Cooper - diabetes and cushings - sweet Cooper has passed

[Squirt's Mom]

Hi,

I want to be sure you read Marianne's previous post about twice a day dosing. You do NOT double the dose so be sure your vet understands this. If he was going to prescribe 60mg a day he will keep very close to that total amount for the day with twice a day dosings - say 30mg in the morning and 30mg at nite.

Loading only occurs when one is using the drug Lysodren. With Trilostane (Vetoryl) there is no loading phase. Instead, ya'll Trilo parents get to play around with tweaking doses and deciding between once a day or twice a day dosing.

Be SURE your vet understands the dosing for twice a day BEFORE you buy or start giving the med to Cooper.

Hugs,
Leslie and the gang

[labblab]

Leslie, thanks so much for emphasizing that. Yes indeed, a daily total of 60 mg. does sound reasonable for Cooper -- but that means only 30 mg. twice a day! That's per the initial dosing formulas given in both of those links (1 mg/kg twice daily, which translates into approx. 1/2 mg. per pound twice daily).

Marianne

[Mel-Tia]

I am just chipping in as I haven't read that an ACTH test is scheduled for 10-14 days this is part of the protocol for giving vetoryl, that result will then give you a reading to determine what your next steps will be for continued testing.

Has your vet spoken to anyone at Dechra yet? Might be worthwhile nudging him in that direction sooner rather than later

Mel

Xxx

[juliwilliams]

We discussed it and he thinks 60mg twice a day is still a conservative dose for him.

We don't have an acth test scheduled for 10-14 days. The vet said 3 weeks from the start date but we'll be testing his insulin dose more often.

I just calculated that his meds are now costing us close to $400 a month. Ugh!! I hate to gripe about money when it's about a dog's life, but ugh!!! I hope the cushings meds will at least lessen his dose of insulin and save some money.

Whoever started this forum is my new hero! What a wealth of information already. Thank you all!

[Jenny & Judi in MN]

My Jenny used Lysodren but she is also diabetic and once her cushings got under control her insulin needs dropped from 7 units twice a day to 3 units twice a day. (she was 7 pounds at the time)

So it made a huge difference for her. Good luck!

[labblab]

Uh oh.....now I am getting worried.

I don't think your vet will find many specialists with large Cushing's practices who currently agree that starting a 59 lb. dog on a daily total of 120 mg. is a conservative dose. At one time in the past, yes. But no longer. Here's another quote from that article by Dr. Peterson:

When this drug was first used in Europe over a decade ago, the original starting dose was 4-10 mg/kg/day (7-12). However, as experience with the drug grew, it became apparent that these doses were too high in many dogs and lower doses were needed. Accordingly, the dosing recommendation on the US package insert states that an initial daily dose of 2.2-6.7 mg/kg is recommended (4).

My recommended starting dose is either 2 mg/kg given once daily or 1 mg/kg given twice daily. This is similar to the doses used in this study by Feldman (13), where the mean trilostane dose administered to his dogs was 0.86 mg/kg, twice daily (or a mean total daily dose of 1.72 mg/kg). Like Feldman, I feel that it is best to start with a daily dose that is at the low end or even lower than that recommended in the package insert. I would never start a dog on a dose at the higher end of the recommended dosage range (4-7 mg/kg), although some dogs with Cushing’s disease will eventually require daily doses that may be this high or even higher.

Dosing Cooper at 120 mg. each day works out to approx. 4 mg/kg -- exactly the level that Dr. Peterson is cautioning against! Starting Cooper at a dosage level this high not only increases the risk of unwanted side effects (which of course is the most important issue), but it also makes the drug more expensive for you. I just checked a couple of online pharmacies and as an example, find that you can purchase sixty 30 mg. capsules of brandname Vetoryl for $120 from Drs. Foster and Smith.

Also, I'm not sure how your vet has arrived at the three-week ACTH testing date, as it is not the timeframe that is recommended by Dechra.

I am including another link for you. It is Dechra's U.S. Product Insert for Vetoryl, and it contains a lot of important info re: appropriate treatment and monitoring. PLEASE DISREGARD THE DOSING CHART, because it contains the outdated dosing information to which Dr. Peterson is referring. Pay attention instead to the fact that the conservative end of the published dosing range is a daily total of 1 mg. per pound. Several of us who have spoken personally with Dechra technical reps have been advised that the 1 mg. per pound formula is the initial dosing amount that they are now generally recommending. Once again, if you or your vet have doubts or questions about this, I encourage you to contact Dechra directly.

http://www.dechra-us.com/files/dechr...ts/Vetoryl.pdf

If you already have the 60 mg. capsules in hand, I realize this presents a dilemma for you. You may be better off sticking with 60 mg. once daily until such time that you are ready to reorder new capsules as opposed to risking an early overdose. Once you have 1-2 ACTH tests under your belt, then you'd have a better idea as to what daily total Cooper truly can handle. But I would want to discuss the pros-and-cons of that approach (starting out once daily) with somebody more knowledgeable about diabetic management. And I would hope that your vet has not ordered more than just a thirty day supply at this point, since dosing changes are not at all unusual after the first thirty days of treatment and sometimes even sooner. (Plus, you likely can find less expensive options for buying your trilostane in the future if you explore options other than directly from your vet.)

Marianne

[juliwilliams]

My children kept me real busy tonight, but I'm going to give him just one pill a day until I can read through that info and talk to the vet. Getting so overwhelmed here. This sure is a steep learning curve! I have no doubt I'll get a handle on this...eventually.

[molly muffin]

Any questions you have just pop in and ask them. Someone will be around to answer.
Starting at 60mg once a day is a good place to start. You will eventually know way more than you probably would ever want to about dosing and standards and testing and everything else, cushings related.

I hope you had a good evening. Let us know how things are going!

Sharlene and Molly muffin

[labblab]

Yes, I also agree that starting with the single 60 mg. in the morning is likely the best move for the time being. We do have some diabetic dogs here who are dosed only once daily, so it's not as though it is never done. Twice daily dosing is the newer recommendation for diabetics, though, so that's why I want you and your vet to be able to consider it in the future.

Marianne

[Squirt's Mom]

Hi,

Learning curve is right! Just don't learn while giving a massive dose of this med to Cooper.

It worries me with Trilo that folks have the idea it is safe - it is NOT any safer than Lysodren so please do not take any chances with Cooper, and your vets attitude is rather cavalier. It will not hurt one little thing to wait before starting the treatment to get this business with the dosage worked out. That is much preferable to giving this dose to him and him ending up in the hospital, or worse. So learn before starting this huge dose.

Hugs,
Leslie and the gang