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Thread: GENERAL GUIDELINES for Dosing and Monitoring Treatment with Vetoryl (trilostane)

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    Join Date
    Apr 2008

    Default GENERAL GUIDELINES for Dosing and Monitoring Treatment with Vetoryl (trilostane)

    GENERAL GUIDELINES for Dosing and Monitoring Treatment with Vetoryl (trilostane)

    • Dechra recommends starting treatment at 1 mg/lb (2.2 mg/kg). A UC Davis study suggests that dogs weighing >66 lbs (30 kg) tend to be more sensitive to Vetoryl and require less of the drug to control the clinical signs of cushing’s than dogs weighing less <66 lbs (30 kg) Based on that study, UC Davis’ established protocol for treating larger dogs starting at doses ranging from .3 to .5 mg/lb (.66 to 1.1mg/kg).

    • Start with the lowest possible dose based on body weight and available combinations of capsule sizes. If a particular dose is unavailable, an alternative is compounded trilostane purchased from a reputable compounding pharmacy such as Diamondback Drugs.

    • Vetoryl MUST be given with food for proper absorption, and a full meal is always preferable. Dogs dosed once daily should be given their Vetoryl alongside a full breakfast. Dogs on twice daily dosing should have their daily meal split a.m. and p.m.

    For members in the UK and EU whose vets are using the new Pre-Vetoryl Cortisol Monitoring Protocol, please refer to Dechra Flowchart directly below. For all others who are using the original ACTH stimulation test protocol, please continue to next bullet point.

    • ACTH stimulation monitoring tests are performed between 4 and 6 hours after the morning dose given WITH FOOD. Some vets prefer to perform the test from 2 to 4 hours after the morning dose. Whatever timing a vet chooses, each and every test must be performed at the same time, every time. NEVER fast your dog for this test as results will be invalid.

    • The 1st ACTH stimulation test should be done between 10-14 days after starting treatment. A dose increase is rarely done at this time as cortisol is expected to drift downward over the next few weeks.

    • The 2nd ACTH stimulation test should be performed 30 days after starting treatment. It is at this point that any necessary dosing adjustments be made.

    • If adjustment in dose is made, the ACTH stimulation test cycle should be started over at 10-14 days, then 30 ...

    • If NO dose adjustment is needed after 30 days, subsequent ACTH stimulation tests are recommended every three months thereafter.

    • Dosage increases should usually be no greater than approximately 25%.

    • A positive response to a dose is interpreted as improvement in clinical signs and a post-ACTH stimulated cortisol concentration between 1.45-9.1 μg/dL (40–250 nmol/L); however, experience in this group shows that most dogs are best controlled in the 2.0–5.5 μg/dL (72–140 nmol/L) range.

    Pet owners must be vigilant in watching for signs that cortisol is too low. Symptoms of low cortisol includes but are not limited to vomiting, diarrhea, lethargy, poor/reduced appetite, weakness, collapse and tremoring. Should you observe one or more of these symptoms, STOP treatment and contact your veterinarian immediately. When in doubt but you feel your pup is not acting like his/herself, it is always best to err on the side of caution and discontinue dosing until you can speak to your vet. In the event your vet is closed, contact or go to your local emergency facility. Withholding Vetoryl, whether a few days or several, will not be detrimental to your dog.

    We highly recommend that you review "Treat their Hyperadrenocorticism" (link provided below).

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