new here TRILOSTANE question

[bluejaysmon]

Thank you all for having me. I recently joined and have an 8ye old shepard on trilostane.
I have been followig these threads for ahwile and I will post more later but I ahve one question Im hoping to have advice on.
Trilostane seems very toxic to humans and I ahve read what it can do.

Bluejay is very unwilling to take it no matter what special treats I use and I ahve been advised to open the capsule and sprinkle it on her food whilst wearing masks and gloves. I must say I am firghtened of this. We have only been on trilostane for a week . Do any of you have any experience with this? Can I get sick from touching it?

One day last week Blue jay bit into the treat and the pill puffed opne, I inhaled a tiny bit and a speck got into one eye and immediatley ran inside and showered rinsed my eyes out like crazy and cleaned off but I did not seek medical help as i had no after effects. I did not know then the toxicity of this drug and now I am wondering if I am at risk. That was 4 days ago and I feel fine but when I mentioned it to my vet they said i might want to see a doctor. I have not felt in any way unwell and I have not touched the pills as I have been wearing gloves.

This drug was taken off the market for humans for all the side effects, how have you all fared with this and does it help?

How do you give it? tricks for treats? Do you open it?

Bluejay has comorbid illness-hypothyroidism and cushing and calcinosis cutis.

I am well veresed in cc, been dealing with it and hypothyroid for months. Cushings diaganosis came last week, hence the trilostane

thank you all in advance, I know I sound a bit overly concerned so thank you for your patience.
Bluejays mon

[bluejaysmon]

I also want to mention the bluejay has done well for over a month on the thyroxine. Her calcinosis is resolving in most of her and she has not had any lethargy etc . She will eat almost anything but regular dog food.

[labblab]

Hello and welcome to you and Bluejay! Before addressing anything else, I want to warn you *against* opening the trilostane capsules and sprinkling the powder — not only for your own health, but also for Bluejay’s. If your vet recommended that you do this, I am quite disturbed. Dechra, the maker of brandname Vetoryl, is adamant that the capsules not be opened nor the powder released. Their written warnings are found on all their literature and packaging, and I’ve had this information verbally confirmed via telephone conversations with their technical reps. The loose powder can be irritating, plus the active ingredient in powder form may not be metabolized properly if it does not remain encapsulated while it is swallowed and travels down the GI tract.

In terms of human risks of exposure, it seems that aside from skin irritation, the greatest risk is to women who are pregnant or trying to become pregnant. Trilostane has been associated with embryonic abnormalities and miscarriage in lab animals. Unless you’re pregnant, I shouldn’t think that your own minimal exposure would account for any worry. But consistent handling of the powder with associated exposure through the skin or inhalation should be avoided, even if giving the powder to Bluejay was a good idea in the first place — which it is not!

If you truly can’t get her to take the capsule while hidden in a treat (peanut butter, soft cheese, liverwurst, “pill pockets” are among the things other folks here have tried), then you may want to consider trying a compounded version of trilostane if you live in a country that permits it. “Compounding” involves altering the delivery system for the active chemical ingredient if the brand version comes in a form or dose that isn’t suitable for a particular patient. Compounding pharmacies here in the U.S. can prepare trilostane in a liquid suspension or flavored chewable tablets, for instance. If a dog can tolerate brandname Vetoryl and it’s affordable for the owner, I tend to recommend it as the best choice because some studies have shown that some compounded alternatives are not as dependable in terms of dosage accuracy and effectiveness. But if Bluejay simply refuses the capsules, then a compounded alternative may be your best bet. We can talk more about your options if this is something you want to consider.

