My Pug Scoop (Precious Scoop has passed... )

I heard from the vet today with Scoop's ACTH results.
Pre was 2.0 Post was 5.2
Where can I find what normal is for being on Vetoryl? The vet said 6 up to something? was normal. So that would make Scoop a little low.

What bothers me is on 12/5(his last ACTH) his numbers were Pre 9.3, Post 10.1
His dose was not changed from Dec. till now but his numbers dropped drastically. Will they keep dropping? I remember in Dec Scoop's opthamologist suggested the vet wait to do the ACTH but the vet didn't want to wait. That was only a couple of weeks after Scoop started with his corneal ulcer. I guess those numbers could have been high because of that, right? Thank goodness she didn't up his dose at that time. The vet said today it might have dropped because of something with his BGs.

Scoop also had a JR wellness blood work done yesterday. The vet wanted to check his calcium because of his calcinosis cutis and putting DMSO on it. I will have to get those results in writing. She said everything looked OK. The one liver value stayed about the same as last time and the other one went down about 200 points.

Scoop's results are actually fine as long as the symptoms are controlled. Anything below < 9 on POST is okay if symptoms are good. If not then up the dose, but with the results still possibly dropping I wouldn't up the dosage right now. They say under 5 POST is good for hair regrowth, but its not necessary to be there. Many aren't. The symptoms and how he is doing is the main thing. When the vet said 6 up to something that is for a dog Not on Trilostane.
Dechra recommends a post of 1.5 and 5.5 mcg/dl, according to their website.

Numbers can continue to drop, so that is not abnormal. Yes if his last ACTH was during the cornea episode then that could have contributed to the numbers being higher I would think.

I'll let others talk about where they buy their vetroyl, but I know quite a few use compounding pharmacies to keep the cost down. Just make sure you have good, reputable one. Trilostane is the ingredient within in vetroyl. What you want is a good compounding pharmacy that is careful with the dosage so that they have the same amount in each pill/capsule.

Have you compared the price to the one you found on line, that is per pill? I didn't even know that you could buy vetroyl online.

Hugs,
Sharlene and Molly Muffin

Sharlene-Thanks. So even if you don't change the dose, the cortisol level can continue to drop?
I haven't asked the compounding pharmacy how much they get. I do know Drs. Foster and Smith are a lot cheaper than the vet. You do need your vet to send a prescription in to them to be able to get the Vetoryl.

Sometimes I wonder.The vet thought the 6 was the low. She also said if anything we would drop the 10mg in the evening but to wait till she consults with an IMS. I told her Scoop doesn't take 10mg in the evening. He takes all 40mg in the morning. That surprised me when she said that. I wonder if I missed something along the way. Something was said about maybe doing a split dose but she never told me to do it. Besides, the IMS splits the dose but she makes it higher not split what he is on. The vet and I talked about that.

Scoop was just restless. He circled around a couple of times then snuggled against my leg. He hasn't done that in a long time. I could feel him trembling. Until recently I would not notice any trembling at night. Just wonder why. He seems extra sleepy the last couple of days. Yesterday I thought maybe because of going for the ACTH but today he was the same way. All I do is worry about everything.

Pharmacies do not sell compounded trilostane in dosage strengths in which brand-name Vetoryl is sold. So, if one is giving their dog 30mg of the brand-name Vetoryl, and then would want it compounded, the pharmacy could compound either 29mg or 31mg strengths.

We have seen many dogs here have their cortisol drop lower on a dose that was being given over a period of time.

Love and hugs,
Lori

Lori-Thanks. So there is a slight difference between compounded Trilo and Vetoryl. Do the pharmacies have to do it that way because they can't be the same as Vetoryl?

No there isn't any difference, between trilostane and vetroyl. Pharmacies just can't sell anything in the exact dosage that the brand name vertroyl comes in. I saw someone say they ordered theirs from 1-900-Pets-Med online. Diamondback in Arizona is another compounding pharmacy that many have used.

hugs,
Sharlene and Molly Muffin

Vicki, my heart sank when I read that your vet is concerned that Scoop's ACTH result is too low. After his having been on trilostane treatment for these months, I would have hoped that she would know what the desired testing range is for a dog taking the drug. Per the manufacturer of brandname Vetoryl, the post-ACTH result should be between 1.45 ug/dl and 5.4 ug/dl, with it going as high as 9.1 ug/dl as long as a dog's symptoms are well-controlled. Scoop's test result was good, and no decrease is warranted. Since Scoop is diabetic, I've also been bothered that she hasn't pursued the twice daily dosing since it is recommended by so many experts. All in all, it seems as though she is kind of stumbling through the process. It would really be nice if you could get some direct input from a vet who has more experience with all of this, especially since Scoop still sounds unwell. Have you ever spoken directly with the IMS yourself? Would you want to try to arrange a consultation now? I am worried for Scoop and sure wish an expert could take a look at him.

