“Shivering from Vectoryl ?”

[Irmadog]

My 13 year old lab was recently diagnosed with Cushings. She was started on 120mg of Vectoryl at day 5 she appeared to be shivering ever so slightly almost undetectable. Being overly cautious we contacted her Vet and were told to bring her in to receive a shot of Dex.Shivering stopped very quickly.Her dose was dropped to 60 mg and started 4 days later.After 2 days on the lower dose once again noticed the shiver.She has shown no other serious adverse reaction to Vetoryl. Was curious if any other pups have experienced this.

[labblab]

Hello, and welcome to you and your girl! As you can see, I’m a Lab lover myself ;-)))). In answer to your question, yes, tremoring or shivering episodes have been noted by quite a few members here throughout the years. Since your dog’s shivering stopped once her Vetoryl dose was lowered and the dexamethasone was administered, it may well be the case that the shivering is related to a dose of Vetoryl that is too high for her — either a side effect of the med itself, or the result of a cortisol level that has dropped too low. If that’s the case, the return of the shivering may indicate that even the new dose of Vetoryl is still too high for her. Recent research is suggesting that larger dogs may be more sensitive to the effects of Vetoryl, with the recommendation that initial dosing levels be lowered for dogs weighing more than 40 pounds. Here’s a link to a related research summary that was recently posted by one of our administrators here:

https://drive.google.com/file/d/155aj2gOey6_fypWyihlhenygpCjmRdUz/view?fbclid=IwAR00Dljb3HVrhql9TqNAt_rUm__HUmjcB44Q CYsSGmAcns5kmGrNmtAjBXA

Having said all that, it’s also possible that your dog’s shivering is not related to the Vetoryl, but is somehow a symptom of Cushing’s, itself. I’ll go ahead and repost a reply that I wrote to another member a couple of years ago. I do think the info remains pretty, accurate, however. So go ahead and take a look. Afterwards, we’d love to learn more specifics about your dog’s diagnostic and treatment journey. With more information, perhaps we can make addition suggestions on your dog’s behalf. And once again, welcome!

Marianne


Tremors and "shivering" episodes are indeed complaints that we've heard before. My own Cushpup was one who suffered unexplained tremors before starting treatment, and for a period of time afterwards. There is still a lot that is unknown about Cushing's, and episodes like this seem to remain one of the mysteries. As Leslie says, tremoring has been listed as a possible side effect of trilostane, but my own dog started his tremoring before he was even placed on the medication.

Under the "Adverse Reactions" portion of Dechra's U.S. Product Insert for Vetoryl, "shaking/shivering" was reported in 10 dogs out of a total of 107 animals included in an American clinical trial. The big question, of course, is whether the shaking was truly caused by the drug or instead by something else. Since the shaking was observed in dogs during the time period they were taking the medication, it had to be listed as a possible side effect. But I don't think Dechra knows of a specific mechanism that would cause this effect.

As I say, my Cushpup definitely started tremoring prior to being treated with trilostane, so the drug couldn't have been the original cause. However, the tremoring did worsen after treatment was begun. So who knows exactly what was going on. For what it’s worth, here’s a related reply I posted to another member a while back.



Through the years, we have had other members who have worried over unexplained tremoring episodes. My own Cushpup, a Lab, suffered from intermittent involuntary tremoring episodes across his shoulder blades that made him look as though he was shivering. For him, the episodes happened most often when he was sitting down or at rest -- even when he was sleeping. Sometimes he would jerk himself awake, they were that severe. But just as is true for your boy, he would usually just stretch afterwards and never seemed to be in any particular pain or discomfort. The tremors began before he started trilostane treatment, worsened significantly when he first started the drug, and then ended up stopping entirely a few months down the road.

