15 year old poodle on trilostane - frequent dosing increases not helping

[Harley PoMMom]

Diarrhea is always a concern especially when a dog is being treated for Cushing's. Diarrhea can be a sign of cortisol dropping too low but also a symptom of cortisol withdrawl syndrome and the only way to differentiate from the two is with an ACTH stimulation test.

Is her appetite normal? Any vomiting?

[molly muffin]

Twice a day dosing, you don't double the dose, you split the dose. That is textbook for vetroyl. Instead of giving 10mg once a day, you would give 5 mg, twice a day, morning and 12 hours later.
This then comes into the realm of compounding since Dechra doesn't make 5mg vetroyl tablets. But we don't know what the cortisol level is doing yet to say if that is what needs to be done or not. Typically though if you see signs subsiding after giving the pill, but then coming back later in the day, often you would consider, twice a day dosing.
Sharlene and Molly Muffin

[mitsua]

No vomitting, just am diarehhea. Still hungry and still does a lot of drinking and peeing but not so much as before. Vet said that means she has to up the dose since it isn't controlling her symptoms enough plus the panting comes back in the late afternoon. Since it only comes in a 10mg pill, vet said plan on dosing 2x a day with a 10 mg pill. That's what I think is too much. The ACTH stim test is schedule for Tuesday but the vet already told me based on the clinical signs Im telling her that she will need a higher dose. Any thoughts?

[Harley PoMMom]

I would not increase the dose until the ACTH stimulation test results are known and even then I might be reluctant to adjust the dose upward. We have seen here that cortisol levels continue to drop even further within at least the first month of treatment even while remaining on the same dose.

Hugs, Lori

[Renee]

Don't raise the dose just yet. And question the vets competence when they want to raise the dose without benefit of an ACTH.

Also, I would never raise the dose without being on the first dose at least 30 days.

[goldengirl88]

If it were my dog I would withhold trilostane because of the diarrhea to be safe you never give these drugs to a sick dog. I am wondering why you are not getting and ACTH test before doing anything? I never do anything dosage wise without an ACTH first. Blessings
Patti

[mitsua]

not changing the dose until results of ACTH test which will be done tomorrow. Vet said she is just letting me know what's coming so I will be prepared. But I think if she is suggesting upping the dose or giving 10 mg 2x a day based on the clinical signs and acth results, I may get a second opinion from the cushings expert in LA even though he over 100 miles from me. This vet is competent enough but readily admits to not being an internal medicine specialist. And she absolutely will not use a compounding pharmacy. I will have to tread lightly to tell her I am getting a second opinion but will want her to test locally. I don't have a lot of vet options here. She has already said that what I am considering to be lethargic is normal behavior in a 15 year old dog and my expectations may be unrealistic. I replied that it wasn't normal behavior for my 15 year old and she dropped it.

Diarrehea varies from day to day -- some morning almost water; other morning soft stool but only in the am about 1 hr or so after administering trilostane. She is still panting like a steam engine by the early evening and sleeping most of the day and dragging on her walks after administering. THis is day 10 of treatment. Thanks for any input on this.

Will post the results of the LDDS test since someone wrote that I need all the #s, and the ACTH tests when i get them.

[Harley PoMMom]

Trilostane has to be given with food to be properly absorbed, she is getting her Trilostane with food, right?

Canned plain (no spices added) pumpkin may help with diarrhea, just adding a small amount, like a teaspoon, could aid in firming up her stool, one doesn't want to add too much pumpkin because it can act as a laxative too.

[mitsua]

yes, giving with food. Vet called today -- says fluctuations may be her body getting used to the steroids. Willm ake an assessment after the ACTH tomorrow. Seems unconcerned about the diarrehea as it doesn't occur every day. Every day seems to be different reaction with her. Will post results of ACTH tests when received.

[mitsua]

LDEX Test Results

Can someone please comment.

TIme 1 PRe 2.7 norm is 1.0-4.0
Time 2 Post 4 hr 2.7 norm is 1.0-5.0

Time 3 Post 8hr 1.5 norm is 0.0- 1.4

Vet said she has pituitary dependent cushings based on these #s. We just did ACTH stim test today.