Trilostane dosage and initial responses?

[Callie's mom]

Thank you to all the knowledgeable people here, I have been reading threads for the last 2 weeks trying to get educated, prior to registering.

My 11 year old boxer, Callie was recently diagnosed with Cushing's after blood and urine lab by my Vet and then an ultrasound and DDST by a specialist. She was put on liquid trilostane from Diamondback beginning last Tuesday. She will see the specialist this coming Wednesday for her first ACTH.

Firstly, I was wondering how high or low her initial dosage is? I'm having trouble relating her liquid dose to the mg of Vetoryl that people talk about. She is 70 lbs and is getting .5 ml twice a day, so 1 ml a day. The bottle says 60mg, but I don't know if that refers to the total contents of the bottle or her daily dose? I see that Vetoryl comes in 10, 30 and 60 mg. Is her dose particularly high, low, or average?

Secondly, I'm trying to assess her response prior to her testing this next Wednesday. From last Tuesday night through Thursday, I saw no response and did not expect to as I have read it can take weeks, even months for the medicine to have optimum results. To my surprise, I started seeing differences on Friday. From Friday to today she seems less panting and probably less thirst and urination, but this is hard to assess because she is even more tired and lethargic (possibly less wanting to bother to get up to drink and pee) than she had been. She also seems very spacy, hard to get her attention. I know I've read of them getting "depressed" on the medicine and don't know if this is what it is. I certainly had hoped that eventually she would become more energetic than before and not less. She is either very tired or possible sore and/or weak. I have told she is arthritic and have read about the cortisol masking this.

Could anyone address what you think about her dosage level and her initial medicine responses? Thanks in advance

Callie's Mom

[celeste]

Hi Callie's Mom
I am very new to this site as well. But I can tell you, you could not have found a better place to be. These loving people are so supportive, it's like having you own personal vet/psychiatrist/ best friend available to you 24/7'. Although I am in no position to give you any answers, I would like to just say hi. My Frankie is an 11 yr old, 90# boxer boy. He was just officially diagnosed Thursday. I started him on 60 mgs of Trilo capsule Friday. I will transistion to 90 mg Tuesday. The first day after his initial dose, I wanted so bad to see a difference, that I perhaps influenced my brain to see something that I know now wasn't really there. From what I have read from these loving people here, some dogs respond quickly, others not so much. Maybe the bigger the dog the longer it takes? Don't know. I am impatient as well, as it is so hard to see out beloved pups suffer. Frankie's panting is driving me insane. He is restless, yet tired at the same time, and at night he seems to pace alot. But I try very hard to repeat what my Mom used to say: This too shall pass. Not much consolation I know. The experts here will fill you in on so much, more than your vet will. And to be armed with so much knowledge, gives you great power. I love my boxer boy so much, he has had a lifetime of illnesses, and I really feel if I hadn't rescued him he would not be here today. And....the love he has given me, well, I would not have known. And what a loss that would have been for me. I hope your Callie gets better soon and stay strong.
Celeste

[Callie's mom]

Yes, I saw of your 11 yr old boxer boy prior to posting this morning. I can attest to your praising of this forum as I have been using it to learn for a few weeks and fortunately from this, know where my vet is going before she gets there. Sounds like you have been a Godsend to your dog, bless you for that. Been with boxers for 56 years, they RULE

[addy]

Hi and Welcome,

My pup was on liquid antibiotic so I checked his bottle. On that label it states 25mg-1ml. Your bottle says 60mgs. I am not 100% positive but I think you are dosing at 30 mgs twice a day which is under the 1 mg per pound recommendation, that is good news. It would seem to be per your bottle 60mgs-1ml but, again, I am not 100% positive.

If I am wrong, hopefully, someone will correct me

You can always ring up the vet tomorrow morning to double check the dosage. Never be afraid to ask your vet any questions. You are the best advocate for your dog.

[Callie's mom]

Thanks for the info, very helpful, that must mean that 1 ml is 60 mg, this is not written on the bottle, which would have been helpful. As far as I've learned that would be an average dose. I'm concerned because she seems to be getting too weak in her hind legs. She is slipping on my wood floors trying to sit up. Think I'll call the vet first thing in the morning, I'm worried maybe she needs less medicine.

[StarDeb55]

Welcome to you & Callie! Addy is spot on about the dosage you are giving. 60 mg /1ml of medication, since you're giving 0.5 ml twice daily, each dose should be 30 mg.

Debbie

[molly muffin]

Hi and welcome to the forum. I agree that contacting your vet is a good idea.

I am always a bit leery of the liquid trilostane as for some reason it does seem to be that dogs can get too large of a dose. Maybe go ahead and schedule your follow up ACTH test too.

Sharlene and Molly muffin.

[Callie's mom]

Thanks, my first ACTH is already scheduled for Wednesday, 8 days after first dose, I think today could be too early? I'm trying to figure out if the huge increase in her lethargy and not wanting to do anything but eat and then go back to laying sleeping is because of arthritic pain now intense as the trilostane has cut her cortisol or something else, and if it is arthritic pain, can Adequan or something else help the situation, someone here has said Rimadyl is not an option. Going to skip breakfast dose of trilostane until Vet opens and can talk to them.. .It is awful thinking that what I'm intentionally slipping into her food, unbeknownst to her, is seemingly so detrimental to her. Her quality of life was much better prior to the trilostane kicking in.

[Callie's mom]

I've just read elsewhere on this forum that dogs can have a radical kind of crash from cortisol withdrawal and wondering if that's what my dog is experiencing? Logic indicates a tad less dose of trilostane? Wouldn't a little less trilostane reduce the cortisol a little less to ease the crash? Also she had been on daily cosaqin which I withdrew just thinking something less would complicate things less, now I'm thinking that was a mistake and I should start giving her that again?

[labblab]

Good morning, and I'm sorry you and Callie are having a rough time of it right now. Yes, if it were me, I'd probably restart the cosequin. I'm unaware of any interaction between it and trilostane. And also yes, if arthritis is the culprit, there are some other interventions that can be tried, as well.

It could well be that Callie is suffering side effects from rapidly dropping cortisol and lowering the dose -- even if only temporarily -- may ease her discomfort. But it is definitely best to consult with your vet this morning. I also would want to definitely reconfirm the medication dose. Logic would imply that the 1 ml. amount equals 60 mg. But since the bottle doesn't explicitly state that, I suppose there is an outside chance that the stated 60 mg. amount equals one single 0.5 ml dose, and she is actually getting 120 mg. daily. According to the (unfortunately outdated) dosing chart included in Dechra's published Product Data Sheet, 120 mg. is the recommended starting dose for a dog of Callie's weight. So it is possible that she has been started off on that higher dose. I would reconfirm the actual dose with both the vet and also with Diamondback, just to make sure that there has been no confusion between them. The folks at Diamondback are very nice, and it would actually be helpful to alert them that more complete dosing info printed on the bottle or on an insert would be beneficial to an owner. When you talk to Diamondback, also confirm whether you need to handle the liquid med in any special way: do you need to shake it up before dosing to make sure the trilostane is evenly distributed, should it be refrigerated, are there any warning signs that the liquid may be going bad (like crystallization of the contents), etc.

Please do let is know what you find out and what you and your vet decide to do. Also, when you are able, it would be great if you can get your hands on the actual numbers and written summaries associated with Callie's diagnostic tests. That will give us a frame of reference for moving forward.

Marianne