Joined Today (Orlando has passed)

[lalosmom]

I read the link about Dechra's new dosing guidelines, but suspect that my vet is going to start Orlando on a higher dose, probably the 120 mgs. He weighs 75 lbs. When I went to the Dechra website, which is very informative as well, they still had dosing guidelines which indicated that 1-3 mg per lb were okay. Should I be concerned about a higher dose? She also wants him to take some powdered form of herbals, which will never work as he is difficult to pill as it is...and they will cost another $100 per month. I am resolved to give him the Vetoryl and will order from one of your sources this week.

[Harley PoMMom]

I would be very concerned that the vet wants to start out at 120 mg of Vetoryl for a 75 lb dog. The 1-3 mg per pound is outdated and in that article in black-and-white it states

The new, lower recommended starting dose is 2 mg/kg once daily

because

lower starting doses are efficacious and may reduce the risk of side effects.

I would ask your vet to please contact Dechra directly in order to discuss their new revised starting dose recommendation.

Dechra's U.S. office: http://www.dechra-us.com/Default.aspx?ID=365

Also, I would hold off starting something new when Orlando's Vetoryl treatment begins, if Orlando would have any adverse effects it would be difficult to determine if it's the Vetoryl or something else that is the cause of the side effect/s.

Hugs, Lori

[lalosmom]

I will talk to her about that dosage. If she stands completely firm on that dose, I do have the option of going to the vet who treated my GSD when he had degenerative myelopathy....now deceased. If both agree on the higher dose, would you recommend giving him the pill every other day?

I have all but ruled out the herbals from the point of view of expense and difficulty of administering.....and I know that you can buy empty capsules and fill them, but you raise a very good point about not mixing meds in case of side effects and I agree completely.

[pansywags]

If you're open to seeking a second opinion, you might consider consulting with Dr. Bruyette. If I have your location right, you're close to him and he's one of the leading US Cushing's experts.

http://www.vcahospitals.com/west-los...m-dacvim/28374

[lalosmom]

Thank you so much for that link; I have written down the information and given that this is probably my third Cushing's dog, I should have the name of a local specialist.

I have emailed Dechra's support site as well and called them. Their phones are set up so you have to leave a message.

[Harley PoMMom]

If both agree on the higher dose, would you recommend giving him the pill every other day?

Every-other-day dosing is generally not a good option, at any dose. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a rollercoaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower.

Ideally you want to keep the cortisol controlled more consistently during each day.

Hugs, Lori

[lalosmom]

Thanks....that is very good to know. Nothing has been resolved yet as I am waiting to hear from Dechra as I want to have some information for the vet when I talk to her.

[lalosmom]

Lori
I appreciate your PM and will be happy to post.

I emailed Dechra two days ago and this morning at work found a very polite email asking that I call them. I did so immediately and was very surprised when the person who wrote the email answered and was able to respond. They certainly get kudos for customer service, especially for a non-medical professional.
I told them that I expected that my vet was going to prescribe the 120 mg dose for my 75 lb dog and that on their website I had found dosing instructions which said that between 1-3 mgs/lb was acceptable. I was told that Dechra stands by that information and that they recommend that a dog owner follow the vet's instructions on dosing. They did acknowledge that starting with the lowest possible dose is recommended, but not necessarily insisted upon at the vet's discretion. Very polite and helpful all the way through.
The irony of all this, as I was going to place my order with CPP is that my vet wants Orlando to take 100mg/day. Given that his weight has been higher than it is now, I am willing to consider that dose and take responsibility for authorizing it for his treatment. I do understand the position of the boards on dosing.
So as this saga continues, I did call CPP, also very polite and helpful, but they do not supply that dose and told me to contact a compounding pharmacy. I did email Diamondback and am waiting for a reply....only sent the email a few minutes ago so will not expect pricing from them yet. I also have contacts with WestLabs in Gainesville FL from when I treated my GSD for degenerative myelopathy and have contacted them a well.
The vet wants $149 for the Vetoryl, and while I can afford it, I would like to have a little better price if possible as this could go on for a while....hopefully for Orlando and I.

[labblab]

Hello and here is a very belated "welcome" from me, too!

