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Thread: Liquid compound trilostane

  1. #1
    Join Date
    Mar 2024
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    Exclamation Liquid compound trilostane

    I have a 9 lb Maltese, now more like 10 lbs. Who started vetoryl a year ago. He was very hard to diagnose with Cushing's. Around 4 years ago, it was suspected he had Cushing's but the tests weren't confirming this. So his symptoms (panting and bloated belly) were ruled as normal per the vet and his high liver enzymes were ruled as a separate condition. Later on his symptoms became worse (appetite was overwhelmingly growing) and he went through another set of tests at a bigger animal hospital, which also came back negative for Cushing's. Because the vet had no doubt that my Sammy has Cushing's , they did another test , testing for all hormone levels, which confirmed he did have Cushing's. Finally his treatment started with Vetoryl and Enalapril (because of high proteinuria) and he gets his ACTH tests. The last one in December showed he had stabilized at 10 mg twice daily. The proteinuria was not resolving so he was switched to Semintra in January. Because costs were racking up, I switched from vetoryl to compounded trilostane in January as well and in these past two months , my Sammy has lost all his body hair and his belly looks more bloated than ever. He also has thinner skin on his belly and some patches. His vet is on vacation and I cannot see her until 3 weeks. I don't know if i should go to the emergency room. Should I make a change to his medication on my own? The problem with Vetoryl was that Sammy will not take pills no matter what. Every methodyou can suggest, Ive already tried. when he was taking the vetoryl i was actually opening the capsules myself to pour into his food. I knew this wasn't ideal so I opted for the compound liquid through Chewy, but now it doesn't seem to be working because all these new symptoms are appearing for him. On the vetoryl, his other symptoms were always present (strong appetite, panting, bloated belly) but he had all his hair and was at a normal weight. All of a sudden these changes scare me and I dont want to make it worse. Please advise me. Note : Sammy also suffers from recurrent bladder stones ( CaOx) and eats Royal Canin S/O diet. I try to stay away from giving him any food high in oxalate. He also takes denamarin (for years he has taken this, but his liver enzymes have never gotten better) and potassium citrat (for stone prevention), melatonin, Zyrtec, and Semintra (recently started)

  2. #2
    Join Date
    Jan 2024
    Posts
    5

    Default Re: Liquid compound trilostane

    Hi,

    Three different vets told me that liquid compounded trilostane was not a good idea because the amounts vary and you never know what does your pup is actually getting. I like to further research things myself, and found an article titled "Pharmaceutical evaluation of compounded trilostane products" by Audrey K Cook, Cornelia D Nieuwoudt, Susan L Longhofer, dated May 2012. The basic finding was this: "...findings indicate that trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product. The use of compounded trilostane products may therefore negatively impact the management of dogs with hyperadrenocorticism." I am trialing a bottle of CushAway which was created by the Univ. of Tenn's college of vet medicine to see if that plus vetoryl will help my baby. She's only been on it for 2 weeks and won't have blood work for another so I can't honestly say if it's making a difference. The website says, "Trilostane (Vetoryl) works in a similar fashion to CushAway in that it disrupts the chemical process through which cortisol is made. Research indicates that the active ingredients in CushAway, phosphatidylserine, melatonin and HMR lignans, reduce the production of corticosteroids or help rapidly deplete them. Using just CushAway alone may be enough to achieve the desired effect in borderline and mild cases of Cushing’s disease and in more severe cases may be able to reduce your dependence on, or dosage of, Trilostane (Vetoryl). A 1999 Journal of the American Veterinary Medical Association study of internists and dermatologists revealed that more than 50% of board-certified specialists would not treat a dog that has no signs or only minimal clinical signs consistent with Cushing’s disease even if testing indicated they had the disease. The overriding reason for this was concern over an Addisonian crisis reaction or other negative side effects, especially in older dogs. CushAway’s active all-natural ingredients carry a lower risk of serious side effects than either trilostane or mitotane. As with any nutritional product or supplement, always consult your veterinarian before using CushAway along with other medications or treatments." But I saw your pup doesn't like pills and I'm not sure if it can be crushed. I'm also trialing PetWellness Milk Thistle and Adrenal Harmony Gold. Again, no idea if either is working and not sure if you've tried any of these.

  3. #3
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,037

    Default Re: Liquid compound trilostane

    Hi and welcome to you and Sammy!

    Could you do us a favor and round up copies of all tests that were done and post any abnormal values, also we are very interested in the tests that were performed to diagnose the Cushing's.

    Compounded Trilostane isn't recommended, however cost can be a factor when using brand-name Vetoryl so finding a reputable compounding pharmacy is key when going this way.

    I don't think increasing the dose would be advised without performing an ACTH stimulation test to check where his cortisol level is. Is Sammy eating and drinking normally, any diarrhea or vomiting?

    Hugs, Lori

  4. #4
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: Liquid compound trilostane

    Hello and welcome from me, too! Like Lori, I’ll be anxious to see any diagnostic or abnormal test results that you care to share with us. It sounds as though Sammy’s situation may be somewhat complicated, so it’ll help us a lot if we can get a better picture re: the testing that’s been done so far.

    As far as the liquid trilostane, over our years here, I think there are few issues that have generated more discussion than the question of brandname meds vs. compounded alternatives. People have had, and probably continue to have, differing opinions. I’ve certainly come to appreciate the fact that compounded trilostane can be a positive game-changer for folks, either because their dogs need doses that aren’t available in brand form, or because the high cost of Vetoryl would make treatment a huge financial burden, or because their dogs simply won’t take pills in a conventional form. However, the downside is that compounded products are not inspected nor regulated in the same manner as FDA-approved pharmaceutical products, and as Marissa has pointed out above, some past studies have shown some dosage/efficacy irregularities in certain compounded trilostane products. So that remains somewhat of a worry to me. And for this reason, I think the reputation of any given compounder is especially important to investigate. On the thread below, we give people some tips in that regard:

    https://www.k9cushings.com/forum/sho...ushingoid-Dogs

    I haven’t checked to see whether Chewy’s pharmacy is included as a recommended provider, although I would assume — hope! — they are. Regardless, the changes in Sammy’s appearance since making the change would be a concern to me, too. I agree with Lori that, for safety’s sake, you shouldn’t increase the dose without testing. But maybe we can help with some more brain-storming once we get a better picture re: Sammy’s previous testing history.

    In the meantime, once again I want to welcome both you and Sammy.
    Marianne

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