I have some questions about Vetoryl and pregnancy,help me

[Gingerbeer]

Hello ,my dog Mona was diagnosed with Cushings two weeks ago.We bought Vetoryl from other country because there is no cure in Turkey.But when i read the forums ,i see vetoryl is dangerous for pregnant women. And i am curious about in which circumstances? I am pregnant and we are going to start treatment to our dog tomorrow. Is there anybody who is pregnant and using vetoryl?

[labblab]

Hello, and welcome! I am neither a vet nor a doctor, but from reading the information contained in American boxes of Vetoryl, women who are pregnant or trying to conceive should not directly handle the Vetoryl capsules themselves. Someone else should handle the capsules and give them to Mona. This is because the active ingredient, trilostane, can cause birth defects in unborn babies. You don’t want to run the risk of exposing yourself to the chemical by handling the capsules or allowing them to directly touch your skin. I don’t know whether a doctor would say it’s OK for you to handle the capsules if you wear protective gloves. You could ask. But the best thing is probably for you to not handle them at all. And yes, we’ve had other pregnant women who have Cushing’s dogs in their families. But again, you just should not be handling the capsules.

We would love to learn more about Mona. What symptoms and tests led to the Cushing’s diagnosis? How much does she weigh, and what dose of Vetoryl do you have? It’s best not to start with a dose any larger than 2 mg. per kg. Do you have a vet there who will be able to check her blood work after you begin the medication?

Sorry for so many questions, but your answers will help us to learn more about your girl. And once again, welcome!

Marianne

[Gingerbeer]

Thank you Marianne!Mona is 6 years old boxer and she had been treating hypothyroidism for about 2 years and using thyroid pills. Cushing symptoms are almost the same like Cushing disease like ;Obesity/weight gain,Hair loss on the body and tail,drinking too much water.But a month ago despite using thyroid medication she started to drink too much water again and increase urination , lack of energy.Our vet did all the tests and the thyroid was on the lower border and we increased the dose of the drug but neither the water nor the urine volume decrease, I researched and wanted our vet cushing test.In the LDDS test the cortisol level was seen in the highest level and the cushing was diagnosed. Mona is 31 kg .We bought two packets of 60mg Vetoryl from Italy because in there is no cure in Turkey . Our veterinarian says Mona needs 120mg , but tomorrow I will insist on starting with 60mg. Because when i researched i see that the starting dose is 2mg/kg. I am afraid of the side effects so I am going to give her the pill at the veterinary clinic and Iam going to wait all day long.

[labblab]

Thank you so much for your quick reply! From what you’ve written, I understand why you suspected Cushing’s. And yes, I strongly agree with you — I think the 60 mg. capsule is the right place to start. Here is a link to a post that can help explain this new dosing formula to your vet:

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1251#post1251

Also, once there at that post, if you scroll down one reply further down, you’ll also see information about a new Vetoryl monitoring system that only requires testing resting cortisol levels as long as a dog is doing well. That information may be very helpful to your vet, as well.

I’m guessing that Mona will do just fine tomorrow! Please do let us know.

Marianne

[Joan2517]

Hi and welcome to you and Mona. I started my boy Gable at a low dose and we have also done the pre-pill cortisol testing. He is currently on 40mg, 30 with breakfast and 10 with dinner. So far, so good, and the new testing was so much easier on us. He wasn't so stressed out and it cost less than the ACTH test, which lessened my stress!

[Gingerbeer]

Hi!thank you!we started at a low dose today too.60mg. We haven’t seen any side effect so far, im happy.i don’t know the new testing,what is it?

[labblab]

Click on this link and you’ll find out about the new testing. It involves checking the resting cortisol level right before the morning dose of Vetoryl is given with breakfast:

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1252#post1252

I’m so glad to hear that Mona is doing well today!

Marianne

[Gingerbeer]

Thank you! i am so glad too!the resting cortisol level before the morning dose is checked at day 28 ,isnt it? At day 10 we are going to vet to check her cortisol level after 4-6 hour ,having the morning dose of vetoryl.am i right? İ find it very complicated:/

[Harley PoMMom]

Hi and welcome to you and Mona from me as well! So glad you found your way here and we will help you and Mona in any way we can. Could you get the results of the diagnostic test/s for Cushing's that were performed on Mona and post those here?

