so worried advice please - now calcinosis (Vetoryl)

[tiggylola62]

Hello my name is Linda and my gorgeous boy is Tiggy he has just been diagnosed with cushing desease.
I am very worried as our vet has given us trilostane/vetoryl and said to give one 30mg capsule once a day and he weighs 9kg after reading up online I see it is recommened 1mg per 1kg of the dogs weight and to give twice a day which is 10mg more than the recommended dose I read about.
I have spoken to my vet today and mentioned this and I was told he goes by the instructions in the pkt (by the book as it were) he also said Tiggy's bloods were reading at 1100 which is very high as it should not be more than 600-700. Any thoughts would be so helpful as I am so new to this and am scared about giving the 30mg capsule incase it brings on the desease addisons which I read is the opposite of cushings and comes on if overdosed on trilostane/vetoryl.

Thanksfor taking time to read this. by the way Tiggy is a bichon.xxx

[Sage]

Don’t start Cushing’s treatment until YOU are positive
A) That the diagnosis is correct and
B) That you are 100% certain the dosage for the treatment (if/then) chosen is accurate and you have a full understanding of how you are to monitor the program.

There is no rush. Take a deep breath.
What behaviors make you think it is Cushing’s?
What tests were done? (And you will need to post those results here so these fantastic people can offer you their opinions.)
This website will help you tremendously…so get all your paperwork together and make a time line of sorts, and get ready for all the questions heading your way!

[tiggylola62]

Thankyou for your advice I will pick up information about results tomorrow my vet said he has 100% got cushings just concerned about dosage. x

[Sage]

What behaviors make you think it is Cushing’s?

What are the symptoms/behaviors YOU have seen at home that make you believe your dog has Cushing's?
Is the dog:
drinking a lot of water? accidents in the house? ravinous appetite? weakness in back legs?

[frijole]

Hello my name is Linda and my gorgeous boy is Tiggy he has just been diagnosed with cushing desease.
I am very worried as our vet has given us trilostane/vetoryl and said to give one 30mg capsule once a day and he weighs 9kg after reading up online I see it is recommened 1mg per 1kg of the dogs weight and to give twice a day which is 10mg more than the recommended dose I read about.
I have spoken to my vet today and mentioned this and I was told he goes by the instructions in the pkt (by the book as it were) he also said Tiggy's bloods were reading at 1100 which is very high as it should not be more than 600-700. Any thoughts would be so helpful as I am so new to this and am scared about giving the 30mg capsule incase it brings on the desease addisons which I read is the opposite of cushings and comes on if overdosed on trilostane/vetoryl.

Thanksfor taking time to read this. by the way Tiggy is a bichon.xxx

Hi from me as well. I would NOT start at that high of a dose. You are correct in your research and trust me, we have learned the hard way from helping dogs in distress that LESS is better with trilostane and you slowly tweek upwards if need be.

I used lysodren so I am hoping someone that has used trilostane will chime in. Kim

[frijole]

Thankyou for your advice I will pick up information about results tomorrow my vet said he has 100% got cushings just concerned about dosage. x

Please let us know if more than one test was done to diagnose cushings and if so what were they. We ask because it is quite often misdiagnosed... we just like to double check the testing as well as the dosage amounts for all new members... it has saved many a dog from distress, trust me.

Glad you found us - we are here to help, Kim

[Roxee's Dad]

Hello Linda and welcome to you and Tiggy

Symptoms are a very important part in the monitoring of the treatment of cushings. Sage has already mentioned a few of the symptoms.

Dechra the makers of Trilostane have some good information on their website that you may want to print out for your vet.

Starting dose

VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL.

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com.

Notice they say to start at the low end of the range. The link to their website is:
http://www.dechra-us.com/Cushings-Sy...VETORYL-1.aspx

Looking forward to reading more about Tiggy and his cushings test results.