Thanks so much for relaying the content of your conversation with Dechra's U.S. office. They have been very polite and helpful to many of our members (including myself!), and I am so glad you had a similar experience. However, their response to you regarding the 1-3 mg/lb initial dosing range highlights an emerging "incompatibility" between the published guidelines issued by Dechra U.K. vs. those published here in the U.S.

Just to bore you with a little bit of history , back when I first joined this group in 2003, Vetoryl was a medication manufactured by a British company named Arnolds. Arnolds was subsequently bought by Dechra, and Dechra now has a worldwide presence, including a U.S. headquarters. However, Vetoryl is still made in the U.K. To be legally sold there, Vetoryl must be properly registered with their "VMD" (Veterinary Medicines Directorate). To be legally sold in the U.S., Vetoryl is regulated by the FDA. Both regulatory bodies require their own specific filings and published literature re: medication. Until recently, the published initial dosing recommendations for Vetoryl were similar in both countries. However, last year, the official "Summary of Product Characteristics" for Vetoryl filed in the U.K. was revised to reflect this new initial dosing recommendation:

The starting dose for treatment is approximately 2 mg/kg, [or approx. 1 mg/lb] based on available combinations of capsule sizes.

This is an official recommendation, and can be found here (just enter "Vetoryl" in the "Search" window, then click on the SPC for any dosage strength):

http://www.vmd.defra.gov.uk/ProductI...e/Default.aspx

Likewise, it is this revised recommedation that is discussed in the U.K. publication, "Vetsonline," that we often highlight for our members:

http://www.vetsonline.com/news/produ...r-vetoryl.html

This revised recommendation is based on accumulated worldwide research and experience during the past decade, and reflects the current thinking of the majority of the specialists treating Cushing's here in the U.S. as well as elsewhere. It also reflects experiences we have seen here on our forum during this past decade. Put simply, dogs seem to experience fewer unwanted side effects when they are started at lower doses and adjusted upwards if need be, rather than vice versa.

However, the U.S. Product Insert does not reflect language identical to Dechra's revised "SPC" in the U.K. So the folks in Dechra's U.S. office are obligated to verbally relay the original 1-3 mg/lb dosage range that remains published on the FDA-approved insert. However, as they did with you, I believe they usually make a special point in most conversations to also reinforce a newer sentence that immediately follows the stated range, "Start with the lowest possible dose based on body weight and available combinations of capsule sizes." So in truth, this is the same recommendation as that of the new U.K. revisions: start as closely as possible to the 1mg/lb formula.

I know that the U.S. Dechra office will be very happy to talk about the dosing guidelines and the accompanying research experience in great detail with any vet -- probably in even greater detail than they will normally discuss with an owner. So for any U.S. vet who has questions about the appropriateness of starting with a lower rather than a higher dose, I'd encourage the vet to call Dechra directly in order to discuss whether there are individual factors at play that make a higher dose more desirable for any given dog.

Kudos to you for calling Dechra yourself, though, and I hope that the 100 mg. dose will turn out to be just right for Orlando. But I hope that what I've written above will give you and our other members a better understanding of our reasoning when we advocate for lower starting doses. My personal opinion is that the simplified U.K. literature more accurately represents the current dosing trends followed by most Cushing's experts, and I hope the U.S. literature follows suit before long.

Marianne

[lalosmom]

Marianne
Thank you so much for taking the time to explain and for including the link. I did go to it and read the 6 page document carefully. There is a lot of good information there, really an encapsulation of what vetoryl does and what to be aware of. I will certainly refer to it if needed.
I am going to have my vet place an order with Diamondback tomorrow. I spoke to two different representatives today at two different times and their price is definitely the lowest I have found and I would not have known about them if I had not joined this group.
As I was reading the literature it cautioned against handling the pills. Orlando is extremely difficult to pill, does not eat anything in his food, does not like pill pockets, etc. He has only used Nutrical to take pills, which means using my hands. Is that small amount of contact okay or should I use gloves? He will not take anything from a spoon either. All my other dogs were trained to use silverware.
I have referred the information to my vet and asked her to review the amount and contact Dechra.