We never did figure out what caused them. Through the years, other members here have reported similar issues with their dogs under a variety of circumstances: some using trilostane, some using Lysodren (another medication), and also dogs not yet being treated at all. For this reason, it has been hard to point to a single "trigger." It is true that tremors are now listed as a possible side effect of trilostane. But I've always wondered whether such tremors more often just somehow relate to rapidly changing cortisol levels. But the good news is that they didn't really seem to bother my dog at all -- it was ME who was going crazy trying to figure them out!

[Irmadog]

Thank you for responding. A little more info on her shivering episode. It is only noticeable in her neck/ chest area and is very hard to detect and doesn’t seem to cause her any discomfort. Mine and Irma’s vets fear of an addisons crisis is the main concern. She will restart her 60 mg in the morning and be monitored closely with us having Pred dose just in case. We are still trying to get her 2 weeks in to have another levels test to see how the meds are actually working. If it appears the 60 is still to high her vet will drop the dose down again Monday and continue on. Thank you so much for the links after reading them I think we are on the right course and proceeding safely but Irma’s vet and myself are being overly cautious.

[labblab]

I’m so glad those links seemed helpful. You are definitely doing the right thing by monitoring carefully for overdose, and hopefully the 60 mg. will turn out to be a good dose for Irma. We’ll be really interested to hear how things are going for you two, so please do update us as you have the chance.

With my own boy, for the most part his shivering was subtle enough that a casual observer might not have really noticed it. I was watching him with such an eagle eye, though, that nothing ever escaped my attention! Also, he usually napped and slept nearby me, and I could feel the intermittent tremors when I laid my hand on him. It truly did seem like shivering although he was not cold. Anyway, I hope Irma’s shivers will end up causing no more actual problems than did my boy’s.

Best wishes,
Marianne

[Joan2517]

Hi and welcome from me, too. My Gable, who is my second Cushing's dog, is a lab mix and he is currently on 5mg of Vetoryl. He weighs close to 80lbs and we started on 40, which was too much for him. He did have some trembling issues years before his diagnosis, mostly at night where the whole bed would shake. I don't think I ever noticed it during the day. I always thought he was afraid to be upstairs. Eventually, I let him stay downstairs by himself and didn't think anything of it.

My first Cushpup, Lena, had the trembling before and after Vetoryl. She was only about 6lbs and on 30mg at the time of her death. The trembling could have been the increased Cortisol as we never did get her symptoms under control.

I also hope that the dose is not too high for Irma.

[Irmadog]

Hi and welcome from me, too. My Gable, who is my second Cushing's dog, is a lab mix and he is currently on 5mg of Vetoryl. He weighs close to 80lbs and we started on 40, which was too much for him. He did have some trembling issues years before his diagnosis, mostly at night where the whole bed would shake. I don't think I ever noticed it during the day. I always thought he was afraid to be upstairs. Eventually, I let him stay downstairs by himself and didn't think anything of it.

My first Cushpup, Lena, had the trembling before and after Vetoryl. She was only about 6lbs and on 30mg at the time of her death. The trembling could have been the increased Cortisol as we never did get her symptoms under control.

I also hope that the dose is not too high for Irma.

I really appreciate all the info. So far today she has shown no adverse signs. The shivering episodes tend to show up at the 8-10 hr mark after she received her dose. From what I’ve read that’s around the actual time the meds effective range starts to decline. I’m curious with your pup that’s 80lbs and started on 40 mg were you able to continue that dose safely for the 2 weeks until the level test had to be administered? My fear of Addisons out ways the Cushings right now. Thanks again for all the help

[Joan2517]

I can't remember how long he was at that dose, I would need to go back and read his thread. I know we actually lowered it to 30 at one point. Then about 7 or 8 months later I noticed an increase in drinking again and was going to raise it back, but he just didn't seem himself, so we did an ACTH test and it had dropped so low we had to stop. They also found that his thyroid meds were too high which could have contributed to it. I am so glad that I didn't raise it. We started back at I think 10 after a few weeks, but it was still too low, so we went to 5mg. He's been on 5 for at least a year, maybe more and it was going well, but I need to get him tested again because his drinking has increased, he's panting like crazy and his food aggression has gotten out of hand. He may need to go back up to 10, but I'd rather his cortisol is high than have to worry about an Addison crisis. He very sensitive to the Vetoryl.

