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Thread: Question about trilostane side effects

  1. #1
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    Default Question about trilostane side effects

    I just got my dog diagnosed with Cushings but after thinking about it Im pretty sure shes had it for about a year but just didnt develop really obvious signs until the last three months or so. Shes a 12 yr old pitbull. Shes been on 2mg/kg trilostane for a week or so and I can see her potbelly getting smaller and she doesnt drink nearly as much and her energy level is way better than it was. But she generally wont eat her dog food now. Historically shes the type that would eat the whole bag and then some if she was allowed. Im not overly concerned because I know its a common side effect, but when should I expect this to start easing off, or when should I wonder if the dose is too much for her?

  2. #2
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    Default Re: Question about trilostane side effects

    Hi and welcome to you and your sweet girl!

    Could you tell us how much your girl weighs? And when was her last ACTH stimulation test to check her cortisol levels? The ravenous appetite that cushdogs get usually subsides after 2 weeks of treatment but if your girl is off her food entirely, that has me worried. Loss of appetite is one symptom of cortisol dropping too low, is she experiencing any diarrhea, lethargy, or vomiting?

    Could you also tell us which test/s were used to diagnose her Cushing's and would you post those results for us? Is she taking any other herbs/supplements/medications? Did the vet run a CBC/Chemistry blood panel, and if so, could you post those values that are marked abnormal with the reference ranges and units of measurement? Thanks for any additional information you have for us, the more we know the better our feedback can be.

    Hugs, Lori

  3. #3
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    Default Re: Question about trilostane side effects

    Hi,
    Thanks for the reply. I think she is about 60 or 70 lbs. I don’t know what test they used but they had to do one test then wait an hour or two then do the second part so I’m thinking it was ACTH. I don’t know the results just that they said she definitely has Cushing’s. It was a week ago last Wednesday and they sent out the trilostane then and she started it on Thursday. No other supplements now. She had a full blood panel two months ago and the only abnormal reading was that one of her liver enzymes was up a little bit. This was part of what clued me in to the possible Cushing’s since from what I read that can be a common sign. No vomiting or diarrhea that I’m aware of, and her energy is up since she started the meds. Before she would just sleep all day and barely drag herself up long enough to eat. She will eat treats and people food, but not very interested in dog food. She will eat a little sometimes. I’m not giving her any extra treats or people food, just the same that I give the other dogs, because I don’t want her to learn that if she refuses dog food she gets something better. I had a dog before that did this!

  4. #4
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    Default Re: Question about trilostane side effects

    Well this morning she ate a handful of dog food, and just now she had a small meal of dog food. For some reason she likes it better if I put it on the floor she was like that when she was a puppy too for some reason. So maybe it’s just a transient side effect that’s starting to wear off.

  5. #5
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    Default Re: Question about trilostane side effects

    From my math calculation (which could be wrong) the Trilostane dose your dog is taking is 60 mg? If so, than it may be a dose that is too high, it is recommended that a starting dose be no higher than 30 mg, and when larger dogs are concerned this is especially important because from published studies it was found that larger dogs are more sensitive to Trilostane. Here is a link to an article with the published study included: https://drive.google.com/file/d/155a...s5kmGrNmtAjBXA

    Did the vet inform you to give the Trilostane dose with a meal, this is to aid absorption. And when is her next ACTH stimulation test?

    Lori

  6. #6
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    Default Re: Question about trilostane side effects

    Yes your calculation is correct. It’s in liquid form so I can easily adjust the dose. Starting tomorrow I’ll cut it down by half and see how things go. This morning she ate some of her dog food but again, not her normal appetite at all. They said to bring her in for a test in two months, so I don’t want to be giving her too much for that long. All the bottle said was to give it in the morning, but she gets it with her dog food anyway. I wonder is there another thing I can monitor aside from her appetite to determine if she’s getting too much or too little? Her water drinking has gone down to what I would consider normal now and she’s not getting up in the night to go outside, I wonder if I should more closely monitor her drinking since that was one of her main symptoms. Energy level is difficult to monitor because I’m pretty sure she’s had Cushing’s for a long time and her energy level has dropped consistently in the last 6 months, so even though it’s better now it’s difficult to say whether it’s where it should be or not.
    Last edited by Cthorne111; 05-01-2021 at 07:29 AM.

  7. #7
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    Default Re: Question about trilostane side effects

    Proper protocol is to have a ACTH stimulation test performed 2 weeks after starting treatment, however, some vets do forgo this 2 week test when the dog is started at a low dose of Trilostane, which your girl is not. If the 2 week ACTH stimulation test is not done than one is absolutely performed at the one month mark of treatment.

    I'm not a vet, but I've been on this forum for over 10 years so what I post to you is from that experience. When dogs are started out at a high dose of Trilostane, that's when ill side effects are mostly seen. The loss of appetite and her water consumption normalizing so quickly, to me, is a sign that her cortisol may have dropped too low. It usually takes 2 weeks of treatment for that excessive drinking and ravenous appetite to subside so halving her Trilostane dose downward, I believe, is a good idea if you are comfortable doing so. If her appetite doesn't bounce back in a day or two of halving her dose down, than stopping the Trilostane all together and having an ACTH stimulation test would be the next step.

    Hugs, Lori

  8. #8
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    Default Re: Question about trilostane side effects

    Thank you. Yes that is what I’m going to do, starting today I’m halving the dose and we will see what happens with her appetite in a couple of days. How long does it usually take before the pot belly goes away and the muscle weakness starts to improve? She has a hard time getting on the bed or navigating stairs because her back legs don’t have much strength. Will exercise help this get better faster?

  9. #9
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    Default Re: Question about trilostane side effects

    Hi and welcome from us as well!

    Typically once a dog starts to show signs of an overdose you want to stop the med for a few days and let the adrenal glands regenerate. Protocol says 7 days but since you caught this before all the signs were showing I would think a day or two off the med would be fine. Then you start at half, a max of 30mg a day.

    As for when signs improves this is a good explanation from Dr. Edward Feldman from the University of California, Davis once the proper dosage of medication is found:

    Signs resolve in a typical order, with polyphagia (excessive hunger) being the first sign to improve in most dogs. Owners also note that their dogs begin to be more active and pant less, as polydipsia (excessive drinking) and polyuria (excessive peeing) resolve. All these can begin to resolve in just days to a few weeks. Muscle strength and pot belly take longer to resolve and the various skin and hair coat issues may require months. Why is all this important? It has been shown that as these signs resolve, there is parallel improvement in hypertension, susceptibility to infection, proteinuria, and other concerns.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  10. #10
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    Default Re: Question about trilostane side effects

    Thanks. I went ahead with the half dose again this morning and I have to say, she’s acting a lot better than she has in months. She was awake most of the day today, she didn’t have to be prodded to go outside, went out on her own even when she didn’t “need” to. She was her normal food begging self except she was still not totally impressed with her dog food. And maybe it’s my mind but it seems like the hair on her head feels softer than it was. Not normal, but closer to normal. Her hair hasn’t fallen out at all, it just feels like sandpaper. So I’m going to stick with the 30 mg dose for a while and see how things go, as long as her appetite goes back to ‘normal’ within a few days (she’s always been a food greedy dog, so whatever increased appetite she had from Cushing’s wasn’t particularly noticeable). If I don’t see her eating her food normally within a few days I’ll reduce it more but in just two days it seems to be going the right direction.
    Last edited by Cthorne111; 05-03-2021 at 06:04 PM.

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