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Thread: Emma - New Member Post

  1. #11
    Join Date
    Jun 2012
    Location
    Canada
    Posts
    16,150

    Default Re: New Member Post

    Hello and welcome to the forum from me too.

    The importance of giving the meds with food is that food helps with the absorption of the medication and is considered to be an important part of the treatment. So, likely she hasn't been absorbing her dosage as well as she could be. That being said, you want to also have consistency with testing so that you know what the actual results look like. I do want to let you know about a new testing that vets in Europe have been using effectively, that doesn't require an ACTH but a blood draw prior to giving the dosage of trilostane (vetroyl) and see what the cortisol levels are. This is though to be an even more accurate way to determine how a dog is doing on treatment. I'll quote you what marianne wrote another member and provide the link. You can take that to your vet and see if she would be willing to follow that testing protocol (it is supposedly better and saves money)
    Just within the last couple of weeks, those of us in the U.S. have learned that many vets in the U.K. and Europe have shifted away from using ACTH stimulation tests to monitor trilostane treatment unless there is a worry that a dog’s cortisol may have dropped too low. Instead, they are simply measuring resting cortisol right before the next dose of trilostane is due to be given. New research supports the notion that this actually gives better guidance re: the need for dosing increases, and it’s certainly a heck of a lot cheaper. Take a look at this link and the monitoring flowchart that’s included. Your vet may be very interested in this info, as well, and might be willing to investigate it further on your behalf.

    http://www.k9cushings.com/forum/show...=1252#post1252
    You can also check this thread for possible financial help
    http://www.k9cushings.com/forum/show...with-Vet-bills

    the important thing is to get her on track with correct testing and giving her meds with food.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  2. #12
    Join Date
    Feb 2018
    Location
    Eastern NC
    Posts
    64

    Default Re: New Member Post

    Thanks very much for this information. I will talk to y new vet about it.

  3. #13
    Join Date
    Feb 2018
    Location
    Eastern NC
    Posts
    64

    Default Re: New Member Post

    Hello all. I have finally found a new vet for my Emma who takes the time to answer the questions I have about Cushings and who firmly believes in the dosing and testing protocols put out by Dechra for Trilostane. I did bump into a problem rather quickly though when she told me Emma would have to come off the Trilostane compound she is taking and start taking the Trilostane pills made by Dechra, only. I want Emma to have every available advantage in fighting this disease, but I wasnÂ’t aware that the compound was inferior. I purchase the compound from RoadRunner pharmacy in Arizona. They have lines and staff dedicated to pet compounding; I never thought it might not be a safe alternative.
    When the Dr gave me the price for the new Trilostane pills I could not believe how high it was. I will be paying around $200/month for twice a day dosing for a 20 lb dog. (Emma gained 1 lb in the last month - darn it)

    My question is does anyone have any opinions or facts about the compounded version of Trilostane? I do want what is best for Emma, but IÂ’m disabled and the compound was 1/4 of the price - much more affordable for a limited income.

  4. #14
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,037

    Default Re: New Member Post

    Glad you were able to find a vet that will work with you, except for the compounding matter. There have been some studies that have indicated that some compounded versions of Trilostane are not as consistent in dosage, however, many of our members here have used compounded products with success, and if I did not feel as though I could afford the cost of brand name Vetoryl, I personally would opt for a compounded Trilostane. Diamondback Drugs has an extremely good reputation with our members so they would be my choice in purchasing the compounded Trilostane.

    Lori

  5. #15
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New Member Post

    Can you tell us what dose of Vetoryl your new vet is proposing for Emma? Even if you opted for a trial of brandname Vetoryl, a monthly cost of $200 seems excessive. In looking back, it looks to me as though Emma was previously taking around 7 mg. twice daily of the liquid compound? You can’t arrive at exactly that dose with Vetoryl capsules, but for instance, Emma could take a 10 mg. capsule in the morning and a 5 mg. capsule in the evening. With that type of dosing, you could buy a thirty day supply of Vetoryl for about $76 from a reputable internet veterinary pharmacy. Even if she were to take 10 mg. twice daily, a thirty day supply need not cost much more than $100. Is this new vet requiring you to buy the Vetoryl directly from her, or will she supply you with a prescription so that you can shop for a more reasonable price?

    I believe that both Diamondback and Roadrunner are reputable compounding pharmacies. However, as Lori has noted, some research studies have raised question marks about the consistency and efficacy of certain unnamed compounders. As a result, some vets and owners prefer to use brandname Vetoryl when dosing and pricing allows it to be an option. However, a cost of $200 a month would make Vetoryl an unreasonable option for many people. So unless your new vet will allow you to shop for Vetoryl from a less expensive source, I think it’s unrealistic for her to expect you to switch from a compounded alternative. I’m really sorry if this turns out to be an issue that stands between you two.

    Marianne

    P.S. Both Diamondback and Roadrunner are accredited by a national board of compounding pharmacies:

    https://www.achc.org/compounding-pharmacy.html

    And you can check to see whether an internet provider of Vetoryl is credentialed by clicking on the list of pharmacy board verified websites that is given here:

    https://nabp.pharmacy/programs/dotpharmacy/
    Last edited by labblab; 04-18-2018 at 11:41 PM. Reason: To add P.S.

  6. #16
    Join Date
    Feb 2018
    Location
    Eastern NC
    Posts
    64

    Default Re: New Member Post

    Thank you all for your replies. I just called the vets office and was told I can give them the name of an online pharmacy and they will fax the prescription to them. That makes me feel a lot better because I was concerned that she might ask the prescriptions only go through her. That being said, I certainly will use the link to the list of board approved online pharmacies you gave me!