Two very important protocols with Vetoryl is that it has to be given with a meal to be properly absorbed and those ACTH stimulation monitoring tests have to be done 4-6 hours post pill (except if using the pre pill testing method). One quick question; was Mona tested for an UTI or diabetes? The reason I ask is because either one of these can cause a dog to drink and urinate more, cushdogs are prone to UTI's, and diabetes can come on suddenly.

And by the way, Congratulations on the baby!!!!!!

Lori

[Gingerbeer]

Thank you for your attention Lori! yes vet did all the tests - UTı, diabetes, hemogram, t4, free t4, comprehensive profile biochemistry, also ultrasound.
After LDDT test results are;
0 hour of cortizol 6,4
4th hour of cortizol 6,0
8th hour of cortizol 2,1

[Gingerbeer]

Hi,it is me again:) we have been used vetoryl for 3 days,there is no side effects like vomitting,dierrhea etc.She drinks less water and go out less for urine.but still she sleeps a lot and doesn’t willing to play with her toys.is it normal?

[labblab]

Hello again! That’s good that you’re seeing improvement in the thirst and urination, and also that you’re not seeing any bad side effects. As far as regaining more energy — that may take a while. Cushing’s is a disease that develops slowly over time, so several of the symptoms can also take time to improve. And for some dogs, sudden lowering of their cortisol may make them feel even a bit more sluggish for a while as their bodies readjust to the new hormonal balance. So as long as you’re not seeing any bad side effects, I’d just give your girl some more time.

Marianne

[Gingerbeer]

I hope so! Thanks a lot for good advices

[Gingerbeer]

Hello!we went to the vet today and mona’s comprehensive diagnostics are
ALP 1142 High (20,000-150,000 normal)
ALT 244 High (10,000-118,000 normal)
There is no acht test for dogs in Turkey so our vet look mona’s cortisol levels from her blood,we will learn the result 5days later.
I’m confused because of her elevated liver enzyme but our vet said it is not very dangerous now,we will look 18days later again. Do you think it is dangerous for her ? Is it vetoryl side effect?

[Squirt's Mom]

ALP 1142 High (20,000-150,000 normal)
ALT 244 High (10,000-118,000 normal)

Can you verify the normal ranges posted? If those ranges are correct then the ALP nor ALT are elevated.

[Gingerbeer]

ALP 1142 high(20-150normal)
ALT 244 high (10-118 normal)
Sorry there are two types of written diagnostic ,one of them Turkish ,one of them English

[labblab]

Hi again. Those elevations in the ALP and ALT are commonly found in dogs with Cushing’s. They are a result of the disease and not the medication. Your vet is right, though — you don’t need to worry about them much at this point, because it is unlikely that they reflect actual damage to the liver’s ability to function. Over time, they may come down with the Vetoryl treatment. However, for some Cushing’s dogs, they never entirely fall back within the “normal” range again. But for right now, I don’t think you need to worry.

Marianne

[Gingerbeer]

I feel good now,thank you!it is too difficult to be calm when my dog suffering from cushings;(

[Gingerbeer]

Hi. Mona’s cortizol range was 3, after 4 hours taking the Vetoryl. before taking the pill it was 6,4. It has been 10days that she takes the vetoryl 60mg. is it going to decrease slowly? thanks for your supports

[Squirt's Mom]

Hi,

A post number of 3ug/dl is just about perfect! Are you seeing the signs improve? Signs are just as important as the numbers so please let us know if you are seeing changes. As for the number going lower, you do not want it to go much lower than it is. Anything below 2ug/dl is getting into dangerous territory so sticking around 2.5 - 3.5 is perfect!

Hang in there! You're doing fine!
Hugs,
Leslie

[Gingerbeer]

ı am happy to hear that! Water consumption ,and urination is normal.there is not panting.there are no side effects like womitting ,dierrhea... the only thing that i am anxious about is,she sleeps all day,she hasn’t got enough energy ,she doesn’t want to play.but nowadays she wakes up and barks when she hear noise from outside.i think she will be more healthy in the future!because she has been using the vetoryl for only 16days.
Hugs

[Harley PoMMom]

That's great you're seeing improvements in her symptoms, and that post ACTH stimulation level is good. However, a dog's cortisol can continue to drift downward during the first 30 days of treatment so even though her post of 3 ug/dl is ideal you really don't want it to go much lower. As for the lack of energy, Mona just may be one of those dogs that needs their cortisol to be in the higher normal therapeutic ranges, if fact, on the forum we have seen that larger dogs may require less Trilostane, per pound, to control clinical symptoms. Has an ACTH stimulation test been scheduled for the 30 day mark of treatment?

