Question about Vetoryl

[pech58]

Chip had an ultrasound today due to the ongoing gastro issues and as suspected it supported a diagnosis of IBD. For now the plan is to keep him on Metronidazole at a full dose for 2 weeks and than being to taper getting him to a maintenance dose or maybe off completely. We will only know once we being to taper and see if any problems return. The vet wants to restart the Vetoryl at 60mg again. I'm hesitant as I feel what was stated in the previous post is correct - that a post of 3.1 we likely have some room to maybe go down to 30mg. I have a bunch of 60mg capsules so my plan is to open the capsules, split the dose in half and dissolve in broth to put in his food. I'm assuming of course that doing this will not effect the potency of the Vetoryl. Of course I will have him tested again in a month or two.

I got copies of the 3 Stim tests he has had done to post.

8/24/16 Pre 2.5 Post 20.3 (started on 120mg of Vetoryl)

10/5/16 Pre <1.0 Post 2.2 (Dosage reduced to 60mg)

1/20/17 Pre 1.6 Post 3.1 (Dosage unchanged)

[Squirt's Mom]

... so my plan is to open the capsules, split the dose in half and dissolve in broth to put in his food. I'm assuming of course that doing this will not effect the potency of the Vetoryl.

This is not a good plan and goes against expressed directions from Dechra, the manufacturer who states to never open the capsules. There are several reasons for this - 1) the powder inside is not all the active ingredient but also contains fillers so it is impossible to be sure that each portion of powder contains the same amount of Trilostane, the active ingredient in Vetoryl; 2) the coatings on pills and the capsule container are designed to break down at specific places in the digestive tract, some in the stomach, some in small intestines, some in the colon, etc. so by removing that capsule you are forcing the drug to start working in the mouth, throat, etc. and by the time it reaches the place it was intended to start working it may be completely broken down and useless. These are just two of the reasons it is never a good idea to open capsules....in addition to the direction from the manufacturer. So, no, please don't do this.

Tell your vet, who works for you, that you want a 'script for 30 mg and go from there. This is the best and safest way to give this drug....but I would not even think about restarting until everything else is settled as much as possible.

Hugs,
Leslie and the gang

[pech58]

Update = Chip had been doing well. We've been tapering off on the metronidazole and he was down to 250 mg. Restarted the Vetoryl about 10 days ago. Seemed to fine than yesterday had vomiting. Took in him they gave him anti nausea meds to stop the vomiting. The vet checked his electrolytes and sodium levels as he said those would be out of range if the Vetoryl was the source of the problem. Any thoughts on this? The results were normal by the way.

[labblab]

Electrolytes are only half of the equation when Vetoryl overdosing is suspected. Cortisol can drop too low even when the electrolytes remain within normal range (and vice versa). Please see this quote from Dechra's U.S. Product Insert for Vetoryl:

If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

http://www.dechra-us.com/Admin/Publi...ack-insert.pdf

Whenever a dog taking trilostane is unwell with vomiting or diarrhea, low cortisol has to be one of the possibilities that is considered. I personally believe it is unsafe to resume dosing until the dog normalizes or blood testing establishes that there is no problem with either cortisol or the electrolytes. So unfortunately, I don't think your vet's assessment of the situation is correct. Chip's cortisol level may be fine, but I don't believe you can make that assumption based solely on blood chemistry levels.

Marianne

[liltara]

These are common side effect issues that I've seen countless times here in the forum - my dog had similar issues. Primarily inappetence after a period of time ... and vomiting in some cases as well.

He's since been diagnosed with a macroadenoma that seems to be the cause of the inappetence and vomiting. The vet at Dechra feels his tumor swells when cortisol is beginning to be controlled and it affects the appetite and vomit area of the brain which is adjacent to the pituitary where the tumor is.

This is my personal experience, of course, but it is worth talking to your vet about.

[pech58]

Are there any dangers with repeated stopping and starting Vetoryl? I just started him up 10 days ago and now have stopped again because of the vomiting. We restart soon as all seems good again.

[Squirt's Mom]

No, that is one of the good things about Vetoryl - it can be stopped and restarted easily. Please stop giving him this drug while he is sick and tell your vet to do an ACTH immediately to check the cortisol. This is crucial.

[pech58]

It's been a bit since I last posted about Chip. We seem to go through a cycle where he's on the Vetoryl for 60-90 day and he develops GI upset and we have to take him off for a couple of weeks. During the time he's off the Vetoryl, appetite improves and he starts eating like he use to. Start the Vetoryl, appetite decreases and he starts getting sick again. Wondering at this point if we are betting off not treating.

[Harley PoMMom]

Has he had any ACTH stimulation tests done recently to see where his cortisol levels are at?

[molly muffin]

As Lori mentioned it is important to know where his cortisol levels are doing these episodes that he gets sick.

I would look into decreasing the vetroyl dosage personally and see if that doesn't allow him to be treated for cushings, without getting sick