As far as compounded trilostane vs. brandname Vetoryl, Sharlene is right that the effective ingredient should be the same chemical in both. But just so you'll know, compounded trilostane is not the same thing as a generic version of a brandname drug. Both brandname drugs and their generic counterparts are manufactured by pharmaceutical companies under FDA oversight of testing and inspection. However, there are currently no generic versions of Vetoryl for sale anywhere in the world, so brandname Vetoryl is the only version of the drug that is FDA-approved. Compounded drugs are instead prepared onsite by individual pharmacies and fall outside of FDA approval. Some recent studies have shown that there may be less consistency or effectiveness from batch to batch of drugs compounded by some pharmacies. And any inconsistency in the product could lead to less consistent dosing control. It is for this reason that some vets prefer that their patients use brandname Vetoryl and not a compounded substitute. Compounded trilostane is usually much less expensive, however, and we do have many members who have been very satisfied with their compounded product.

You are right in assuming that compounded products legally cannot be sold in the exact same dose as brandname Vetoryl. But you can buy either one online as long as you have a valid prescription from your vet. I'll try to come back later today and give you a link to a thread that lists sources with the best pricing for both types of the drug.

Marianne

http://www.petapothecary.com/
This pet pharmacy is right near my house and was suggested by our IMS. They sell both compounded and name brand. I use the name brand Vetoryl from them as their compounded Trilostane is not much cheaper. I think you can do much better then the prices your vet is charging, they seem high. I cant find my last bill but we don't pay that. Alot of our members purchase from Diamondback Drugs in AZ when the use compounded. Not all compounding pharmacies are created equal so you need to purchase from a reputable pharmacy.

I do know that we all have read that it is easier to control blood sugars when the cortsiol is more evenly controlled throughout the day, which means twice day dosing.

I am not sure why your vet thinks a post of 6ug/dl is low unless it has something to do with controlling Scoop's diabetes. It is not low.
Yes, a dog's cortisol can continue to drop on the same dose but it also can go higher. Keep in mind hormones fluctuate so that is why we have a range of numbers to begin with. My Zoe was appx 6.2 in September, 10.2 post in October and dropped to 7.1 in January all on the same dose. ( I may be off a bit on those numbers, but you understand my point) She has bounced around when she first started on the same dose going lower, then gowing higher.

There can be a difference in Trilostane and Vetoryl as far as how much of the acting ingredient is in a capsule. With the name brand, it does not vary, so we know for sure that 10mg is exactly 10mgs. There was a study done where I think it was 5 different compounding pharmacies Trilostane capsules were tested. Not all of the pharmacies passed the test and the amount of Trilostane in a 10mg capsule varied. This is why we say only use a reputable compounding pharmacy.

Hope this helps a little. Oh- I see Marianne and I were typing at the same time.

Thanks Sharlene, Marianne, Addy
That all helps to understand better.

Marianne-a while back twice daily dosing was mentioned. I don't remember the reason we didn't pursue it at that time. I do know the IMS that the vet has been in contact with said she ups the dose and then splits it for twice daily dosing. Scoop did see that IMS back in Nov. We had a long visit. The IMS said she feels Scoop's vet is doing the right things. This was when we were trying to find out a reason for Scoop's weight loss. At that same time he also had a visit with the neurologist trying to see what his head tilt is all about. Then the following week he had the ultrasound and MRI done and then his ear surgery. That facility is over an hour away from where we live. We do have IMS closer to home. I wish we would have gone there originally but wth the neurologist thing we just did it at the same time. A while back I said something to my husband about talking to someone else and he didn't think it would make a difference. I'll see if I can print out that article from Dr. Peterson and talk to the vet again. I don't think she'll be against it but it seems to me she should be the one to suggest it. If the dose gets split, does another ACTH have to be done 10-14 days? Since he's on 40mg would the best be 20-20 or could it be 30-10? Sure wish Dechra made 20mg. It would be expensive to use 4-10mg. I guess that's when you check into compounding.

I just don't know what to think. I feel so bad for Scoop. All Scoop does is sleep or wait to eat. He has no interest in anything. It seems like ever since he totally lost his eye sight. I wish I could give his sight back and see if it makes a difference.
Be back later.
Thanks everyone.

I know this all sucks for you and for Scoop. If you do decide to go double dosage, then I'd try to keep it even to start with, just because of the diabetes.

Others here probably have more knowledge though on that. I know quite a few don't do the same, they might do more in the mornings and less in the evenings.

hugs,
Sharlene and Molly Muffin