Suni

For the results of the UC:CR to be accurate, you don’t want the dog to be either unusually agitated or sedated when the urine samples are being collected — you want an accurate reflection of the typical amount of cortisol that the dog is producing on a daily basis. So you’ll want to collect the last batch of urine first thing in the morning of the day you’re taking Suni in, *before* you give her any Valium. We’ve been advised that the pooled urine sample should stay refrigerated prior to analysis. So depending on how long the drive is to the vet, taking it in a cooler would likely be a good idea. You can double check all this with your vet to make sure you’re following the protocol that she wants. But this is what we’ve generally been told.

Update on Suni. I caved, and did exactly what I said I wouldn't do. She has been diagnosed with pituitary cushings. We will start Trilostane treatment in a couple weeks or so. She just spent 4 days in the hospital on an IV with a stomach infection, so treatment won't be until she gets her strength and weight back. I am still reluctant, but must do all I can to make her golden years as happy and healthy as possible.

I am asking for experience in Trilo users for feed back. What is the lowest dose I can start her on? I know nothing about the med as Misty was treated with Lysodren. Just so you know.... I will be asking a lot of questions because I trust this group completely when it comes to advice. Doctors know a lot, but experience is worth its weight in gold.

On a brighter note. Adequan injections are helping her collapsing trachea so much. She coughs very rarely and that's the only thing I can contribute the success to. As the Doc said, "It's time something went right for her"!!

Hope all you furmoms and furbabes are doing well and keeping safe. It's fast becoming a very uncertain future for all of us. God Bless. XXOO

Hi again, Shelba! That’s great news that Suni’s cough is responding well to the Adequan — that has to be a huge relief to you!! As far as the trilostane treatment, we’ll surely do all we can to be helpful to you. I’m going to start by giving you links to two threads on our Resources forum that contain a lot of helpful info. I encourage you to take a look at them now, in advance of starting treatment. This way, you’ll have the chance to address many potential questions ahead of time. Taken together, the two threads address treatment and monitoring considerations, as well as suggesting ways in which costs may possibly be lessened. So do take a look and we can discuss any aspects that you’re still wondering about.

https://www.k9cushings.com/forum/sho...TH-Stimulation

https://www.k9cushings.com/forum/sho...096#post211096

To address your specific question about dosing, the generally accepted formula for calculating the initial dose for a dog weighing less than 40 pounds is to prescribe 1 mg. per pound of the dog’s weight. I believe you’ve told us that Suni weighs 10 pounds, so theoretically that would place her starting dose at 10 mg. and Dechra, the manufacturer of brandname Vetoryl, does produce a 10 mg. capsule. However, they also manufacture 5 mg. capsules, as well. In your situation, I’m thinking you’d prefer to be cautious re: the size of her starting dose and therefore the 5 mg. capsule may be the best place to start.

When you read the second link I’m giving you about cost-cutting methods, you’ll see that compounded Rx’s of trilostane can be prepared at any dose other than the capsules manufactured by Dechra. So you could start even lower if you wanted to have a compounded dose prepared for Suni. All things being equal, I personally recommend that folks start off with brandname Vetoryl if they can afford it and if a capsule is available in the dose that they are needing. I feel more comfortable with making the switch to a compounded product once the dog has been stabilized on the brandname Vetoryl (for reasons that are discussed in that link). But especially with smaller dogs who need a dose that’s not available via Vetoryl, compounding provides the answer.

OK, I’m gonna leave things right here for the moment. As I say, this way you can do some initial research on your own and then return to us with any additional questions. I sure hope our little girl bounces back quickly from her infection!

Marianne

Thank you so much for the links Marianne, and I will most definitely dive in reading and studying them. I plan on knowing a lot more when we start treatment than I do right now, thanks to you and the folks here. The way the doctor talked, she doesn't want to start anything until Suni gets back to her initial weight and health. So maybe a month or so. I was glad to hear the info on the lowest dose to start with. That was my first request.

On a positive note, she is doing really well and bouncing back rather fast. Much relief there! I will be checking in often and I appreciate you more than you will ever know.

So Vetoryl is more effective than Trilostane? For some reason, my low IQ thought they were the same.

Not necessarily. Trilostane is the active ingredient in Vetoryl. When a dose or form of medication, like a liquid, is needed that Dechra doesn't supply then Vetoryl is compounded and is then referred to by the active ingredient, Trilostane. Dechra only produces capsules and only in 5, 10, 30, 60, and 120mg doses. So if a pup needs 6mg and can't swallow pills, the Vetoryl can be compounded into a liquid with which 6mg can be given easily. So Vetoryl is the brand name unaltered from Dechra, the manufacturer, and Trilostane is the compounded form of Vetoryl.

