Hello, and welcome to you and Lucy! I surely understand how worried you are about your girl, and I’ll return again a bit later on to add some more thoughts. However, I wanted to quickly address your dosing question before you increase Lucy’s dose to 120 mg. for your daily total. You are correct that several prominent researchers/clinicians recommend administering a daily total less than the formula of 1mg. per pound for larger dogs. I’m including below a couple of links for you to review. The first is to a general resource thread re: Vetoryl treatment. Embedded within that thread you’ll find the quote that I’ve added below, as well as a link that specifically addresses the administration of smaller doses to larger dogs.

I do realize that Calcinosis cutis can become a grave treatment issue if it flares out of control, and for that reason, significant reduction of circulating cortisol is an important goal. I’m so sorry to see your photos of Lucy’s skin problem and to recognize the discomfort it must bring to her. However, *over* suppression of cortisol is also a very serious concern. If Lucy were my own dog, I believe I would want to ask the vet to hold off on the dosing increase at least until the first cortisol monitoring test is performed, ideally at the two-week mark but no later than the one month mark. We’ve come to learn that cortisol levels can continue to drift downward throughout the first 30 days of treatment, even when the dose is left unchanged. So before increasing her dose further, I’d first want to know how the 60 mg. dose is affecting her.

But please do review this information on your own, and feel free to ask additional questions. As I say, I’ll also plan to stop back by later on. In the meantime, once again, welcome to you and Lucy!

https://www.k9cushings.com/forum/sho...TH-Stimulation

FOR MEMBERS WITH LARGER DOGS, studies, as well as the vast amount of experience with Vetoryl acquired since FDA approval, clearly shows that many larger dogs over 44 lbs (20 kg) are quite sensitive to the drug, requiring much smaller Vetoryl (trilostane) doses. UC Davis, as well as other premier veterinary teaching institutions, have established their own much lower dosing protocol for their larger patients. If you have a larger dog, please see “Vetoryl (trilostane) – Larger Dogs Smaller Doses” link can be found at the bottom of the page. This is very important because most general practice vets are not aware of this critical development and unfortunately, Dechra has not revised their dosing recommendations for larger dogs as of this writing.
https://www.k9cushings.com/forum/att...1&d=1659215316

Marianne