Over our years here, I think there are few issues that have generated more discussion than the question of brandname meds vs. compounded alternatives. People have had, and probably continue to have, differing opinions. For what it’s worth, here are my own thoughts. I’ve certainly come to appreciate the fact that compounded trilostane can be a positive game-changer for folks, either because their dogs need doses that aren’t available in brand form, or because the high cost of Vetoryl would make treatment a huge financial burden. However, the downside is that compounded products are not inspected nor regulated in the same manner as FDA-approved pharmaceutical products, and some past studies have shown some dosage/efficacy irregularities in certain compounded trilostane products. So that remains somewhat of a worry to me. And for this reason, I think the reputation of any given compounder is especially important to investigate. On the thread below, we give people some tips in that regard:

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

Just as you have done with Reggie, my own personal preference would be to start off with brandname Vetoryl if the dose and cost is something my dog and I could handle. I would just have greater confidence about the consistency of the dose and efficacy. Once my dog became stabilized on a dose, that would be the time I’d feel more comfortable about trying a switch to a compounded version if the ongoing cost of Vetoryl is too burdensome since, at that point, I’d have the results of the Vetoryl with which to compare.

If you do end up sticking with Vetoryl, however, one other cost-saving possibility might be to give unequal twice daily doses. For instance, if Reggie hypothetically ultimately ended up with a 90 mg. daily total, one option might be to give one 60 mg. in the morning and one 30 mg. capsule in the evening. In a situation where the doses are unequal, the maker of Vetoryl recommends giving the larger dose of the two in the morning. Your internist might not be in favor of unequal dosing at all, and instead be more in favor of a compounded equal dose. But I just thought I’d mention it as yet one other option depending upon the total daily dose you ultimately end up with.

Marianne