Question about trilostane side effects

[Cthorne111]

I just got my dog diagnosed with Cushings but after thinking about it I’m pretty sure she’s had it for about a year but just didn’t develop really obvious signs until the last three months or so. She’s a 12 yr old pitbull. She’s been on 2mg/kg trilostane for a week or so and I can see her potbelly getting smaller and she doesn’t drink nearly as much and her energy level is way better than it was. But she generally won’t eat her dog food now. Historically she’s the type that would eat the whole bag and then some if she was allowed. I’m not overly concerned because I know it’s a common side effect, but when should I expect this to start easing off, or when should I wonder if the dose is too much for her?

[Harley PoMMom]

Hi and welcome to you and your sweet girl!

Could you tell us how much your girl weighs? And when was her last ACTH stimulation test to check her cortisol levels? The ravenous appetite that cushdogs get usually subsides after 2 weeks of treatment but if your girl is off her food entirely, that has me worried. Loss of appetite is one symptom of cortisol dropping too low, is she experiencing any diarrhea, lethargy, or vomiting?

Could you also tell us which test/s were used to diagnose her Cushing's and would you post those results for us? Is she taking any other herbs/supplements/medications? Did the vet run a CBC/Chemistry blood panel, and if so, could you post those values that are marked abnormal with the reference ranges and units of measurement? Thanks for any additional information you have for us, the more we know the better our feedback can be.

Hugs, Lori

[Cthorne111]

Hi,
Thanks for the reply. I think she is about 60 or 70 lbs. I don’t know what test they used but they had to do one test then wait an hour or two then do the second part so I’m thinking it was ACTH. I don’t know the results just that they said she definitely has Cushing’s. It was a week ago last Wednesday and they sent out the trilostane then and she started it on Thursday. No other supplements now. She had a full blood panel two months ago and the only abnormal reading was that one of her liver enzymes was up a little bit. This was part of what clued me in to the possible Cushing’s since from what I read that can be a common sign. No vomiting or diarrhea that I’m aware of, and her energy is up since she started the meds. Before she would just sleep all day and barely drag herself up long enough to eat. She will eat treats and people food, but not very interested in dog food. She will eat a little sometimes. I’m not giving her any extra treats or people food, just the same that I give the other dogs, because I don’t want her to learn that if she refuses dog food she gets something better. I had a dog before that did this!

[Cthorne111]

Well this morning she ate a handful of dog food, and just now she had a small meal of dog food. For some reason she likes it better if I put it on the floor :) she was like that when she was a puppy too for some reason. :confused: So maybe it’s just a transient side effect that’s starting to wear off.

[Harley PoMMom]

From my math calculation (which could be wrong) the Trilostane dose your dog is taking is 60 mg? If so, than it may be a dose that is too high, it is recommended that a starting dose be no higher than 30 mg, and when larger dogs are concerned this is especially important because from published studies it was found that larger dogs are more sensitive to Trilostane. Here is a link to an article with the published study included: https://drive.google.com/file/d/155aj2gOey6_fypWyihlhenygpCjmRdUz/view?fbclid=IwAR00Dljb3HVrhql9TqNAt_rUm__HUmjcB44Q CYsSGmAcns5kmGrNmtAjBXA

Did the vet inform you to give the Trilostane dose with a meal, this is to aid absorption. And when is her next ACTH stimulation test?

Lori

[Cthorne111]

Yes your calculation is correct. It’s in liquid form so I can easily adjust the dose. Starting tomorrow I’ll cut it down by half and see how things go. This morning she ate some of her dog food but again, not her normal appetite at all. They said to bring her in for a test in two months, so I don’t want to be giving her too much for that long. All the bottle said was to give it in the morning, but she gets it with her dog food anyway. I wonder is there another thing I can monitor aside from her appetite to determine if she’s getting too much or too little? Her water drinking has gone down to what I would consider normal now and she’s not getting up in the night to go outside, I wonder if I should more closely monitor her drinking since that was one of her main symptoms. Energy level is difficult to monitor because I’m pretty sure she’s had Cushing’s for a long time and her energy level has dropped consistently in the last 6 months, so even though it’s better now it’s difficult to say whether it’s where it should be or not.

