My JRT on Vetoryl will not eat

[Frankie Lee]

We just started his Vetoryl, 30 mg dose, on Wednesday, August 12, 2020. He is refusing almost everything to eat...he will eat Vienna sausages. His stool has been pretty runny and had a small amount of blood in it on Friday morning. Consulted with his veterinarian and suggested 10 mg of famotidine and don't give Vetoryl for a couple of days. He's still not eating much. Any suggestions on how to get him to eat.

Thanks

[labblab]

Hello and welcome! I’m so sorry your boy is doing poorly, though, and if he’s not better by tomorrow morning I do believe he needs to be seen by the vet in order to have blood drawn to check his cortisol level and his basic blood chemistries. Although they also could be caused by something else, the symptoms you are describing are consistent with an overdose of the Vetoryl. When that occurs, often the only intervention that’s necessary is to halt the Vetoryl as your vet has already recommended. But after three days off the medication, you’d expect to see improvement if the dog’s cortisol and/or other blood levels are stabilizing on their own. Sometimes direct intervention is required in the form of giving supplemental steroids in order to replace the natural adrenal hormones that have been driven *too* low by the Vetoryl.

Vetoryl overdosing can cause serious, even life-threatening, effects if a dog’s levels have fallen so low as to need supplementation. So you do need to continue to monitor him carefully today and tonight. If his condition worsens with ongoing diarrhea, vomiting, or lethargy, he needs to be seen by a vet ASAP.

Hopefully, though, you’ll see some improvement as the day goes on. If so, you need to continue to withhold the Vetoryl for the time being, until his appetite and overall behavior have normalized. At that point, a lower dose may be considered. For the time being, though, no more medication.

In the meantime, can you tell us more about your boy’s overall health history? What symptoms led to the Cushing’s testing, and what tests were performed? Also, how much does he weigh? The current recommendation is to begin Vetoryl at a dose that does not exceed 1 mg. per pound. If he weighs less than 30 pounds, that creates further suspicion that he may indeed be overdosed.

Sorry for so many questions, but your answers will help guide us as we move forward. I surely do hope he’s feeling better, and once again, welcome.

Marianne

[Frankie Lee]

Hi! I saw my vet last Friday 8/14/2020. She told me to hold his dose for a couple of days and then try again. He is feeling better and tolerating the Vetoryl better. Playing today and ate a.small can of Cesar food last night. This morning he would only eat the sausages. My vet thinks he is feeling badly because the meds need to be given on full stomach.

He is a Jack Russell that weighs 22 pounds. He is on 1 pill of 30 mg Vetoryl and 10 mg famotadine.

He has been drinking a lot, having pee accidents in his bed and has a little pot belly. Also was eating like crazy which he never had since I adopted him 12 uears ago. Always been a picky eater until recently. He had an ACTH stimulation test, routine chemistry and CBC, UA, irine culture, ultrasound of his belly, and the second cortisol test ( low dose something or other...don't remember the name of that one). Final diagnosis after all that was Cushings. He also has an enlarged liver, elevated ALT and a heart murmur.

Hope this gives you the info you need.

The vet gave him an appetite stimulant today called entyce.

Thanks for your help. He's my little man.

Michelle. Frankie's mom

[labblab]

Michelle, thanks so much for this additional information! It definitely helps us to better understand what’s going on with Frankie, and yup, he surely does exhibit many classic Cushing’s symptoms.

I do have renewed concern about the size of his Vetoryl dose, however. When Vetoryl was first introduced nearly 20 years ago, the recommended doses were much higher. However, over the years, researchers and specialized clinicians have reduced their recommendations significantly in order to reduce the incidence of unwanted side effects and actual overdose. As I mentioned above, the current most commonly recommended starting formula is to begin at a dose that doesn’t exceed 1 mg. per pound. So Frankie’s dose is nearly 30% higher than that, and that amount of Vetoryl may simply be more than he can comfortably — and even safely — tolerate. Here’s a link to a post on our “Helpful Resources” forum that more thoroughly explains the shift to lower dosing:

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

Unfortunately, unless a vet commonly treats Cushing’s dogs in his/her practice, the vet may be unaware of these dosing revisions. Complicating the situation is the fact that the actual published product insert in U.S. boxes of Vetoryl may even reflect older dosing formulas. So I encourage you to print off the information contained in the post I referenced above, and discuss it in detail with your vet. (Be sure to note that 1 mg./lb. is equivalent to 2.2 mg./kg.).

If Frankie were my own dog, I would not want to start him off with a dose any higher than 20 mg. daily. His inappetance may truly be a warning sign that his 30 mg. dose is simply too high. Also, I know you’re so anxious to get him to eat, but I’m fearful that the Vienna sausages likely contain a lot of fat. If that’s true, you may risk triggering an attack of pancreatitis since Cushpups may be more vulnerable to suffering from pancreatitis, especially when dietary fat intake is high. So tempting him with some lower fat options may be safer. However, if a dog taking Vetoryl loses his appetite, I do think that concern re: overdosing needs to be the first priority. And that is something I hope you’ll discuss further with your vet, as soon as possible.

Marianne

[Frankie Lee]

Thanks Marianne. I will definitely discuss this with my vet. I gave him the appetite stimulant and he ate dog food for dinner. I know the sausages are terrible for him but I couldn't get him to eat anything else. Maybe he will start eating dog food now. Thanks again. Michelle