Not all compounding pharmacies are equal so you want do some research if using compounded medications of any kind. We used to relied on Diamondback out of AZ but sadly they sold out to Wedgewood Pharmacy and the quality dropped quickly. There is a pharmacy out of New Jersey called CareFirst Specialty Pharmacy that the admins of the Facebook groups researched and talked with and now recommend most of the time. Here is a link to their information:
https://www.cfspharmacy.pharmacy/

I'm glad to hear Suni is already feeling better and pray this trend continues!
Hugs,
Leslie

Hey girl, this is definitely *not* a low IQ issue — this stuff is just plain confusing for everyone!

But here’s the crux of things. Trilostane is the chemical name for the active ingredient in Vetoryl. So from a chemical standpoint, they are the same thing. However, Vetoryl refers to the brandname veterinary version that was initially researched, patented, manufactured and marketed by a pharmaceutical company named Dechra. To this day and to my knowledge, I believe Dechra still holds exclusive right to the large-scale pharmaceutical manufacture of an FDA-approved veterinary version of the medication. Through the years, I had assumed that generic versions would be made, once Dechra’s original patent expired. But I’m not aware of this happening yet. Generic versions of medications are also made by large-scale pharmaceutical companies, and generics sold in the U.S. must also meet FDA standards. But as we know from our experience with human meds, generics can be a whole lot more affordable! But I guess nobody has felt that a generic version of trilostane would be enough of a money-maker to launch into formal manufacture.

So that leaves us with compounded versions of trilostane as being the only alternative to Vetoryl. Compounded trilostane products are put together by individual compounding pharmacies, theoretically customized to each patient via the Rx written by the dog’s vet. Legally, compounded products cannot duplicate brandname products. There is supposed to be a reason why the compounded product is necessary — either a dose or delivery system that is not available in the brand. Compounded medications can certainly be a life-saver when a dose or form (e.g., liquid instead of a capsule) is not available in the brand. Compounded trilostane is typically far less expensive than Vetoryl, as well. However, there can be a downside to compounding, too. Since the meds are being prepared by individual pharmacists, they are not FDA-approved and at least one study has shown greater variability in the dose and effectiveness of some compounded products as compared to Vetoryl. However, due to individual dosing needs and even just the exorbitant expense of brandname Vetoryl, compounded versions of trilostane can offer some owners the best and even only viable option for treatment.

You can read more about these issues on the “Cost-saving” link that I gave you above. If folks want to consider compounded trilostane, there are also tips in that thread to help owners identify reliable compounders who conform to some established professional standards. This can offer greater peace of mind re: the purchase of a compounded product.

So the long and the short of it is that we often do get sloppy and use “trilostane” here in our answers to refer to both Vetoryl and compounded alternatives. But basically we’re just generally referring to treatment using that particular chemical (like “mitotane” and Lysodren). Usually the owner will tell us at the outset which version they’re actually using. As I said earlier earlier, though, my personal preference is to start dogs off on Vetoryl if it is affordable and available in the desired dose. This is because of the study results showing greater variability among compounded versions. I’d like to make sure my dog can tolerate the approved version of the med first. Once stabilized on a certain dose, that would be the point that I’d consider switching to a compounded version if Vetoryl is too expensive to handle longterm. But that’s just my own opinion. As I say, you’ll see more about this all in the resource thread above.

Marianne

I see that Leslie and I were writing at the same time, and I’m so glad she had a chance to add her additional info, including the link to CareFirst Pharmacy. I do want to add one more thing to what she and I have both already written. And that’s to say that even though trilostane is the active ingredient in Vetoryl, compounders typically are not actually starting with Vetoryl as the basis for their own product. Instead, they are buying raw trilostane from their own chemical suppliers to incorporate in their preparations. This may be one reason why there might be more variability in the strength or effectiveness of some compounded products. And this is why it’s important that folks select a reputable compounder to prepare medications for their pups (or for themselves, for that matter!). You’re wanting to use a compounder who sources their base chemicals from a reputable supplier, as well.

So, if I start Suni on Vetoryl, would the 5 mgs be considered a low dose for her? 12 Pounds? My head is spinning!! Thanks guys. I will make if with y'all's help!!

Yep, I believe 5 mg. would be considered a lower dose by many clinicians. If Suni were my own dog, that’s probably the starting dose I’d be advocating for.