Have I finally found my friends? (Palmer has crossed over the Bridge)

Hi Debbie-

Thanks for your input. I think that's a good idea. Before we start back up, I'll pose that to the vet. That makes more sense to me as well.

-Susan

I spoke with the vet already. She thinks it would be fine to try that, but that the capsule, so far as she and her supplier know, only comes in 30mg capsules. She suggested splitting one capsule-1/2 in AM and 1/2 in PM.

I went online to try to find out if there were any other dosage capsules available anywhere. In so doing, I ran across the following, It is from
the Journal of the American Hospital Association.

Long-Term Efficacy of Trilostane Administered Twice Daily in Dogs With Pituitary-Dependent Hyperadrenocorticism

Dolores Perez Alenza, DVM, PhD, Carolina Arenas, DVM, Mari Luz Lopez, DVM and Carlos Melian, DVM, PhD From the Veterinary Teaching Hospital (Perez Alenza, Arenas), Veterinary School, Complutense University of Madrid, 28040 Madrid, Spain and Clinica Veterinaria Atlantico (Lopez, Melian), Pi y Margall, 42, 35006, Las Palmas de Gran Canaria, Spain.
Address all correspondence to Dr. Arenas.
Trilostane is considered an efficacious and safe medication for canine pituitary-dependent hyperadrenocorticism (PDH). Its recommended frequency of administration is once daily. In this prospective study, the efficacy, toxicity, and long-term outcome of trilostane administered twice daily per os were evaluated in 44 dogs with PDH. Mean initial dose was 3.1 mg/kg q 12 hours, and mean final dose was 3.2 mg/kg q 12 hours. The final total daily dose was lower than previously reported for once-daily administration. The mean survival time for affected dogs was 930 days.

The vet said the advantages of splitting up dosage is a gray area. She said the mfg. suggests that it not be done and that some studies show it's helpful.

She suggested we try splitting up the 30mg pill-half in AM and half in PM. We're going to try that before we retry an increase. We won't be doing that until we are sure he does not have a virus. She wants him totally back to "normal" before we make any changes. That way we can determine if his reaction is truly due to the Trilo.
[IMG]file:///C:/DOCUME%7E1/SUSANS%7E1/LOCALS%7E1/Temp/moz-screenshot.jpg[/IMG]

That's where we stand.

-Susan

Hi Susan,

If you will recall, I suggested that you ask your vet to do a urine cortisol creatinine ratio to determine if Palmer needs twice daily dosing. Is there any reason why your vet didn't opt to do this test before advising you to increase Palmers Trilo dose? He probably does but keep in mind that you opted to treat with a drug that is not recommended for a dog like Palmer, whose intermediate hormones were already elevated. The problem can therefore be that Trilostane is elevating the intermediates to a greater extent and causing the symptoms you are seeing. It is very important that your vet follow proper protocol so that she can make an educated determination as to why Palmer is still symptomatic. Telling you that "something is going around out there" and then instructing you to test the water a second time with a possible overdose doesn't sit well with me at all but then, I'm a little different than most people.

If it is determined that twice daily dosing is necessary, then the proper protocol involves a formula of sorts where you slighty increase the once daily dose and then split into two equal doses in the am and pm. I believe Palmer is on 30mg so you would increase to 40mg and divide into two 20mg doses to be given as close to every 12 hours as possible. I personally would go with this or the 20mg and 10mg Debbie suggested before I would take the risk of making Palmer sick again.

Glynda

P.S. I see that you were typing faster than I can and posted before I hit the send button. I'm at work so it takes me an hour to get one post done in between the interruptions. I am glad to hear that you are splitting the current dose rather than trying the increase again. Whew!

Thanks Glynda. The "something is going around out there" was my cryptic reporting of the conversation. She said something about having seen a lot of dogs with a virus, now.

I have been able to determine that in June the FDA approved 10 mg capsules. I cannot find out if they're available yet. I emailed the mfg support line.

Will someone please tell me what "PU/PD" stands for? Maybe pick up/ put down?? ;););) Ah-I found it! Excess urination/ excess thirst. Why can't they talk in regular folk talk???:confused::confused:

-Susan

It must be Friday:D:D

I just found this online "Cortisol levels are now considered a biological marker of suicide risk."

