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Managing Cushing’s Syndrome (HyperAdrenocorticism)
with Trilostane (Vetoryl)
There are a number of drugs
that are currently used to manage hyperadrenocorticism. Trilostane has
recently been licensed in the U.S. for this purpose and has proven to be
a very effective drug with lower incidence of side effects than some of
our other options, particularly, Lysodren.
Trilostane treats
hyperadrenocorticism by interfering with the production of cortisol (as
well as other adrenal steroid hormones). Since it does not kill any
adrenal cells (as lysodren does), the effects of the drug are usually
reversible with discontinuation or reduction in dosage.
What are the side effects
of Trilostane:
Some patients may exhibit
reduced appetite and lethargy after treatment with this drug. If
complete loss of appetite, vomiting, diarrhea and/or weakness occurs, it
may be signs of over dosage and you should bring your pet in for
evaluation.
In rare cases (1 in 50
patients), this drug can cause destruction of the adrenal gland and
force the pet to develop Addison’s syndrome (hypoAdrenocorticism).
If this should occur, the patient will need supportive care and
medications to re-supply the body with the hormones no longer being
supplied by the adrenal glands. While most pets, will regain adrenal
function in a few weeks, some may not and may require lifelong therapy.
How long will it take for
Cushing’s symptoms to improve?
In most dogs, the heavy
thirst and urination and panting aspect of Cushing’s will improve within
7 to 28 weeks. The heavy appetite will usually normalize within 3
months. Chronic skin changes may take up to a year to improve.
How do we monitor the
effectiveness of this drug?
10 days after starting the
drug we will perform the following:
- Physical Examination
- Serum Biochemical
Profile
- ACTH stimulation test (4
hours after morning pill)
Our goal for therapy is to
obtain a cortisol level between 2 and 7 ug/dl from the ACTH stimulation
test. If the results of the test are lower than this, we will most
likely stop the drug for a week and restart it at a lower dose (25 –50%
lower). This may require you obtaining an alternate strength of the
drug as the capsules cannot be split.
We will need to repeat the
ACTH Stimulation test at 6 weeks and at 12 weeks to ensure your
pet’s safety and the effectiveness of the drug.
Once we have your pet
regulated, we will have to repeat the ACTH Stimulation test every 6
months and a biochemical profile once yearly. Due to the potential
danger of this drug if overdosed, refills will not be authorized without
this regimen of testing.
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