[tiggylola62]

Hello to all I am so glad I found you all this is so worrying.
I will try to answer your questions. Tiggy has been on the royal canin obesity diet for a couple of years as he was overweight (big tummy)although I give my babies treats I did not think it was justified that he remained the same or gained weight over this period i'm sure the vets and family blamed me for overfeeding, my poor boy was so so hungry. Tiggy seemed old (as he is a rescue we are not sure of his age recent vet is saying he thinks he is in double figures.

18 months ago he had ops on both his crucic's and slipping pattela's again this was put down to his weight which did not help because lack of mobility.

He has been drinking more and urinating more including during the night I would not have noticed his over drinking as I have another dog and have at least 4 bowls in the house.

Tiggy's had a nasty round sore on his tummy when it cleared up it left a black scar even though it was not deep. his hair is thinner on both sides and on mainly one side his skin has gone dark.

He had a blood test which was sent off this rang alarm bell which led to an acth test these came back for positive cushings here are the results of the tests that were high. started 30ml vetoril once a day yesterday. Alt88 Alp348 cholestrerol 9 platelets555 Cortisol base 116.0 Cortisol 1 hour post1139. thankyou so much. xxxxxxxx

[labblab]

Hello Linda,

Thank you so much for posting this additional info about Tiggy. All the symptoms that you have written about are indeed consistent with Cushing's, and the post-ACTH result of 1139 nmol/l (which converts to 41 ug/dl which is the measuring unit used in the U.S.) is definitely elevated and a "positive" indicator for Cushing's as well. So I do understand why your vet has chosen to start Tiggy on the Vetoryl.

As far as dosing -- I am guessing that you live in the U.K., and if so, your vet will be relying on a different product information sheet than the one that is included with Vetoryl sold here in the U.S. For the most part, all the information is the same or at least very similar. But there are a few differences in wording and content. Here is a link to a U.K. Datasheet for the 10 mg. size of Vetoryl:

http://www.dechra-eu.com/files/dechr...s_16-12-10.pdf

You will see displayed a prominent dosing chart that indeed lists 30 mg. as the recommended starting dose for a dog of Tiggy's weight. As a matter of fact, the chart in the U.S. Product Insert makes the same recommendation. So your vet is right by saying that he/she is going by Dechra's published recommendation. The difference is that the Dechra literature here in the U.S. additionally lists an initial dosing range with the advice to start at the lowest end to minimize side effects (as John has noted in his reply above). Dechra literature in both countries recommends starting first with a once daily dose, and only switching to twice daily dosing in the event that symptoms do not seem to be controlled effectively throughout a full 24-hour time period.

The bottom line is that there is still some variability in the dosing protocols that are preferred by different researchers and clinicians throughout the world. But your vet's recommendation is supported by the published Dechra literature. Having said that, it may well turn out to be the case that Tiggy will actually end up doing better on a different dose altogether -- either greater or smaller. The proof of the pudding will be your observations of his behavior as well as monitoring ACTH testing. The first ACTH test should be performed approximately two weeks into treatment. Has your vet talked with you about scheduling a monitoring ACTH? As long as Tiggy appears to be doing well, then I don't think you need to be overly worried about the starting dose, as long as the monitoring testing is also performed as recommended. But if he seems "off" to you in any way, then you need to temporarily stop the Vetoryl and notify your vet so as to lower the dose and/or speed up the monitoring test.

Marianne

[addy]

Hi and Welcome,

Everyone has given you terrific information. My Zoe is on Trilostane. She has colitis/inflammatory bowel disease so we started on a low dose of Trilostane and kept increases to 25 % to 50%. While that worked for Zoe by avoiding side effects and keeping her colitis in control, it did not get her cortisol down to therapeutic range. We now uncovered allergies as well and I am in the process of bringing her cortisol down further.

Zoe is 18 pounds (she gained weight) and I just bumped her to 40mg once a day. I admit my heart was in my throat yesterday and I had a knot in my stomach as the dose seems to be getting up there but I know if she has any kind of problem, I stop the drug.

I am sharing my story with you in hopes you can see you are not alone. Here in the states, the endocrinologists and internists are all over the place about what the correct dosing should be.

hugs,
addy