell, your bedside manner is fine.;)

Your boy was put on 120 mg. of Trilostane a day, then wasn't tested with an ACTH for 5 weeks!!! An ACTH test should be performed within 10-14 Days of starting treatment. This is to minimize the chance of crashing, as you put it. Was he sent home with any Prednisone? That can help him bounce back, if his cortisol drops too low. It sounds like it has already.

How much does your boy weigh? The recommended starting dose of Trilostane is 1mg. Per pound, per day. Yes, no more Trilostane for the time being. How is he feeling otherwise? Lethargy, vomiting, diarrhea?

I agree with the others. I would get his electrolytes checked ASAP. I would also find a vet who has more Cushings knowledge, once this current crisis is over. The medications used to treat Cushing's are extremely strong and dangerous if dosed improperly. That is why monitoring through ACTH testing is crucial. Please post his last ACTH test numbers.

Lastly, monitor him very closely. Use your parental instincts. If he is acting very ill through the night, get him to the closest emergency vet, don't wait until morning. Yes, this is serious.

Please keep us posted. We will help in any way we can.

As you see, Darrell's bedside manner is better than mine.;)

Kathy

[a2743]

Thanks to all for your responses. I need to get the ACTH test results from the Vet and will post them asap. In the meantime here are a few more points. (1) When he started on the meds he was about 93 pounds now about 87 pounds. (2) He eats like crazy I think he would eat all day long. (3) No vomiting or diarrhea. (4) Still drinking quite a lot of water and panting. (5) Still pretty active, we have a 10 year old Lab and when we let them out to do their business he still runs around and plays. (6) I think his electrolytes were checked and came back ok, but not sure on this I need to check. When I get the test results I will post them.

[dsbailey]

After 5 weeks on such a high dosage and low numbers one would think the hunger and drinking would have subsided substantially.

What steps and test were used to diagnose Cushings? Can you get the test results used for diagnosis - Bloodwork (Some key liver numbers should have been out of range), LDDS (Low-Dose Dexamethasone Suppression) test, Ultrasound findings.

If I were to restart my 87 lb dog on Trilostane after this waiting period and ACTH test it would be on no more that 60 mg once per day and I would test again at day 10 and make no upward adjustments for 30 days. As I said "My girl weighs 57 lbs and has stabilized on 30 mg once per day"

[a2743]

Here are some blood work results that I was able to get from one of the Vets we have seen (three total) and this Vet was the one who came up with cushings. The Vet I mentioned in my earlier post, the one who said adrenal had crashed (I don't yet have any numbers for this) and took Brodie off the meds after doing ACTH test is coming this week to test again.

In the bloodwork they tested for 26 different items and 4 were out of range: AST (SGOT) results 74 IU/L HIGH Range 15-66
ALT (SGPT) results 170 IU/L HIGH Range 12-118
Alk Phosphatase results 1,200 IU/L HIGH Range 5-131
BUN results 5 mg/dl LOW Range 6-31

That's all I have for now.

[dsbailey]

The Vet I mentioned in my earlier post, the one who said adrenal had crashed (I don't yet have any numbers for this)

Get those test results when you can and post the pre and post values and the units of measure.

The liver numbers you posted are typical for untreated cushings dogs - nothing is horrible, just a stressed liver. The BUN (urea nitrogen on some reports) I'm not sure about because my girls were in-range 17 and her AST was in-range at 36. But her ALKP was 1532, ALT was 267. They are now BUN 14, ALKP 422, and ALT 102 after 6 months of treatment.

[molly muffin]

The values we are looking for in regards to the ACTH test is the Pre number and post number it tells you how low or how the cortisol is and how the adrenal glands are functioning. It could be it wasn't so low or long that the adrenals bounced back quickly, but without the numbers on the ACTH you just don't know for sure.

Liver enzymes can often be higher with cushings.

[a2743]

More test information. Here are the results from the test on 10/7 where the Vet said take Brodie off the Trilostane right now. CORTISOL RESTING RESULT 0.08 ug/dl REF RANGE 1.00-5.00
CORTISOL POST ACTH RESULT 0.34 ug/dl REF RANGE 8.00 - 20.00

Yesterday the Vet did another test and when those results are known I will post them. I should also mention that during our conversation yesterday Addisons came up as a possibility??

One last thing, he is still eating like crazy with no weight gain. Just to give you an idea he eats 3 cans of wet food and that or more in dry as well per day.

[dsbailey]

The actual range that should be used for a canine getting treated with Trilostane / Vetoryl is lower (1.5 - 9.1) ug/dl. With that said "Wow" I've only been in this group a bit over 6 months and haven't seen a post of .34 - I've seen some nice 3.4's :rolleyes:.

I'm glad you've gotten a new doc and waiting on new results. Sounds kinda like your pup was slammed so hard that the symptoms didn't have time to subside or something. I honestly don't know.

Keep us up to date

Darrell and Loli

[Harley PoMMom]

More test information. Here are the results from the test on 10/7 where the Vet said take Brodie off the Trilostane right now. CORTISOL RESTING RESULT 0.08 ug/dl REF RANGE 1.00-5.00
CORTISOL POST ACTH RESULT 0.34 ug/dl REF RANGE 8.00 - 20.00

Yesterday the Vet did another test and when those results are known I will post them. I should also mention that during our conversation yesterday Addisons came up as a possibility??

Like Darrell I am very concerned about those stim numbers, if the post is .34 that is dangerously low and a supplementary glucocorticoid is needed such as prednisone. Also the electrolytes should be checked to make sure that they are normal.

With his post that low that is considered an Addison's crisis and if not addressed properly with medications it becomes life threatening.


One last thing, he is still eating like crazy with no weight gain. Just to give you an idea he eats 3 cans of wet food and that or more in dry as well per day.

I'm glad he still has an appetite, is his drinking/urinating normal?

Hugs, Lori

[molly muffin]

YIKES, they that is very low. Addisons would be if the adrenal glands don't start to produce cortisol, then you are permently Addison, but sometimes you are having an Addisons crisis where the cortisol goes low, you give a big of pred for a set period of time, wean off it, and then see if the adrenals have responded.
Depending on what the test numbers are from this test, you might want to discuss that option with your vet.