Claire, I’ve taken the liberty of reposting here a conversation we’re having over on K9C. This way, the folks here will know what we’re discussing re: the Cushing’s side of things. Again, good luck with the vet visit tomorrow! And here’s your question for us Cushing’s people:
And this how I replied:
…This morning is the first time in a week he has down into a normal glue range. He ran above 400 from 5 PM yesterday to 5 AM this morning and suddenly went down. So at least we know he still responds to insulin. Tomorrow we will see the Internist and I think he should check Remy’s cortisol level to see if it’s gone back up above normal or not. He has been off the Vetoryl (trilostane) for about three weeks now. He seems to be very sensitive to it so IF it’s decided he needs to go back on and we know 5 mg is too much for him even every other day, what is the alternative? Mixed opinions on a compounded liquid from what I have read. As far as symptoms, Remy has never had much in the way of Cush symptoms. I’d be very happy for advice here!!
I really do endorse the idea of re-checking Remy’s cortisol. And if the decision is made to restart treatment, I really don’t see how you have a reasonable alternative other than shifting to a compounded product. In general, I personally endorse using brandname Vetoryl if that is “do-able” for the reason given in my quote below. I recently posted this on another member’s thread, so you may have seen it already. But I’ll go ahead and repeat it here.
If Remy’s cortisol is elevated again, then I think turning to compounding is your only viable option — especially as opposed to giving a higher dose on a less than daily basis. As Leslie has discussed earlier, you really want to keep cortisol levels continually as consistent as possible for all Cushpups. But for diabetic dogs, we’ve been told this is especially important. Even to the extent of preferably dosing diabetic dogs twice daily, when that is feasible. Given Remy’s apparent sensitivity to trilostane, once daily dosing probably remains the most likely option. So that would mean less than 5 mg. daily. And that means necessarily switching to a compound.
Even though a compounded liquid would be the easiest route to go, I’m personally not a big fan of trilostane in liquid form. My opinion is not based on any research or professional guidance. But again, over our years here, it just seems to me that we’ve seen more dogs experience unpredictable results on liquid compounds rather than solid compounds of trilostane. Solids do offer far less flexibility. But heck, in Remy’s case you could probably even get an initial batch of compounded pills or capsules in 1 mg. dosages. Presumably a compounder could make it that small. That way you’d have total control over dosage changes. So that’s likely the direction I’d try to go myself if Remy’s cortisol is up again. But again, other folks feel differently about liquids and that would also remain an option.
Definitely good luck tomorrow, and let us know what you find out as soon as you can.
…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. 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, or because their dogs simply won’t take pills in a conventional form. However, the downside is that compounded products are not inspected nor regulated in the same manner as FDA-approved pharmaceutical products, and as Marissa has pointed out above, 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
https://www.k9cushings.com/forum/sho...ushingoid-Dogs
Even though a compounded liquid would be the easiest route to go, I’m personally not a big fan of trilostane in liquid form. My opinion is not based on any research or professional guidance. But again, over our years here, it just seems to me that we’ve seen more dogs experience unpredictable results on liquid compounds rather than solid compounds of trilostane. Solids do offer far less flexibility. But heck, in Remy’s case you could probably even get an initial batch of compounded pills or capsules in 1 mg. dosages. Presumably a compounder could make it that small. That way you’d have total control over dosage changes. So that’s likely the direction I’d try to go myself if Remy’s cortisol is up again. But again, other folks feel differently about liquids and that would also remain an option.
Definitely good luck tomorrow, and let us know what you find out as soon as you can.
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