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Old 05-12-2009, 12:50 AM
k9cushings k9cushings is offline
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Default The Lysodren "maintenance" phase

The maintenance phase of therapy, according to Dr. Feldman, "involves choosing a regimen and altering that regimen as required". It's not exactly the same for each and every dog, and that's why we need a Vet with expertise and a good understanding of how to adjust the dosage if necessary and when necessary to suit each individual dog and its sensitivity to the drug.

On the "average", the entire weekly dose is usually just about the same dose as you used to give in just one day of the loading. But it can be even less or a bit more, whatever is necessary to keep the cortisol levels in that target range of 1-5 ug/dl (USA values) or 30-110 nmol/L (values in which cortisol is measured in most of the rest of the world).

A dog who loads in only 3 days at 50 mg of Lysodren a day for each kg of the dog's body weight (50 mg/kg/day) probably needs less Lysodren to keep the cortisol levels in the target range (1-5 ug/dl) than a dog who takes 10 days or more to load with the same loading dosage.

Dr. Feldman's protocol says that the weekly maintenance dose may be anywhere from 25 to 50 mg of Lysodren per week for each kg of the dog's bodyweight. (i.e. 25-50 mg/kg/week)

The Vet has to consider the individual dog and how quickly the loading went etc and then decide what the weekly maintenance dose should be.

The entire weekly dose may be given to the dog all in one day, or can be divided up into smaller doses during the week.

Some dogs do take the weekly dose all in one day, either all in one large dose or they may be given half of it in the morning with breakfast and the other half at suppertime.

More often, however, dogs don't get the entire weekly dose in one day, they get it in divided doses during each week ... maybe half of the total weekly dose on Monday and the other half on Thursday, or it can be divided even further and given as one third of the total weekly dose on Monday, another third given on Wednesday and the remaining third of the weekly dose on Friday, for example.

As for testing during maintenance therapy, Dr. Feldman suggests doing a followup ACTH stim test after one month of weekly maintenance dosing.

At that point you'll get a good idea if the chosen maintenance dose is working well and keeping the cortisol levels where they should be (between 1-5 ug/dl). The ACTH stim test results will tell the Vet if the dose needs adjusting or not.

If the numbers are nicely in the target range at one month into the maintenance dosing, then it is advised to do another ACTH stim test in about 3 months again to check to see if dosage adjustments are needed or not.

If all is well, you may be able to do ACTH tests only every 4 to 6 months after that.

At any time if the dog develops any symptoms at all (appetite, water consumption, behaviour) that might indicate that the cortisol levels are getting too high or too low again, you'd need to do an ACTH stim test to see where the cortisol levels are and if the dose might need adjusting.