Vetoryl
Disclaimer: This site has been created by www.MedicAnimal.com for information purposes only. MedicAnimal is a proud retailer of Vetoryl but is not affiliated with or related to the manufacturer of Vetoryl and the contents of this site are neither sponsored or endorsed by the manufacturer of Vetoryl.
Introduction
Cushing’s Disease: Understanding the diagnosis and management with trilostane
What is Cushing’s?
Cushing’s Disease refers to the overproduction of a hormone called cortisol over a long period of time. Cortisol is an important hormone that helps to regulate the body’s metabolism and it’s response to stress. Cortisol is produced by two small glands called the adrenal glands, located behind each kidney. The production of cortisol by the adrenal glands is controlled by another hormone called ACTH, which is produced by the pituitary gland in the brain. When more cortisol is required the pituitary gland increases its production of ACTH, the ACTH then acts to stimulate the adrenal glands to produce more cortisol. When less cortisol is needed less ACTH will be produced by the pituitary, and cortisol production by the adrenals will reduce also.
Animals with Cushing’s Disease will produce too much cortisol over a long period of time. This can be due to either:
- A benign tumour in the pituitary gland: this causes the pituitary gland to produce too much ACTH, which in turn means too much cortisol will be produced by the adrenals. This is the more common form of Cushing’s Disease.
- A tumour in the adrenal gland itself, causing the glad to produce too much cortisol.
If too much cortisol is produced over a long period of time the dog will slowly develop the signs of Cushing’s Disease. Without treatment your dog also runs the risk of developing other serious medical conditions such as diabetes, blood clots in the lungs, inflammation of the pancreas, kidney or lower urinary tract infections.
What are the signs of Cushing’s Disease?
Cushing’s Disease is most common in older dogs and is more often seen in small breeds. The symptoms may include some or all of the following:
- Hair loss
- A pot belly
- Frequent drinking / increased water consumption
- Frequent urination
- Ravenous appetite
- Thin skin
- Muscle wastage
- Excessive panting
- Behavioural changes.
If you are concerned that your dog is showing some or all of these signs it is recommended that you contact your vet immediately.
How is it diagnosed?
Diagnosis can be complicated. Often more than one series of blood tests will be required and your dog may need to stay at the vet clinic for a few hours or for the day. The way that the diagnosis is achieved will depend on factors specific to your dog and your vet will talk you through the process in detail.
Can it be cured?
Unfortunately Cushing’s Disease cannot be cured, but it can be managed successfully with medication and monitoring. Cushing’s Disease is often treated with a drug called trilostane. Trilostane is a daily medication that is used to block the production of cortisol by the adrenal glands.
Once the diagnosis is confirmed your dog can begin on treatment. Dogs that are to begin Trilostane therapy are usually started on the recommended average dose for their bodyweight. A follow-up test 10 days after starting treatment is necessary to see whether the dose needs to be adjusted at all to suit your dog’s particular needs. Most dogs continue to have these follow up blood tests (called ACTH stimulation tests) frequently until they have been stabilised on a dose that is providing good control of the symptoms of Cushing’s Disease and of their cortisol levels . From that point onwards it is recommended that your dog continue to have regular tests at approximately 3 monthly intervals to ensure the dose is still “just right”.
Frequently Asked Questions about Trilostane
Does Trilostane have to be given every day?
Yes. Trilostane is a short-acting drug, so it must be given daily.
What should I do if I forget a dose?
Check with your vet. NEVER give a double dose of Trilostane.
Does my dog need to be on this treatment for life?
Yes. In order to successfully manage the condition your dog will require permanent daily treatment.
How long will it take before I see signs that my dog is improving?
Some symptoms, such as frequent urination and excessive drinking, will improve rapidly. Other symptoms including hair loss and pot belly may be slower to improve.
Are there any side effects of Trilostane?
Trilostane is generally well tolerated by dogs, but if you notice any new signs of illness whilst your dog is on treatment contact your vet immediately. Particular vigilance is warranted during the early stages of treatment, and in the period immediately following a change in dose. Important signs to watch out for include vomiting, diarrhoea, lethargy and loss of appetite. If you notice some or all of these stop treatment and contact your vet without delay.
Vetoryl is available as:
1. Vetoryl 10mg Hard Capsules
2. Vetoryl 30mg Hard Capsules
3. Vetoryl 60mg Hard Capsules
4. Vetoryl 120mg Hard Capsules
Presentation
1. Vetoryl 10mg Hard Capsules
Vetoryl 10 mg hard capsules for dogs, containing 10 mg of Trilostane.
Hard gelatin capsules (ivory body/black cap) containing 10 mg of Trilostane.
The ivory body is printed with the strength of the capsule.
2. Vetoryl 30mg Hard Capsules
Hard Gelatin capsules (ivory body/black cap) containing 30 mg of Trilostane. The ivory body is printed with the strength of the capsule.
3. Vetoryl 60mg Hard Capsules
Hard Gelatin capsules (ivory body/black cap) containing 60 mg of Trilostane. The ivory body is printed with the strength of the capsule.
4. Vetoryl 120mg Hard Capsules
Hard Gelatin capsules (ivory body/black cap) containing 120 mg of Trilostane. The ivory body is printed with the strength of the capsule.
Uses
For the treatment of Cushing's syndrome (excess production of corticosteroids from the adrenal glands) in dogs.