[Harley PoMMom]

Proper protocol is to have a ACTH stimulation test performed 2 weeks after starting treatment, however, some vets do forgo this 2 week test when the dog is started at a low dose of Trilostane, which your girl is not. If the 2 week ACTH stimulation test is not done than one is absolutely performed at the one month mark of treatment.

I'm not a vet, but I've been on this forum for over 10 years so what I post to you is from that experience. When dogs are started out at a high dose of Trilostane, that's when ill side effects are mostly seen. The loss of appetite and her water consumption normalizing so quickly, to me, is a sign that her cortisol may have dropped too low. It usually takes 2 weeks of treatment for that excessive drinking and ravenous appetite to subside so halving her Trilostane dose downward, I believe, is a good idea if you are comfortable doing so. If her appetite doesn't bounce back in a day or two of halving her dose down, than stopping the Trilostane all together and having an ACTH stimulation test would be the next step.

Hugs, Lori

[Cthorne111]

Thank you. Yes that is what I’m going to do, starting today I’m halving the dose and we will see what happens with her appetite in a couple of days. How long does it usually take before the pot belly goes away and the muscle weakness starts to improve? She has a hard time getting on the bed or navigating stairs because her back legs don’t have much strength. Will exercise help this get better faster?

[Squirt's Mom]

Hi and welcome from us as well!

Typically once a dog starts to show signs of an overdose you want to stop the med for a few days and let the adrenal glands regenerate. Protocol says 7 days but since you caught this before all the signs were showing I would think a day or two off the med would be fine. Then you start at half, a max of 30mg a day.

As for when signs improves this is a good explanation from Dr. Edward Feldman from the University of California, Davis once the proper dosage of medication is found:

Signs resolve in a typical order, with polyphagia (excessive hunger) being the first sign to improve in most dogs. Owners also note that their dogs begin to be more active and pant less, as polydipsia (excessive drinking) and polyuria (excessive peeing) resolve. All these can begin to resolve in just days to a few weeks. Muscle strength and pot belly take longer to resolve and the various skin and hair coat issues may require months. Why is all this important? It has been shown that as these signs resolve, there is parallel improvement in hypertension, susceptibility to infection, proteinuria, and other concerns.

Hugs,
Leslie

[Cthorne111]

Thanks. I went ahead with the half dose again this morning and I have to say, she’s acting a lot better than she has in months. She was awake most of the day today, she didn’t have to be prodded to go outside, went out on her own even when she didn’t “need” to. She was her normal food begging self except she was still not totally impressed with her dog food. And maybe it’s my mind but it seems like the hair on her head feels softer than it was. Not normal, but closer to normal. Her hair hasn’t fallen out at all, it just feels like sandpaper. So I’m going to stick with the 30 mg dose for a while and see how things go, as long as her appetite goes back to ‘normal’ within a few days (she’s always been a food greedy dog, so whatever increased appetite she had from Cushing’s wasn’t particularly noticeable). If I don’t see her eating her food normally within a few days I’ll reduce it more but in just two days it seems to be going the right direction.

[Squirt's Mom]

That's good news! I pray she continues to do well on the reduced dose!

