Newly diagnosed - Any success stories with Tristolane?

[Bamafanroz]

Update on Rexie: He has been on 20 mg dosed once daily with his meal for the day. He started the tristolane 6 days ago. What a difference this medicine has made for all of us! He is sleeping all night and not waking us to potty! He’s running around, playing with his toys and chasing his kitty siblings (they love it and have missed playing with him).

He goes in for his blood testing on Tuesday which will be 13 days from the starting of this medication. I am only seeing positive side effects so far! No lethargy, no poor appetite, etc.

What will vet be looking for with this blood testing? How will we know if he needs to titrations up or down with this medicine? What else should I be looking for or ask my vet about at our next visit?

[Squirt's Mom]

Great news about the improvements so far! As for what the vet will look for - they will, or should, ask you if you are seeing improvements in the signs and which one and how much improvement. The blood work they will do is what will tell them the actual amount of cortisol in Rexie's system and if that is within range, still too high, or too low. Regardless of the number you do NOT want to increase the dose just yet because the cortisol typically continues to fall for the first 30 days on the same dose. If the cortisol is too low, however, then a decrease is required. In some cases if the dog has been started on a VERY conservative dose and the signs are not improving at all plus the test shows the cortisol is still too high then it is ok to increase by a small margin. In general increases should be around 25% of the previous dose....never doubled. So what you are looking for this test is a decrease in the cortisol since you say the signs are improving. Keep an eye out for the negative signs but it sounds like you and Rexie are off to a great start!

Hugs,
Leslie

[Bamafanroz]

Thanks for the reply! I did not realize that his cortisol level could still go too low at this dose without an increase so thanks so much for sharing! I will be vigilant for signs of adverse events. What are the first symptoms I should notice?

[Joan2517]

Lethargy, vomiting, diarrhea, refusing to eat or drink....

[labblab]

Hi again from me! Just wanted to add a couple more thoughts, too. First, I want to clarify Rex’s dosage. When you first wrote, you said he’d be getting 10 mg. a day, but now you’re mentioning 20 mg.? Given his weight of approx. 17 pounds, 20 mg. is still an appropriate starting dose, but I just want to make sure if that’s really where we’re at.

Also, if Rex is being given an ACTH stimulation test next week to monitor his cortisol level, it’s important that he be given his morning dose of trilostane along with breakfast, as usual. He should not be fasted before taking the test. This is because trilostane needs to be given along with food in order to be metabolized properly. If not, the monitoring test may falsely indicate that his cortisol is running higher than usual. As Leslie has written, dosing increases are usually not made until after 30 days, regardless. But with every monitoring test, we want the results to be as accurate as possible.

Here’s a link to a publication printed by Dechra, maker of brand name Vetoryl. At the bottom, you’ll see a flowchart that shows you how dosing decisions are made based on monitoring ACTH tests. I think this info may be helpful.

http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf

Continued good luck, and keep up the good work!
Marianne

[Bamafanroz]

Hi Marianne,

I was mistaken about the 10mg dosage. The capsules were supplied in 10mg dosage and once I received them, the instructions read to start with 2 capsules once daily with full breakfast - so ended up being a 20 mg total dose each morning.

He’s still doing well. No negative side effects.

My next question is will this medicine help improve the abnormal liver enzymes and proteinuria improve with reducing the cortisol level?

[labblab]

Thanks so much for clarifying the dosage. As noted earlier, 20 mg. is still a reasonable starting dose for a dog weighing 17 pounds. And the fact that Rex continues to be doing well is an excellent indicator.

As far as the proteinuria and elevated liver enzymes, yes, we’ll be hoping to see improvement in both areas but it may take some time. As far as the liver enzymes, our experience here is that liver numbers do improve with treatment although they may never totally return to “normal” lab ranges. However, functionally, that doesn’t pose a great worry.

If elevated cortisol is the root cause of the proteinuria, then yes, we’ll also hope for improvement with trilostane treatment. If the proteinuria remains persistently elevated, however, your vet may well add in some additional treatments: an ACE inhibitor such as enalapril or benazepril, Omega 3 fatty acid supplements, and moderate restriction of dietary protein intake. Here’s a link to an IDEXX laboratory publication that discusses diagnosis and treatment of proteinuria, in general. You’ll see that the first and most important step, however, is treating the underlying cause of the proteinuria if that can be determined. So in Rex’s case, you’re doing exactly that with the trilostane.

https://www.idexx.com/files/proteinuria-dx-update.pdf

Marianne

[Bamafanroz]

So I took Rexie in for his ACTH Stimulant testing and electrolytes today. I’ll have results tomorrow and will share with you.

Clinically he’s doing well. No lethargy, or negative side effects. He’s drinking and pot tying less, too.

If he’s doing well....... should the dose be changed at this point? And what questions should I ask Vet to understand how best to manage this going forward. The bloodwork cost $305 today and he needs this testing repeated again in 2 weeks. Then 60 days, then every 90 days and more often again if dosing is changed at any point. Sigh.

Does this sound correct?

[Harley PoMMom]

So I took Rexie in for his ACTH Stimulant testing and electrolytes today. I’ll have results tomorrow and will share with you.

Clinically he’s doing well. No lethargy, or negative side effects. He’s drinking and pot tying less, too.

Glad he is doing well on treatment and we will be waiting anxiously with you for those test results!

If he’s doing well....... should the dose be changed at this point?

It is recommended that no dosage increase be done until the dog has been on Trilostane for 30 days, this is because cortisol can continue to drift downwards during the first 30 days of treatment, so if Rex is doing well on his current dosage than it shouldn't be adjusted. Now, if he would start showing signs of cortisol dropping too low than lowering the dosage is warranted.

The bloodwork cost $305 today and he needs this testing repeated again in 2 weeks. Then 60 days, then every 90 days and more often again if dosing is changed at any point. Sigh.

Does this sound correct?

Yes, Rex's cortisol will need to be tested again as you have stated. I also want to include a couple links from our helpful Resource Forum where you will find information about Trilostane/Vetoryl, particularly this thread titled: Cost Savings for Owners of Cushingoid Dogs AND Trilostane/Vetoryl Information and Resources

Lori

[Squirt's Mom]

Did Rexie's result make it in yet?