Does this mean I should have Palmer on a suicide watch?;););)

It just struck me as funny........I know it's serious.

-Susan

Hi Susan,

I'm coming in late here and I'm a little confused and concerned. It sounds like you are using the standard 30mg capsules (Vetoryl I presume) and that the vet is recommending that you split the capsules open? That is very dangerous for both you and Palmer as this exposes you to the Trilostane (which can mess with female hormones) and, if you are sprinkling the powder on his food, could result in some very nasty irritation to his throat and possibly esophagus. It would also be pretty difficult to get a really accurate split dose that way.

I believe a the 10mg Vetoryl capsule may have got FDA approval in June - I'm far from 100% sure of that but if it is right then you should be able to get 10mg caps for tweaking purposes. Even if that isn't the case then you should be able to get the 30mg capsules compounded (by a compounding pharmacy) into smaller doses - this is something quite a few people have had done. That would be a lot safer for both you and Palmer if you need to vary the dose outside 30mg increments and the 10mg caps are not yet available.

Here's what is under the Human Warning's section of Dechra's Vetoryl package insert (bolding is mine):

Quote:

---

HUMAN WARNINGS:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

---

(This is a link to the package insert PDF file: http://www.dechra-us.com/File/prod_vetyrol.pdf)

Now for the confusion: What dose is Palmer on now - is it 30mg capsule (Vetoryl?) once per day? In the past you mentioned "pills" - did you mean capsules or were you using a compounded pill form of Trilostane previously and have gone to Vetoryl capsules now following FDA approval?

Alison

Quote:

---

Originally Posted by Palmer's Mom

It must be Friday:D:D

I just found this online "Cortisol levels are now considered a biological marker of suicide risk."

Does this mean I should have Palmer on a suicide watch?;););)

It just struck me as funny........I know it's serious.

-Susan

---

Susan,

When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners. :D:p:D

PU/PD means polyuria (excessive urination) and polydipsia (excess water intake).

As I recall, you have a compounded version of vetoryl in tablet form which Palmer was getting once daily. I seem to remember this because most of us thought you were mistaken because we had never heard of Trilostane tablets. Vetoryl comes in capsules and so do the vast majority of compounded Trilostane. You can get any mg you need compounded in capsule form at any number of compound pharmacies. I used to purchase mine from Diamondback Drugs in Scottsdale, AZ. Many other members use them as well.

www.diamondbackdrugs.com

Glynda

Glynda & Alison, when I saw the increased dose suggested by the vet, I went back & re-read the thread. From what I can determine, Palmer has been on 30 mg. once daily. Now, whether or not Susan is talking about opening the capsules, she will have to clarify that point.

Debbie

How nice to hear from so many!

I think you got it right, Glynda!! - "When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners."-
I am sorry to have been confusing. I am giving Palmer capsules. I tend to call everything re: medication a "pill." We have been using the 30 mg Vetoryl. We have been giving one capsule each morning. The one day we added 1/2 capsule in the evening. Palmer had the diarrhea and we have been back on the one capsule - but we are splitting it between AM and PM. The vet mentioned compounding. It sounds like that may be the way for us to go....at least to try. Thank you for the link.


Alison - I am aware of the warnings given with the pill. My child bearing abilities ended twenty years ago. We are very careful to wash our hands thoroughly....but I do think the compounding would be preferable. I had not given thought to the possibility of irritation to Palmer's throat. Obviously I would not want to do that. As the only option for Trilostane presented to me was the 30 mg capsules....I figured I had no choice but to open them and split them.


The 10mg were approved in June. I have been unable to find out if they are on the market yet.

Susan

Susan, if you are wanting to obtain brandname Vetoryl in 10 mg. capsules, I suggest you contact Masters Marketing (a U.K. internet pharmacy): http://www.masters-uk.com/veterinary/home.php

Even though the 10 mg. capsules received FDA approval in June and will soon be available, it appears that they have not yet been distributed to vets for sale to the public (per Dechra's U.S. website). Until they ARE available for purchase through American vets, you may still be able to order them from Masters. I suggest you contact Masters to see what they can tell you about the situation.

Good luck!
Marianne