Lori

[Gingerbeer]

There is no ACTH Test for dogs in Turkey.our vet looked at her cortizol level. After 28days of treatment he is going to look at the cortizol level again.
Mona has hypothyroid and had been treated for it before the vetoryl.now our vet is waiting for 28days to see if it is a secondary disease or it is a specific disease. We dont treat mona for hypothyroid.after 28 days of vetoryl treatment ,he will look her free T4 and T4 level ,she will be treated for it too may be.may be she isn’t energetic because of hypothyroid we don’t know for now.May be she need cortizol level to be energetic

[Harley PoMMom]

Hi. Mona’s cortizol range was 3, after 4 hours taking the Vetoryl. before taking the pill it was 6,4. It has been 10days that she takes the vetoryl 60mg. is it going to decrease slowly? thanks for your supports

So is the 6.4 a resting cortisol level? And the 3 was the level after 4 hours post pill BUT with no stimulating agent, correct?

[Gingerbeer]

Yes it is true

[Harley PoMMom]

Well, I'm a bit puzzled as to why they did the 4 hour blood draw after the Trilostane was administered. :confused: For the pre-pill method, you would give the Trilostane at the regular time and than the resting cortisol blood draw is done the next day before the Trilostane is given (one would make an appointment just before the next Trilostane dose is due).

[Gingerbeer]

İ am puzzled with the situation too! I don’t know why the vet did it! He said we will use the same dose of the vetoryl 😬next time i want him to do the test before taking the pill. They don’t know much about the treatment because there is no cure in Turkey and may be he uses the other way to do treatment🤔

[Harley PoMMom]

Click on this link and you’ll find out about the new pre-pill testing, you can also print any information out and take it along to the vet!
http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1252#post1252

[Gingerbeer]

İ sent it to my vet today and wanted him to read. And also sent this
https://thehormonelab.com/handbook/adrenocortical-function/interpretation-of-cortisol-measured-before-and-after-trilostane

[Joan2517]

I've done the pre-pill with Gable and it worked out fine. So much less stress on all of us.

[Gingerbeer]

Iam happy to hear that.

[Gingerbeer]

Me again with questions�� She sleeps all day long, she isnt happy, she doesn’t want to go out, doesn’t want to play.are these side effects of the high dosage? she seems lethargic. Should i decrease the dosage? When was your dogs became energetic after the treatment? Was it take time? I am going to go to vet tomorrow and talk about treatment.

[Harley PoMMom]

Is she drinking/urinating normally? How is her appetite?

[Gingerbeer]

They are normal.she seems only lethargic.she seems unhappy and doesnt wave her tail😐

[Harley PoMMom]

If she's eating and drinking/urinating normally than I wouldn't think the cortisol is too low, but one really doesn't know without doing a full ACTH stimulation test. Decreasing her dose of Vetoryl or just stopping it can be options. If you choose to discontinue it and her energy picks up than probably she just needs her cortisol to run a bit higher to feel better.

[Gingerbeer]

We went to the vet today, and the vet did pre-pill and post-pill tests. we are waiting for the results. and also the blood test is normal so our vet doesnt want to stop treatment or decrease the dosage.

[Harley PoMMom]

Why is the vet doing a post pill blood draw without the stimulating agent? Your best option for testing is to just do the pre pill method.

[Gingerbeer]

I dont know🤔 he doesnt want to use stimulating agent.he thinks mona is doing well.he also did pre-pill method

[Joan2517]

The pre pill method is just checking the level before the first dose and that's it, one blood draw without any stimulating agent. Is that what they did?

[Gingerbeer]

Yes,before taking the pill,he took her blood.

[labblab]

I’m guessing your vet is following the protocol that was used in this study which involved testing resting cortisol levels both pre-pill and also three hours after. There’s nothing at all wrong with this — it provides a bit more information than the pre-pill test alone. As the study says, if only one test is done, the pre-pill test appears to be the more accurate. But if your vet wants to test twice, that will provide even some additional insight into the action of the trilostane on your dog’s adrenal function.

https://veterinaryrecord.bmj.com/content/179/23/597

Marianne

[Harley PoMMom]

I agree that there's nothing wrong with that but why perform the added poke and expense when it really isn't necessary.