I'm waiting for a check to clear and then I will have a full workup done, and I think a spa day, nails clipped and medicated bath (he has allergies and gets hot spots that get infected). Before Vetoryl he had lost most of his fur around his lower back. After being on the meds for a about a year, his fur came back beautifully and has held steady at the 5mg. He's a big boy and I just can't get him into the tub or shower without hurting my back. I bought a child's pool a couple of years ago thinking that would work...nope!

He is 12 years old and is starting to have the back end weakness and because he's so big, getting up and down is starting to be a problem for him, but he never complains and still tries to do whatever our other dogs do. Because of this forum, I know more than I did with my precious Lena. I didn't rush into treatment with Gabe the way I did with her, and I told the vet what dose we would start him at. Luckily the vet I work with now listens to me and works with what I want. He has also learned a lot from what I bring to him from what I learn here. It's been better this time around...

[Irmadog]

Update on Irma. So we are now on 10mg of Vetoryl pushing towards the 10-14 day mark to get an ACTH test done to check her levels.She’s about a Week in on this dose.As for the shivering episodes we are almost convinced at this point it was not a reaction to the meds but had to be and will continue to be overly cautious.She takes it in the morning with her breakfast and has some early help with her Cushings symptoms but still haven’t been on it long enough yet. Now every evening about 7:00 or about the 12 hour mark after her dose the symptoms really get going water intake,panting,restlessness and doing what I call the “low rider” were she drops her rear end while standing.This goes on for 2-3 hrs until she finally will relax somewhat but she still gets up through the night every 2 hrs on the dot. We try to calm her by petting and giving her a massage rub down which helps. The improvement we are seeing already is she appears to be coming out of the foggines her personality and some interest in things starting to show. Late next week we will know a little more but I’m encouraged on the direction everything is going.

[labblab]

Thank you so much for this update. I absolutely agree with you that it’s better to be safer than sorry, so I applaud your decisions going forward. We’ll be very anxious to learn the monitoring testing results next week, and it may well turn out that a higher dose can be tolerated going forward with associated symptom improvement. We’ll surely hope for that improvement very soon.

So carry on, and please do check back again next week if not sooner.
Marianne

[Kevin]

I feel kind of dumb offering any advice as I'm just beginning to post out here on our Dog Cooper. So consider this more sharing of information on what I've observed.

Cooper has faced the shaking and shivering off/on from the beginning of his Cushing journey. Its not all the time and is rather sporadic. I do NOT believe Coopers has had anything to do with Vetoryl as he has been off Vetoryl for a few months now(just starting back on it as some may know who are following the thread). The poor guy has lost so much hair that we kind of thought it was due to being cold. Its been 80+ most of the summer so now we just believe it is another of the Cush symptoms.

[Irmadog]

Appreciate your input with Coopers experience. Irma’s “shivering” is so faint and sporadic too. I have learned that the scary adverse reaction would be a whole body/muscle tremor. Getting her dose dropped really low so we can get another ACTH test done is going to go a long way with her Cushings management.Her symptoms right this moment have been the increased water and urinating and the restlessness in the evening. She is on a single small dose now and we have seen a improvement in her personality and a slight improvement during the day with other symptoms. She’s a 12/13 year old black lab (guestimentvon age since she’s a rescue) about 70 lbs.

[Irmadog]

Also wanted to post about Dechra the manufacture of Vetoryl they are very helpful with any questions or concerns we may have. There is a 24 hr medical hot line where they will start a medical file for your pet and answer and collaborate with your veterinarian.Our vet reached out and shared Irma’s lab work and history with them and offered a great deal of assistance.I’ll post the phone number later after work.Hope this can offer some help to the other families out there that are helping their pets with Cushings.

