View Full Version : What to give Lysodren with?
Lgutt
11-14-2018, 07:56 AM
Hello All!
My 11 year old Shepard/Lab mix was just diagnosed with Cushings yesterday. We have been doing the testing for a few weeks now and finally did the ultrasound yesterday and sure enough he has an adrenal tumor on the left side. We are going to start him on 500mg of Lysodren twice a day to load. I've been reading that it has to be given with something fatty so I'm just looking to see what you all would recommend. Thankfully he will eat ANYTHING you give him, the only positive from Cushings I guess, so I'm open to any ideas!
Thanks for the help,
Leeza
lulusmom
11-14-2018, 09:37 AM
Hi Leeza and welcome to the forum.
To answer your question, Lysodren must be given with food for proper absorption. It is fat soluble and is best absorbed when given with something with a little fat in it. Peanut butter was my go to. My cushdogs were not on a restricted fat food so that was not an issue. We have seen dogs on very low fat food who did not absorb the drug well. Now having answered your question, I am a bit concerned that your vet has prescribed Lysodren for an adrenal tumor. Adrenal tumors are highly resistant to Lysodren so much larger loading doses are needed to kill off enough adrenal tissue to effectively reduce cortisol. Adverse side effects are to be expected at these doses which is why this drug has fallen out of favor for the treatment of adrenal tumors. Vetoryl is the first line of treatment for adrenal tumors as side effects are much less and normal recommended doses are highly effective in controlling cortisol. How much does your dog weigh? What symptoms does he have? A low dose dexamethasone suppression (LDDS) test or the acth stimulation test is done to diagnose cushing's. Can you get copies of whichever one your vet did and share the numbers with us? The LDDS should have a pre, a 4 hour and an 8 hour result. The acth stimulation test usually has two numbers, a pre and 1 hour; however, if acth gel is used as the stimulating agent,m there are three numbers, a pre, 1 hour and 2 hour. Lastly can you get a copy of abdominal ultrasound interpretation. I would be very interested in knowing if the right adrenal tumor is normal in size or much smaller or even atrophied? This is important to know because if the adrenal tumor on the left gland is functional and over-secreting cortisol, the right gland basically shuts down and shrinks due to lack of use. If the right adrenal gland is normal in size or even a bit enlarged, it's possible the adrenal tumor is non-functional and your dog might have pituitary dependent disease or both. Seeing the results of those tests would help us greatly. You have plenty of time to get all of your ducks in a row. I have successfully loaded dogs more than a few times and know that drug like the back of my hand which is why I have great concerns about your vet's choice of treatment. There is no limit on the amount of information you can share with us, so the more, the better. If you proceed with Lysodren loading, you will play the most important role in your boy's treatment and your vet should have provided you with extensive counseling as to what that entails. I have to do some chores for a bit but I'll be back later. We have a lot of credible resource material that I will share when I return. I look forward to hearing a lot more about your precious guy. I'm glad you found us.
Glynda
labblab
11-14-2018, 09:43 AM
Hello, Leeza, and welcome to you and your sweet boy. I’m going to give you a link to some helpful Lysodren loading instructions contained on our Resources forum. There you’ll see the recommendation to offer your dog a meal prior to giving the Lysodren, both morning and evening. The benefit is actually two-fold. Any decrease in appetite is an important indicator that the loading phase may have been completed. Therefore, you want to monitor meal consumption prior to giving any more Lysodren, rather than giving the medication first. Making sure your dog has first eaten also aids in the metabolism of the drug. The fat that’s contained in the food is probably already enough, but you can make sure by then wrapping the pill in a bit of soft regular cheese, cream cheese, or peanut butter. Anyway, here’s the link:
http://www.k9cushings.com/forum/showthread.php?181-Lysodren-loading-Instructions-and-related-tips
By the way, it’s recently come to our attention that Lysodren may soon become somewhat more difficult to obtain. So here’s another link to a new post that describes sourcing options for the medication:
http://www.k9cushings.com/forum/showthread.php?9111-Lysodren-shortage&p=208672#post208672
One thing I will also mention is that sometimes it turns out that dogs with adrenal tumors (as opposed to pituitary tumors) end up requiring larger doses of Lysodren in order to effectively lower cortisol levels. In turn, this can increase the likelihood of some of the unwanted side effects. If this were to happen with your dog, your vet might consider shifting his treatment to trilostane, a different Cushing’s medication. However, that can be a discussion for another time, and only if your boy doesn’t seem to be responding properly to the Lysodren.
So do take a look at those loading tips, and let us know of additional questions. We’d also love to learn more about your boy and the path that’s led to this Cushing’s diagnosis.
Once again, welcome!
Marianne
P.S. I’m so glad to see that Glynda also responded to you while I was typing out my own reply. She has personal experience with Lysodren that is invaluable. So forgive me for any duplication of thoughts, and do carefully review her suggestions!
Lgutt
11-14-2018, 05:07 PM
My dog weighs 56lbs has been super thirsty for awhile now and peeing in the house, very hungry, and panting.
I asked the vet about Vetoryl and he said that he didn't recommend that because it is primarily used for pituitary tumors.
We have done the Dex test and the results were 2.6, 2.2, 2.1. He wants to do the ACTH test once he has had the lysodren. I don't have the exact results of the ultrasound but he said it is a left side adrenal tumor and it has calcified but is not in any major vessels.
lulusmom
11-15-2018, 01:00 AM
Hi again.