[Cthorne111]

Hi,
In an earlier post I explained my pitbull was just diagnosed with Cushing’s and stopped eating her dog food about three days after I started treatment with trilostane 60mg. I lowered her dose by half to 30mg and her appetite has improved somewhat. She’s still not particularly enthusiastic about her dog food (she will pick at it) but will beg for any and all other food or treats that’s on the go so I’m not particularly worried at this point. Her energy is better than it’s been in months and excessive drinking has seemed to subside for the most part. She has lost some weight but that’s a good thing, she was a little too chunky before and I’m sure it’s good for her hips being a large dog, to be a bit slimmer. My question is, I’m wondering whether I should get a dog vitamin for her, especially if she’s not eating a lot of her dog food. I would give it to my other two also. She is on glucosamine as an arthritis preventative, but that gets sprinkled over her dog food which she’s not eating much of now. Other than that she’s not on any other supplements. And her coat is dry and falling out from the Cushing’s so maybe a vitamin would help that recover faster. I know that there can be huge differences in quality even with human vitamins, much less something as unregulated as dog vitamins so I’m looking for recommendations. I don’t want to either throw my money away, or give them something harmful.

[Squirt's Mom]

Hi,

I have merged your thread about vitamins into your baby's original thread. Unlike some social media platforms, we like to keep all posts about each dog in one thread. That way it is easier to keep up with history and allows you to create a sort of diary of her Cushing's journey so you can see patterns or get reminders of events, comments, etc. should you need them.

As for vitamins, I'm not familiar enough with multi-vitamins for dogs to offer much info. I would suggest you ask her vet tho. They may have something specific that could help with the appetite. I know mine have received B12 injections in the past when appetite fell off but they were much older dogs. But that is the extent of my experience with canine multi-vitamins.

Is she continuing to improve on the half dose?

[labblab]

Here’s a belated welcome from me! I’m sorry I haven’t have the chance to write to you earlier, but I’m so glad to hear that your girl seems to be doing better on the reduced dose of trilostane. Like Leslie, though, I’m afraid I don’t know enough about vitamins for dogs to be able to make any specific recommendations. The addition of some omega fatty acids might be helpful for her skin and coat. I’ve used a combination fish/borage seed/flaxseed oil capsule with my Lab girl at various times. But I’m not knowledgeable about vitamins, and I agree with Leslie that your best and safest bet is probably to consult with your vet.

The issue of inappetance, regardless of cause, is always so upsetting with our furkids. Again, my elderly Lab has been really, really picky off-and-on since December. Finally (knock on wood so as not to jinx things!) she’s back to her normal appetite just by mixing some crumbled cooked ground turkey into her kibble along with some warm water — kind of like a stew. That is surely not innovative nor exotic by any means, but after trying several other combos, this is the one that she seems to be happy with — at least for now.

Anyway, continued good luck to you, and we’ll be anxious for more updates.
Marianne

[Cthorne111]

Thanks for the welcome! She seems to be doing well so far, her energy level continues to be great and the excessive drinking has still settled down. Her appetite isn’t what it was before, but it’s not that she won’t eat, it’s more that she holds out from eating her dog food to see if she can get something better. But she does usually eat most of it if I pour it out of her dish onto the floor :confused: and she eats everything else we give her. I’m sure if I mixed something in with her food she would eat it all but I don’t want to spoil her unnecessarily. Her pot belly and muscle weakness is still there but I expect that to take a bit of time to resolve. So I think the drug is doing what it’s supposed to do and I don’t think she’s on too much now with the half dose. It’s nice to see her personality coming back again, she was so tired all the time before she was diagnosed that she was in a bit of a stupor most of the time. Now she’s voluntarily going outside, walking around the yard and going into the garage when we are out there, looking for pieces of wood and toys to chew on etc. like she used to. She even came running to me the other day and tried to leap over some things in her way, it was more of a stumble with the muscle weakness but it’s the thought that counts lol!

[lulusmom]

It appears your girl has been on 30 mg trilostane since May 2nd. Since your vet has never done an acth stimulation test, one is due now so I highly recommend you book that appointment asap. It's always amazing when our dogs start acting like the dog we knew but it is very important to adhere to monitoring protocol so that you know what your girl's cortisol status is. Happy dogs can have low cortisol and if you don't detect it through testing and make the necessary downward adjustment, happy dogs can get very sick.