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Helpful Resources for Owners of Cushing's Dogs Important information, including links to informative websites, relevant veterinary literature, how to find a Specialist and more

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Old 05-12-2009, 12:45 AM
k9cushings k9cushings is offline
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Arrow Lysodren loading Instructions and related tips

Here are the Lysodren loading Instructions from the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995

Quote:
INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

Because of the potency of Lysodren, the veterinarian is encouraged not to rely on the instructions given to an owner. Never provide the owner with more than 8 days of Lysodren, initially. This drug is highly successful in eliminating the signs of hyperadrenocorticism because of its potency coupled with close communication between owner and veterinarian. Either the veterinarian or a technician should contact the owner for a verbal report regarding the dog every day beginning with the second day of therapy. In this way, the owner is impressed with the veterinarian's concern and the need to observe the animal closely.

It is wise for the owner to feed the dog two small meals each day, as previously described. The dog's appetite should be observed prior to each administration of Lysodren. If food is rapidly consumed (with or without polydipsia), medication is warranted.

If food is consumed either slowly or not at all, medication should be discontinued until consultation with the veterinarian.

Usually the initial loading dose phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60 ml/kg/day.

The water intake in polydipsic dogs may decrease to the normal range in as few as 2 days or take as long as 35 days (average is 5 to 9 days) Owners must continue to monitor the water intake daily until it falls to or below 60 ml/kg/day. Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed.

A small percentage of dogs demonstrate mild gastric irritation or systemic signs of illness from the Lysodren 1 to 3 days after medication has been started. These signs include anorexia, vomiting, diarrhea, weakness and lethargy.

If any of these signs are observed, the medication should be discontinued until the veterinarian can evaluate the dog. If the signs are the result of drug sensitivity and not because the treatment is complete, dividing the dose further may be helpful; discontinuing the medication for a few days may be necessary.

It is recommended that treatment be initiated on a Sunday, so that if illness develops after a few days, the veterinarian should be available during the regular work week rather than on a weekend.
According to the protocol for Lysodren loading described above, the loading dose is usually 50 mg Lysodren per kg of the dog's weight (50 mg/kg/day) and is given each DAY of the loading period.

To calculate your dog's weight in kg, divide the weight in lbs by 2.2 (example: a 22 lb dog weighs 10 kg)

Once the dog is successfully "loaded" (also called "induced") the maintenance phase of treatment will begin. The maintenance dose is usually 25 to 50 mg of Lysodren per kg of the dog's weight per WEEK (25-50 mg/kg/week) and can be given in divided doses. Example: 500 mg Lysodren per week can be given as 250 mg twice a week, or 375 mg per week could be given as 125 mg three times a week etc. The entire weekly dose is often the same amount as the dose per day that was given during the loading phase.

The weekly maintenance dose is usually determined by weight of the dog, but the Vet will also take into account how quickly the dog becomes successfully loaded, which may help to indicate the particular dog's sensitivity to the Lysodren. A dog that loads in 3 days might be started on a lower maintenance dose than a dog who took 10 days to load, for example.

The recommended target range for good control of the cortisol production is a result of 1-5 ug/dl for both the pre and post ACTH stimulation test numbers. An ACTH stimulation test is done as soon as it is suspected that the dog is loaded, to confirm if a successful loading has been achieved. An ACTH stim test is done again after a month of giving the weekly maintenance dose and another ACTH stim test is performed after three months of maintenance therapy, to be sure that the weekly maintenance dose of Lysodren is correct for the individual dog. An ACTH stim test should then be performed every 4 to 6 months to monitor the cortisol production and to determine if any dose changes may be needed along the way. Any changes in the dog's eating or drinking habits or behavior should be reported to the Vet immediately and an ACTH stim test will likely be needed to check the dog's cortisol levels and to see if the dose needs adjusting.

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A collection of "tips" from our members and their Vets:

Lysodren is better absorbed if given with a meal. The food also acts as a buffer and can help to protect against gastric upset.

Many of our members have found it easier to administer the Lysodren by wrapping the pill in some food that the dog likes and will eat readily. Wrapping the pill in some food also helps to protect the throat and esophagus from irritation.

In order to ensure that the Lysodren goes all the way down to the tummy, it's a good idea to feed the dog 3/4 of the meal, then give the Lysodren wrapped in or hidden in some food and then feed the remainder of the meal to the dog. Also, since a poor appetite can sometimes be a sign that cortisol levels may be too low, if a dog refuses to eat the first 3/4 of the meal it could be an indication that cortisol levels should be checked (with an ACTH test) before giving any more Lysodren, so call the Vet to report any noticeable changes in your dog's appetite.

For dogs who may experience some gastric upset from the medication, a Vet may prescribe a weight-appropriate dose of Pepcid AC to be given to the dog about 15 minutes to half an hour before the meal with which the Lysodren is given.

Lysodren is a powerful drug which works by specifically targeting and eroding away some of the adrenal cortex, thus reducing the amount of cortisol that the adrenal glands can produce. By reducing the cortisol production (which in an untreated Cushings dog is abnormally high) you help to prevent internal organ damage (to the liver, heart, kidneys etc) that excessive cortisol production causes over time.

To help mitigate any possible toxicity to the liver from the Lysodren medication itself, many of us give our dogs Milk Thistle (silymarin) as recommended by our Vets for our dogs. Milk Thistle is sold in most Health Food stores. As with any other supplement you are thinking of giving to your dog, please check with your Vet first. And remember that it's probably best not to start more than one new "thing" at a time, just in case there are any "side effects", even minor ones. If you start a dog on more than one new thing (drug or supplement) you would not know what the cause may be if you've started both at the same time.

The Milk Thistle bottle will have a recommended dosage per day for humans. The guide below has been used by some of our members and their Vets to help calculate how much Milk Thistle is right for their dogs.

dog weighs 5-10 lbs - give 15% of the dose recommended for humans
dog weighs 11-20 lbs - give 20% of the dose recommended for humans
dog weighs 21-40 lbs - give 30% of the dose recommended for humans
dog weighs 41-70 lbs - give 50% of the dose recommended for humans
dog weighs 71-100 lbs - give 75% of the dose recommended for humans
dog weighs 100 lbs or more - give 100% of the dose recommended for humans

Many of us keep a daily journal in which we note information such as what our dogs eat, how much water they drink, what meds and/or supplements they are given and their demeanor and behaviours. Having that kind of information at our fingertips can be very helpful sometimes.

Many of us also request copies of all Lab test results to keep in a file folder at home. Having our own copies of those Lab reports has really come in handy sometimes.

Be sure to ask your Vet what you are supposed to do if you ever need help for your dog overnight, on weekends or when your own Vet is on vacation. You may never need to implement it, but knowing where to get help and having an emergency plan is very important.

Successful treatment of Canine Cushing's requires a good heads-up Vet and a vigilant owner who work together as a team to keep the dog well. Always report any changes or unusual behaviors to your Vet immediately. We are our Vet's "eyes and ears" at home.
  #2  
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.
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