Dad of Lulu - sweet Lulu has crossed The Bridge

OK that is too low. Anything below 1.0 IS Addisonian. That doesn't mean it's permanent but continuation at the same level is just asking for that to happen.

How is Lulu acting? With those results we'd normally see extreme lethargy and inability to get up. Please do not give any more of the drug. A few days off will allow her cortisol to rise to levels that are acceptable.

I have to leave for work and am counting on others here to help you should you have more questions. Sending positive vibes your way. Kim

THe post number is the one that counts and it is below 1.0. The manufacturer would tell you to cease giving it fwiw.

Well Lulu has up and down days. You know I think she has been a bit more not with it and of course down 3 lb. since 2 1/2 weeks ago. She is in good spirits and can get up, still has trouble lying down.

I think the last couple of days though she has been a bit more tired.

So you think that not having any trilostane until Wednesday, and then giving her the lower dose then won't shock her?

Please do not give Lulu her Trilostane today.

Per Dechra:

< 1.45 Stop treatment. Re-start at a decreased dose
1.45 to 5.4 Continue on same dose
> 5.4 to 9.1 EITHER: Continue on current dose if clinical signs are well controlled
OR: Increase dose if clinical signs of hyperadrenocorticism are still evident*

> 9.1 Increase initial dose

As you can see, the manufacturer of Vetoryl clearly states any post under 1.45 stop treatment and restart at decreased dose. This would apply to compounded Trilostane as well.

One thing I do like about Trilo (Vetoryl) is that it can be stopped and restarted easily with few, if any, adverse effects. It would be much worse on Lulu, and you, if her cortisol were to get too low...and there is always the possibility of permanently damaging the adrenals so that she becomes Addisonian. ;)

Much less risk associated with withhold the higher dose than giving it if she already getting too low...as it sounds she may be from the description of her behaviors.

Hugs,
Leslie and the gang

Thanks, I will call the vet. I don't know if he will agree, but I think you all have the right info. The values for Vetoryl are the same then as trilostane?

Yes, the values are the same. Vetoryl is just the brand name of Trilostane.

Perhaps your vet was just busy or miscommunicated somehow. My IMS has had to have a few refresher courses from me.;);)

Just wanted to pop in to tell you that I'm in agreement with the rest of the crew: if there's any doubt, it is better to withhold the medication than to administer it. I'm posting a link to the U.S. Product Insert for brandname Vetoryl:

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

You can read through their recommendations and warnings in conjunction with cortisol levels that have dropped too low. Perhaps Lulu's cortisol is not as low as we are fearing, and that is why your vet did not tell you to discontinue the dosing. But it is important to know for certain what that ACTH result was in order to know how to proceed.

Marianne

Marianne, the pre I posted at 1.2 and the post at 0.8. I don't know the reference, but I haven't given Lulu her dose this morning.

Alternatively, I am going to ask Dr. Booth if he wants her on a reduced dose sooner, to see if I can get 3 or 4 pills from the local pharmacy we got them from in the beginning. They were more expensive than the Kentucky place, but I could run over there today if they could put together four pills.

If those are the results of the most recent ACTH, she is toooo low and the med must be stopped and not restarted until signs are strong again and an ACTH shows the cortisol level is rising beyond the highest allowed for Trilo.

And no, the ranges for Lysodren and Trilostane (Vetoryl) are not the same, close but not the same.

Trilo (Vetoryl) =

http://www.dechra-us.com/files//dech...l_Brochure.pdf

A positive response to therapy is regarded as an
improvement in clinical signs and a post-ACTH
serum cortisol concentration of between
1.45 μ/dL and 9.1 μ/dL (40-250 nmol/L). (The post of 9.1 u/dl is acceptable ONLY if ALL signs are well controlled.)

For Lysodren =

http://www.k9cushings.com/forum/showthread.php?t=181

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

Hope this helps...and again do not give any more Trilo of any dose if those numbers are from Lulu's most recent ACTH.

Hugs,
Leslie and the gang

PS. You might want to print this chart off and show it to your vet. ;)