But first and foremost, no, please don’t open up those capsules!
Marianne

[bluejaysmon]

Marianne,

Thank you so much! I did not open them and was also quite surprised the vet suggested that and I truly thank you for your words. Everything I read was a no and I know there are reasons for warnings on labels. Then I thought maybe I should be more open, then I thought no! Everything about this is new so I am looking for experienced folks, and bluejay and I are so happy to have found you. I wonder if the pills are making her sick and that is why she refuses them as she did fine with her antibiotics and thyroxine and trilostane is also a small pill. She still has calcinosis and has been ailing for a few months now and has been through biopsies, blood work and we only recently moved over 2000 miles to our new home. She was not ill when we moved, had excellent blood work back in January so this all came on so fast it has winded and saddened us and we live rurally with few vets so each trip to the new vet is along ordeal. I just don't want to put her through more and force the pills down her. I would love any suggestions. Liquid trilostane was priced to us at 500.00 a month, is that normal? thank you thank you patricia

[labblab]

Yikes, $500 a month sounds really expensive to me. Can you tell us how much Bluejay weighs, and also what dose of trilostane has been prescribed? Current recommendations are to start with a dose that does not exceed a formula of 1 mg. per pound. So it’s hard for me to imagine she’d be starting on a dose that would work out to be this expensive. But let’s see what’s been prescribed for her.

Also, would the vet be supplying the liquid him/herself? If so, that could account for the high price if they are somehow preparing the solution on their own. Compounding pharmacies typically charge less, sometimes significantly less, for their trilostane products than brandname Vetoryl would cost. But a prescription is always required, and some vets are reluctant to approve compounded products from out-of-state pharmacies for their patients. To read more about the related issues and pros-and-cons, take a look at this thread on our Resources forum. As you scroll down, you’ll see a section about compounding pharmacies, as well as links to a couple of pharmacies that members have recommended to us. You can do a price comparison based on the links you’ll find there.

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

I’m so sorry you’ve had to deal with so much during this year that’s proving to be such a worldwide challenge in so many ways. A move is daunting all by itself, but having a sick doggie has got to make it doubly difficult. Good for you for working so hard to make things right for Bluejay during such a tough time!! Anyway, take a look at that thread, and then we can talk some more.

Marianne

[bluejaysmon]

Hi Marianne, Bluejay is 63 pounds and is on once a day 60mg . I would give her the liquid and believe me, there is nothing I wouldn't do for my beautiful blue (or my boy joe). Bluejay came to me as a young puppy with an injured hip cause someone left her in the woods around my home and I found her. She was smiling and she still is but she is sad and tired and we are filling her with love and good food but I wonder if these meds are harming more. I imagine all of us will ill furries feel this Love to all

[bluejaysmon]

Her cortisol level at her ACHT test was 30

[labblab]

Did you see the links to the compounding pharmacies that are embedded in the thread I directed you to earlier? If so, you’ll see that CareFirst Pharmacy was offering a month’s worth of liquid suspension for a daily dose of 60 mg. for only about $60. Definitely a far cry from $500!! That pricing is at least a year old, so you’d need to check for current pricing. But what a big difference. You’ll see they also offer flavored chewable tablets. I’ve never used this pharmacy myself, so I can’t offer any personal feedback. But we’ve heard positive recommendations from others. Plus, there are other compounding pharmacy options you can consider.

One thing I want to mention is that at least one set of researchers are suggesting that the 1 mg. per pound formula may be too much medication for many larger dogs. For whatever reason, heavier dogs may not need as much trilostane, per pound, as smaller dogs in order to effectively control cortisol. I do know that Calcinosis Cutis can be a huge challenge to overcome, and that vets may wish to keep cortisol levels for dogs with CC under even tighter control than otherwise might be the case. So it may be the case that Bluejay may end up needing the full 60 mg., or even more, to keep her cortisol in line. But especially if you do opt for a liquid suspension or a chewable that can be safely divided, you may want to discuss starting off with a lower dose for at least the first couple of weeks. Once you have a chance to see how she responds, both externally and also in terms of monitoring bloodwork, you can better judge whether the full 60 mg. seems reasonable. She may also end up feeling better in the process if her cortisol level is brought down more gradually. Just a thought.

Marianne