[Gingerbeer]

I feel good now.thank you.our vet only takes the test costs and he makes lots of discounts to us,because we take care of lots of homeless animals too and also vetoryl is very expensive for us😐 im very happy to find this group and you!!!i feel relax when i talk with you,and learn lots of things.because no one in Turkey to talk about Cushing disease.lots of thanks and hugs.

[Gingerbeer]

Hi !her pre-pill result is 4,1 .our vet said its normal range.he wants us to go with same dosage 60mg.but mona is very lethargic and drinks little water,for example today after her dinner (she ate half of the meal) she went to the water bowl and waited ,she didnt drink.normally she drinks water after her meals.what can i do?stop the treatment for 7 days and then start with the same dosage? Or stop the treatment for 7 days and then start with decrease dosage? Im confused🙁 maybe she is lethargic for hypothyroid but why does her water consumption decrease😞 i will take her morning first urine and want my vet to test it.we can learn if she drinks enough water or not.what are your advices?

[Harley PoMMom]

It definitely won't hurt to stop the Vetoryl to see if she perks up.

[Gingerbeer]

İm so desperate today!Turkish prescriptions dont be accepted by pharmacies or vets in aboard.we cant get the pills🙁 my girl is ill but i cant get the pills!what can i do?do you have solutions?do you know someonen who can help me to get the pills?🙁

[Harley PoMMom]

Is there a reputable compounding pharmacy where you live that can compound the Trilostane? Many of our members use the online compounding pharmacy, Diamondback Drugs, maybe you could contact them and see if they can do it: 1-866-578-4420, their website: https://www.diamondbackdrugs.com/

[labblab]

If you have no options at all in Turkey, do you have friends in any neighboring country where Vetoryl or compounded trilostane is available? If so, they might be able to act as an intermediary for you. If your vet faxes a copy of a valid prescription and his/her vet license to the pharmacist in that country, the pharmacist may be willing to supply the medication to you “in care of” your friend’s address. In turn, your friend could then mail in on to you. Might that work for you?

[Gingerbeer]

Diamondback dont ship to Turkey. We have friends in lots of countries,they try to buy vetoryl but pharmacies dont sell with Turkish Prescriptions,they want their countries prescriptions.do you know countries that sell the pills without prescriptions or accept Turkish prescriptions?

[labblab]

OK, this idea may not work, but are any of your friends pet-owners who have regular vets of their own? If so, maybe your vet could contact a friend’s vet in a country where Vetoryl is sold. After your vet confirms that your dog is genuinely a patient along with the need for the Vetoryl, maybe the friend’s vet would write a prescription for your dog, thus allowing your friend to buy it on your behalf to ship to you? Just trying to think of anything that might work...

[Gingerbeer]

Hello again,we are going to get the pils from Italy again.but im not sure about the mg,we had started with 30mg ,but today our vet wanted us to stop the treatment.because mona doesnt drink water or drink very little water when we begin the treatment.we had been using for 6days but she didnt want to drink water after 4days of treatment.she went to the water bowl,she standed in front of it,wanted to drink but then went away from the water.im confused again and we are waitng for tyroid and cortizol tests result.she eats but doesnt want to drink,what do you think about ? İt isnt normal isnt it? And also sometimes her hind legs trembles:(

[Harley PoMMom]

Hi !her pre-pill result is 4,1 .our vet said its normal range.he wants us to go with same dosage 60mg...

I see in this post she was taking 60 mg of Vetoryl, so if you start treatment again I wouldn't want to go over that strength of Vetoryl, lower would be better especially since she isn't drinking. How much is she drinking, can you measure it? And how much does she weigh? Were her electrolytes checked recently?

[Gingerbeer]

Our vet wanted to go with 60mg,but then we decided to began with 30mg.after 7days we started with 30mg,she is 32kg,she drank 200 or 300ml yesterday.we stopped the treatment yesterday ,still waiting for cortizol an tyroid test results�� no her electrolytes werent checked. İt is so difficult to find the right dose of vetoryl.

[Harley PoMMom]

She should be drinking a lot more water than that per day, average is 60 ml per kilogram of weight. Does she look dehydrated? Are her gums pale and/or pasty?

[Gingerbeer]

No ,she isnt dehydrated.we went to the vet and he gave us oralade,sometimes i give oralade to her.her tyroid level is so low t4;0,7 ,free t4;0,5 so we started to hypothyroid treatment again.she doesnt drink enough water but she seems more energetic now.but i dont know when we will start the vetoryl again.i wanna ldds test again before starting vetoryl