I've been thinking about you all day and I am very concerned that your vet has chosen to treat your dog with Lysodren. As I mentioned in my prior post, adrenal tumors are highly resistant to Lysodren which requires much larger and often toxic doses to achieve loading. Your vet has prescribed less than 50 mg/kg which is less than the normal loading dose for dogs with pituitary dependent disease so chances are great that you will have a protracted loading phase which will most likely end up costing you more money for additional acth stimulation tests. Your vet is very much mistaken when he said Vetoryl is primarily used for pituitary based disease. Vetoryl is not only used for adrenal tumors, it is much preferred to Lysodren. Dr. Edward C. Feldman, Professor Emeritus at UC Davis, has written the chapter on canine hyperadrenocorticism for internal medicine teaching textbooks for decades and he has an affinity for Lysodren because he's prescribed it for his patients for 40 years. However, he does not prescribe it for his patients with adrenal tumors. He prescribes Vetoryl. Dr. Feldman lectures at veterinary conferences worldwide on canine cushing's and its effective treatments so you can't find a more credible expert. I have provided a link below to a hand out of one of his lectures at the 2016 Southern European Veterinary Conference held in Spain. If you will scroll down to page four to the section titled "Medical Therapy Using Trilostane (active ingredient in Vetoryl - Background, Action, Efficacy and Safety as compared with o,p'-DDD (chemical name for mitotane which is active ingredient in Lysodren)", in the second paragraph you will see that Dr. Feldman states; "Trilostane is an unequivocally more effective treatment for ATH (adrenal tumor hyperadrenocorticism)". Most Internal Medicine Specialists across the country know Dr. Feldman by name and though your vet is probably a general practitioner, it's very possible he has heard his name as well. Please either provide this link to your vet or print out the document and share it with him so that he understands that prescribing Lysodren for adrenal tumors is not the best choice. I have a lot of experience with Lysodren having loaded my two pituitary cushdogs twice, and if I were to have another cushdog with a functional adrenal tumor, I would not put my dog at such high risk adverse reactions when there is a better option in Vetoryl. After looking at the results of the low dose dex suppression test, I'm even more curious as to whether your dog's adrenal tumor is functional. As I mentioned previously, if the right adrenal gland is normal, it could be that the adrenal tumor on the left gland is non-functional which would mean your dog's symptoms may be caused by a pituitary tumor. The results of the low dose dex test shows that your dog suppressed at 4 and 8 hours which is not typically what we see with an adrenal tumor. Can you ask your vet if the right adrenal gland was normal, smaller or unable to visualize? Based on the information you have shared with us so far, I'm not certain your vet has a lot of experience with cushing's or its effective treatments. It's my hope that your responses to my questions will help us in understanding his rationale. No matter which treatment you and your vet agree on, we're here to help in any way we can. I just hope you can convince your vet to switch to Vetoryl with the help of the document I have provided.
https://drive.google.com/file/d/0B5RToo4GC5HPWXQtVUZrNmlXZHM/view
P.S. I am not a veterinary professional. I am an educated pet owner who has spent 13 years doing exhaustive research on canine cushing's and it's treatments.
Lgutt
11-15-2018, 04:42 PM
What are the high risk adverse reactions? Is it possible to try the lysodren and then switch to vetoryl if needed?
Harley PoMMom
11-15-2018, 08:08 PM
Since a higher than normal loading dose of Lysodren is generally needed when a dog has Cushing's from an adrenal tumor there is a greater chance that an Addison's crisis can happen which can be life threatening.
When switching from Lysodren to Vetoryl or vice versa, a 30 day washout period is recommended.
Lgutt
11-16-2018, 08:07 AM
Ok thanks for the info!
lulusmom
11-16-2018, 11:42 AM
Lisa, in addition to the increased risk of an Addisonian crisis, the most common side effect of Lysodren is GI effects so even if cortisol does not drop too low, a dog can get sick on these extremely high doses. This may not even be an issue if your dog does not have a functional adrenal tumor but if she does, I truly believe your vet has chosen the wrong treatment and has prescribed a dose that is likely to be too low. I have provided you with very credible reference material to use in your discussions with your vet. I realize it is difficult to challenge our vets but we are our dog's only voice and when you are dealing with such a serious cytotoxic drug, I sincerely believe you need to understand why your vet has chosen a treatment that is not recommended by world renowned experts for the multiple reasons we've shared. Vetoryl is extremely effective which is why it is the first line of treatment for adrenal tumors. Just to give your vet the benefit of the doubt, Vetoryl should not be given to dogs with primary liver and/or kidney disease so perhaps that may be why he has chosen Lysodren???? If not, I'm not sure your vet understands that he is not acting in your dog's best interest. Many members here, including me, have or have had gp vets who did not act in our dogs' best interest and most vets are very much open minded when presented with questions that are supported by facts in hand. I highly recommend that you don't tell your vet that a bunch of strangers on the internet told you so because that is usually not well received and rightfully so. Take credit for doing your own due diligence on the drug and show him why you are asking.
Joan2517
11-16-2018, 03:56 PM
Hi Lisa,
With my first Cushing's dog, Lena, I trusted my vet and thought he knew what he was doing. He raised her dosage from 10mgs to 30mgs within 6 weeks. She was only 5lbs. No one told me to give the meds with a full meal, just food, which could've been a piece of cheese or ham. I didn't know enough about Cushing's to question him about anything. It wasn't until I found this forum and received so much information. Sadly it was too late for my Lena.
I have another dog with Cushing's and this time we are doing it my way from everything I've learned here. The main vet in the practice poo poo'd everything I wanted, but there is another who was much more willing to learn and very excited with all the information that I have. Gable has been on 40mgs of Vetoryl since May, we are doing the pre pill testing and he is doing really well. He looks great, plays like a puppy again and is much happier than he was six months ago.
My point is that not all vets are as up on Cushing's treatment as they should be, or think they are. Mine wasn't then and still isn't now, so we use the other one. You must be the advocate for your dog, and you have every right to be that advocate.
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