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Note that phrase - studies done after the datasheet was published supports starting at a lower dose than originally recommended. Your vet may not be familiar with these studies (posted on the first page of your thread) and may well appreciate being brought up to speed. ;)Quote:
...is consistent with the recommended dose range on the Vetoryl datasheet.
Our vet is in tomorrow so I'll go and see her and take that with me.
He seems to be OK - no diarrhoea or any other side effects.
Nice to see you again Alison. So you have started administrating the 120mg then? How many days has it been so far? Have you noticed anything different at all?
Because she's in the UK.. the FDA rules are applying to her, that's why Dechra won't start a file with her.
Don't feel bad, for us in Canada they won't either.
He's had three days of the 120mg - I'll speak to his vet tomorrow though - she's part time since she had her baby and I'd much rather keep consistency and speak with her. He seems to be fine - haven't really noticed any changes for better or worse.
Hi Alison,
I am so sorry that Dechra was of no help to you and even sorrier that they have given you a false sense of security. I am so angry at them right now for their cavalier attitude, I could spit nails. We in the U.S. are lucky to have a Dechra division fully staffed with vets who will speak to us owners directly; however, I believe we have had a few members here in the states who got a response like yours. The fact of the matter is that Dechra has been negligent in safeguarding our dogs against overdosing based on their current recommendations. One of our admins, Marianne, has been in touch with Dechra here in the U.S. more than a few times and they told her that they hadn't updated their package inserts due to cost constraints but they are verbally recommending that treatment be started at the lowest recommended dose. Once this drug was approved in the U.S., the sale of Vetoryl skyrocketed and so did the documented experience. It has been used to treat dogs here for over seven years and clinical trials by UC Davis and others indicate that Dechra's dosing recommendations are quite risky.
If you want proof for your vet, please print out a paper entitled "Update on the Use of Trilostane" authored by Dr. Ellen Behrend, a board certified internal medicine specialist, and contributor to Dechra's continuing education program. This paper comes directly from Dechra's website and I highly recommend that your vet follow Dr. Behrand's dosing and monitoring protocol included in this paper. I have included the url below. You will find a relevant quote from Dr. Dr. Behrend which reads,
Dr. Behrend suggests that this amount is still too high by stating that,Quote:
Originally, the recommended starting dose for
trilostane in Europe was 2 to 10 mg/kg Q 24 H.
However, as experience with the drug grew, it
became apparent that lower doses were needed.
Accordingly, the dosing recommendation on the
U.S. package insert is 2.2 to 6.7 mg/kg Q 24 H.
http://www.dechra-us.com/.../Case%20...trilostane.pdfQuote:
My recommended starting dose is either 2 mg/kg
Q 24 H or 1 mg/kg Q 12 H, with adjustments
made as needed based on adrenocorticotropic
hormone (ACTH) stimulation testing.
So Dechra's own paid expert veterinary specialist ignores the low end of the range (2.2mg/kg) and would start Cairo on 2mg per kg which equates to 56mg once daily. This would most likely be bumped up to 60mg which is an available dose from Dechra. UC Davis would probably start Cairo on an even lower dose based on their own extensive experience with the drug....so shame on the rep at Dechra who supported your vet's decision because it's in accordance with the packaging insert.
I know from experience that questioning your vet is uncomfortable, even when you know what you are talking about but when you are new to the canine cushing's world, it's even harder. How can you possibly argue a point unless you understand it. It's my hope that the credible reference material we are giving you will 1) help you understand things better and 2) give you a lot more self assurance when asking questions of your vet. If your vet dismisses you and assures you that he knows what he's doing, don't believe him because we've given you the proof that he doesn't.
Now having said all that, it could very well be that Cairo will tolerate a 120mg dose but it could very well be that he doesn't and he ends up in an emergency clinic on iv fluids and steroid supplementation and costing you a lot more in hospital bills and more than the usual number of acth stim tests. I personally wouldn't take that chance, especially when world reknown experts like Drs. Ellen Behrend and Edward C Feldman have my back.
Glynda
P.S. I started this post this morning and just now finished and see that in the last several hours, you posted that Cairo has been on 120mg for three days and tolerating it. I'm glad but that doesn't mean he's out of the woods so please keep a very close eye on him. I could delete my post but decided to keep it here because I think it is important information for anybody who may read your thread.
Hi Alison,
Checking in to see how Cairo and you are doing.
Hope everything is going well.
Sharlene and Molly Muffin
Hi Sharlene,
He's doing fantastic. He's had his first ACTH Stim Test and the vet was really pleased. His cortisol levels were 88 and the range was 50 - 150.
When she saw him she couldn't believe how well he was looking - the shine's coming back on his coat, he had his twinkle in his eye and looked so much more happier. She says he's got his mojo back.
He's also lost about 2kg in weight and looks less bloated than he did. He's still not able to go for huge long walks - we let him dictate the distance he goes and he's probably only managing about quarter of a mile but he's showing interest on his walks and sniffing and snuffling about the place.
He goes back on Monday for his second Stim Test (that's the four week mark from starting on the Vetoryl).
He's still got his little bald patches but I'm not expecting them to get better for a while yet, but as I said, he's less bloated looking, isn't drinking and peeing the way he was and isn't scrounging food all the time either. He looks a much happier boy.
I probably shouldn't have started another thread about the Synacthen shortage here in the UK but I've come back to this thread to try and keep things together.
Cairo seems to be still doing OK - since we can't get the stim test done, he's been getting baseline cortisol and electrolytes done.
We've noticed a tiny little bald patch though - his skin looks fine - it's just a little round bald bit. He seems fine in himself - but I worry because he doesn't always show illness - when his cortisol levels dropped too low, he was running about like a mad thing while we took the call from the vet - no sign that his cortisol was too low.
Is a new bald patch something to worry about?
You can always get a skin scrapping and have it checked to see what it is. That is probably what I would do. It could be anything and you really don't know if you need a special shampoo, or antibiotics or something until you know what it is.
Glad to hear that he is doing okay other than the skin patch.
The baselines have been good?
Sharlene and molly muffin