    Emma is receiving a Trilostane compound of 50mg/ml per bottle, with instructions to dose her 0.1 ml every 12 hours.

    Just a thought about the Trilostane compounding..... I do believe that Roadrunner and Diamondback Pharmacies are reputable and trustworthy. I'm thankful for their compound of Trilostane. I know that Emma's symptoms lessened when I started her on the compound from Roadrunner Pharmacy for the first time on December 28, 2017. I am relieved there is an option for pet owners, like myself, to treat their fur babies for Cushings if they cannot afford the brand Trilostane pills. I have noticed, though, that Emma's symptoms seem to start getting worse as I am nearing the end of her bottled compound, which lasts 1 month.

    She drinks more water, is voraciously hungry, very sleepy... to the same extent as before she started taking the compound. This happened twice, with her February bottle and her March bottle. It can all be in my mind, that is for sure. That's what I've been telling myself, but I did google the topic and read it was possible, and today i read a very interesting article on the fight that Roadrunner and other pet pharmacies are having in California to get the laws changed so that they can sell their compounds in that state. It does mention in that article the concern that sometimes, some compounds can lose their effectiveness, in as quickly as 2 weeks.

    I don't take that as a reason to stay away from compounds because pharmacies such as Diamondback and Roadrunner have many years of experience and many satisfied customers. It does make me want to fill her prescription a little early though! I haven't ordered a new bottle for April yet because she is going to start on Trilostane pills soon, 10mg once a day, until she has her follow up stim test 14 days later. And I'm nervous about using the bottom of the bottle of compound, and Emma not acting very well. I pray that she gets on her new regime soon, and she starts to feel better again. I am going to buy a box of Trilostane from the vet today, and start Emma on it tomorrow. Next month I will hopefully have found a pharmacy that is not so expensive as this vet's prices.

    This is a link to the article in case anyone would like to read it
    http://news.vin.com/VINNews.aspx?articleId=44812
    Last edited by emmagirl; 04-19-2018 at 02:04 PM. Reason: trying to get url to work

  7. #17
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New Member Post

    Thanks so much for that link, and I’ll be anxious to read it and also to write more to you later on. I’m hoping to catch you before you head to the vet, though. I’m hoping your vet will not actually charge you $200 for one box of thirty 10 mg. Vetoryl capsules. Here’s a link to the pricing page for California Pet Pharmacy. They’re listed on that accredited website, and will charge only $42 for one box. Maybe if you print out this page, your vet will agree to match that price. My own vet will do that as long as the price isn’t lower than his own cost. There are plenty of other internet pharmacy options, as well, but I was able to find this one quickly and wanted to get the link posted as an example.

    https://www.californiapetpharmacy.co...-30-count.html

    Marianne

  8. #18
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New Member Post

    OK, I’m back again and have had the chance to read that link. It’s very interesting, and just one more chapter in a long book of contentiousness surrounding the oversight of compounding pharmacy practices in the U.S. I will say that my own personal impression is that, over the years, we’ve seen what appear to be more irregularities with liquid trilostane suspensions than with trilo compounded in solid form. And the short shelf life discussed in the link may relate to that. But that’s just my impression. We’ve had members who have had difficulty stabilizing their dogs while taking brandname Vetoryl as well as compounded trilo. However, this is the central research study that has raised the question marks about compounded products.

    https://www.researchgate.net/publica...stane_Products

    As you’ll see, the pharmacies responsible for the flawed trilo are not identified in the study. As a result, our best advice is to tell folks to search out compounding pharmacies with established reputations and professional accreditation. Everything being equal, I do suggest to folks that they may want to begin treatment with Vetoryl, and only subsequently make the switch to a compounded product after the dog has been stabilized on an established dose. But as I wrote above, whenever cost or dosage size make Vetoryl a hardship, then certainly I’d opt for a compounded product from a reliable pharmacy.

    You may find it interesting to look at this summary re: the status of veterinary compounding that was posted on this forum back in 2009. Amazingly enough, a lot of the controversy is yet to be resolved!

    http://www.k9cushings.com/forum/show...=1254#post1254

    Marianne

  9. #19
    Join Date
    Apr 2008
    Location
    Tennessee
    Posts
    6,593

    Default Re: New Member Post

    Hi and a belated welcome to you and Emma.

    I am happy to hear that your vet is willing to call in prescriptions to reputable pharmacies. Shopping prices is great and because we have so many members who buy from online pharmacies, we can share the ones that are most frequently used and recommended. In addition to California Pet Pharmacy for which Marianne has provided a link above, I've provided two more below who are reliable and are highly competitive in their pricing that most cannot beat. I've provided a link to Allivet and Valley Vet and their current prices for 30 ct 10 mg. I've also included California Pet Pharmacy pricing for your reference.

    http://www.allivet.com/p-2590-vetory...oaAiRBEALw_wcB $38.95 5% off if placed on auto ship. Free shipping on orders over $49 (You can always ask your vet to provide a 60 day supply once you get Emma's cortisol stabilized on an effective dose)

    https://www.valleyvet.com/ct_detail....caAivcEALw_wcB $38.95 Free shipping on orders over $59.00

    https://www.californiapetpharmacy.co...h=10mg+vetoryl $41.95 Free shipping on orders over $100

    Glynda

  10. #20
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New Member Post

    I’m so glad Glynda added these additional resources. Yet one more that comes to mind is Lambert Veterinary Supply. I just checked and their current pricing is the same as California Pet Pharmacy. All four of these pharmacies are on the “Safe Pharmacy” list maintained by the National Association of Boards of Pharmacy in the link given above (Allivet is listed under the account name of “Agropec”).

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