[Joan2517]

Yes, Dechra is very helpful. I called the hot line when I inadvertently took Gable's pills by mistake. Apparently it is a common occurrence! LOL!

[jenner1026]

Interesting thread! When you all mention "shivering" do you mean a whole body shiver?

My dog Jet's back leg or legs shake and tremble at times - mostly while he is first laying down (especially if you go to pet or rub his leg - it really starts trembling!). Sometimes while he is standing I notice it too. Not enough for him not to be able to stand or move, it's just a weird shaking or vibrating almost.
I just assumed it's because he is almost 11 years old and a tall lab. I also have him on Dasuquin supplements because I thought this was the beginning of arthritis and my vet said good things about these supplements.

I never even thought it was related to the Cushings or medication but now I am intrigued....

[labblab]

For my Cushpup, the tremoring was focused across his shoulder blades and was most obvious when he was laying down, at rest. The tremors kind of came in waves and he really did look like a human does when shivering in the cold. Unfortunately, I can't really tell you specifics about other dogs. My Lab boy did suffer from the hind end muscle wasting commonly associated with Cushing's, and I would think that could also cause some leg tremoring for some dogs. That wasn't the case for my boy, but it's not hard for me to imagine it could play a part in Jet's shakes.

Marianne

[jenner1026]

For my Cushpup, the tremoring was focused across his shoulder blades and was most obvious when he was laying down, at rest. The tremors kind of came in waves and he really did look like a human does when shivering in the cold. Unfortunately, I can't really tell you specifics about other dogs. My Lab boy did suffer from the hind end muscle wasting commonly associated with Cushing's, and I would think that could also cause some leg tremoring for some dogs. That wasn't the case for my boy, but it's not hard for me to imagine it could play a part in Jet's shakes.

Marianne

Thank you!!!

[Irmadog]

Thank you!!!

Irma’s was just in her throat/neck area and it appears it was nothing to do with her medication.More likely a little nerves or anxiety issue.Her vet said to watch for full body tremors in regards to Addisons crisis.We still watch her like a hawk though and she’s never left alone for long periods of time.

[Irmadog]

Irma update… She went 16 days straight on 10mg and had her ACTH and lab work done Tuesday. Levels are unchanged and basically the same as her first test. Her blood work and general health are very good and her vet as well as her family are very happy. With that being said she has been put back on a 60 mg dose of Vetoryl once daily in the morning and will go for 2 weeks and have another levels check. While on the 10 mg dose there was very little change in the main symptoms water intake,peeing etc but we have noticed improvement in her wanting to engage with her family and the fog of feeling like crap lifting.She does have the pituitary dependent form of Cushings as well if I failed to mention that before. A little info for families that might be taking their pup for the test after you get to pick them up they will have an increase in Cushings symptoms (drinking water,peeing, general restlessness and some rear end weakness)for at least a day which is normal. Fingers crossed on this return to 60 mg but we are all encouraged! Hope this helps.

[labblab]

I’m so glad she hasn’t suffered any ill effects thus far. That’s quite a leap from 10 mg. clear back up to 60 mg., though. When you say her test results were the same as before, do you mean the same as before she started any treatment at all? Can you tell us the actual numerical results for both those tests? That’ll help give us a frame of reference for the effect of the medication.

I’m realizing we never asked you how much Irma weighs, nor had the chance to talk about the fact that ongoing clinical experience has suggested that large dogs may be more sensitive to the effects of trilostane than are smaller dogs, thus requiring a smaller dose per pound of body weight. I know you’ve spoken with Dechra and also had originally planned to put her on 60 mg. after the decrease from 120. I do understand why you’re now wanting to increase her dose, and if Dechra is on board with the 60 mg., I probably shouldn’t be worrying. But still, being the Nervous Nellie that I am, I’d feel better knowing the actual numbers for her ACTH tests.

Marianne

[Irmadog]

I’m so glad she hasn’t suffered any ill effects thus far. That’s quite a leap from 10 mg. clear back up to 60 mg., though. When you say her test results were the same as before, do you mean the same as before she started any treatment at all? Can you tell us the actual numerical results for both those tests? That’ll help give us a frame of reference for the effect of the medication.

I’m realizing we never asked you how much Irma weighs, nor had the chance to talk about the fact that ongoing clinical experience has suggested that large dogs may be more sensitive to the effects of trilostane than are smaller dogs, thus requiring a smaller dose per pound of body weight. I know you’ve spoken with Dechra and also had originally planned to put her on 60 mg. after the decrease from 120. I do understand why you’re now wanting to increase her dose, and if Dechra is on board with the 60 mg., I probably shouldn’t be worrying. But still, being the Nervous Nellie that I am, I’d feel better knowing the actual numbers for her ACTH tests.

Marianne. Irma is 72 lbs. I don’t have the lab work print out will try and get a copy tomorrow it took about 24 hrs to get results back. I do know that Dechra was given copies of initial labs and recent and after confirming with her vet they felt she would be fine to go to 60. The shivering that she experienced on 120 and then 60 mg she did have an episode while taking the 10 and we did not give her pred or a shit of dex and monitored her closely and the episode subsided in just a few minutes and she never showed any serious or scary episodes since. Luckily my mother is a retired surgical vet tech and has been watching her like a hawk. The more I research and listen to my mothers experience plus Irma’s current vet the full body tremors are what we really need to be watching for.Irma gets her dose in the morning and isn’t left alone at all for more than a few minutes at the most and it appears that adverse side effects tend to show themselves within those first few hours. But we have pred on hand and she can be at her vet in less than 10 minutes. Thanks again

[Irmadog]

A shot of dex no a shit lol!

[labblab]

A shot of dex no a shit lol!

;);););)

OK, I feel much better that Dechra is onboard with this dose. Just for your info, though, here’s a link to a summary written by one of our other staffers that addresses the recommendation that’s been made by multiple researchers/clinicians to lower the starting dose for larger dogs. You’ll see that for a dog of Irma’s weight, they’d probably be recommending an initial daily *total* no more than about 30 mg. (regardless of whether they choose to dose once or twice a day). I know you and your vet will be watching her like a hawk, but if she should start to appear unwell on the 60 mg. dose, a swift dosage decrease may be in order.

https://drive.google.com/file/d/155aj2gOey6_fypWyihlhenygpCjmRdUz/view?fbclid=IwAR00Dljb3HVrhql9TqNAt_rUm__HUmjcB44Q CYsSGmAcns5kmGrNmtAjBXA

Definitely let us know how things are going, and good luck!
Marianne

[Irmadog]

Definitely let us know how things are going, and good luck!
Marianne[/QUOTE]
Well the 60mg once a day appeared to be a little to much again.5-6 days into that dosage Irma started to show signs of lethargy and was becoming very wobbly on her feet.These adverse reactions would go away about the 10-12 hour mark after getting her Vetoryl. So the dose was dropped down to 10mg twice a day. She ran this dose for 2 weeks. No adverse side effects ever showed and seen only improvement in her mental state. There was little to no effect on the water intake and peeing constantly.She is now doing 20 mg twice a day for another 2 weeks and she will have another test to check her levels. She is definitely happier but it’s been so hot here she hasn’t been able to go the park and see her friends so she is getting cabin fever. After the next appointment if there is any situation with meds either not being effective or causing her any adverse symptoms she will be referred to NC State university and be re-evaluated there.

[labblab]

Thanks so much for checking in with us, and yes, it sounds like a good gameplan to go ahead and consult with NC State if things remain amiss after the next testing. Hopefully they’ll settle down by then, though. I’ll be keeping my fingers crossed for you guys, and will continue to watch for further updates.

Best wishes,
Marianne