Vetoryl may be used for treatment of both pituitary-dependent and adrenal-dependent hyperadrenocorticism in dogs.
An accurate diagnosis of hyperadrenocorticism is essential.
Dosage & administration
For oral administration to dogs.
Information for the animal owner:
Follow the dosage instructions given by your veterinary surgeon. In clinical studies, an average starting dose of 6 mg/kg once daily was effective; however, the dose should be adjusted according to individual response, as determined by monitoring by your veterinary surgeon. Most dogs were eventually stabilised on doses between 2-10 mg/kg/day. Administer orally, once daily, with food. Dosing in the morning is preferable as this will allow your veterinary surgeon to perform monitoring tests 4-6 hours following administration of the dose.
Do not divide or open capsules.
Information for the veterinary surgeon:
Amounts to be administered: Practical starting doses are recommended as follows:
Bodyweight (kg) | Starting dose (mg) | Dosage (mg/kg) |
>3 and <10 | 30 | 3 - 10 |
>10 and <20 | 60 | 3 - 6 |
>20 and <40 | 120 | 3 - 6 |
>40 | 120 - 240 | 3 - 6 |
The dose should then be titrated according to individual response as determined by monitoring.
Should symptoms not be adequately controlled for an entire 24 hour inter-dose period, consideration should be given to increasing the daily dose by as small an increment as possible and dividing it between morning and evening doses. A small number of animals may require doses significantly in excess of 10 mg per kg bodyweight per day. In these situations appropriate additional monitoring should be implemented.
10 mg capsules should be used in dogs that require particularly small doses of Trilostane, and to assist with dosage adjustments.
Where there is no apparent response to treatment, the diagnosis should be re-evaluated. Dose increases may be necessary. Do not use in dogs weighing less than 3 kg.
Monitoring: Samples should be taken for biochemistry (including electrolytes) and an ACTH stimulation test pre-treatment and then at 10 days, 4 weeks, 12 weeks, and thereafter every 3 months, following initial diagnosis and after each dose adjustment. It is imperative that ACTH stimulation tests are performed 4-6 hours post-dosing to enable accurate interpretation of results.
Regular assessment of the clinical progress of the disease should also be made at each of the above time points.
Price comparison
Contra-indications, warnings, etc.
Do not use in animals suffering from liver disease and/or poor kidney function.
Adverse reactions:
(Information for the animal owner) If your dog becomes lethargic, develops vomiting or diarrhoea, or has a depressed appetite, stop treatment and consult your veterinary surgeon.
If you notice any serious effects or other effects not mentioned in the leaflet, please inform your veterinary surgeon.
(Information for the veterinary surgeon) Corticosteroid withdrawal syndrome or hypocortisolaemia should be distinguished from hypoadrenocorticism by evaluation of serum electrolytes.
Signs associated with iatrogenic hypoadrenocorticism, including weakness, lethargy, anorexia, vomiting and diarrhoea may occur, particularly if monitoring is not adequate. Signs are generally reversible within a variable period following withdrawal of treatment. Acute Addisonian crisis (collapse) may also occur. Lethargy, vomiting, diarrhoea and anorexia have been seen in dogs treated with Trilostane in the absence of evidence of hypoadrenocorticism.
There have been occasional isolated reports of adrenal necrosis in treated dogs which may result in hypoadrenocorticism.
Subclinical renal dysfunction may be unmasked by treatment with the product.
Treatment may unmask arthritis due to a reduction in endogenous corticosteroid levels.
A small number of reports have been received of sudden death during Trilostane treatment.
Other mild, rare, adverse effects include ataxia, hypersalivation, bloating, muscle tremors and skin changes.
Special warnings:
(Information for the animal owner) If your dog is being treated with any other medications advise your veterinary surgeon prior to the use of Vetoryl.
Do not use in pregnant or nursing bitches or in any animals intended for breeding.
Tell your veterinary surgeon if your dog is suffering from concurrent illnesses, especially liver disease, kidney disease, anaemia or diabetes mellitus.
Tell your veterinary surgeon if you intend to breed from your dog or your dog is pregnant or nursing.
(Information for the veterinary surgeon) The product should be used with extreme caution in dogs with pre-existing anaemia as further reductions in packed-cell volume and haemoglobin may occur. Regular monitoring should be undertaken.
As the majority of cases of hyperadrenocorticism are diagnosed in dogs between the ages of 10-15 years, other pathological processes are frequently present. It is particularly important to screen cases for primary hepatic disease and renal insufficiency as the product is contraindicated in these cases.
Dogs should be monitored at regular intervals for diabetes mellitus. The presence of diabetes mellitus and hyperadrenocorticism together requires specific monitoring.
If a dog has previously been treated with Mitotane, its adrenal function will have been reduced. Experience in the field suggests that an interval of at least one month should elapse between cessation of Mitotane and the introduction of Trilostane. Close monitoring of adrenal function is advised, as dogs may be more susceptible to the effects of Trilostane.
Close monitoring during treatment should be carried out. Particular attention should be paid to liver enzymes, electrolytes, urea and creatinine.
In the event of a non-stimulatory ACTH stimulation test during monitoring, treatment should be stopped for 7 days and then re-started at a lower dose. Repeat the ACTH stimulation test after a further 14 days. If the result is still non-stimulatory, stop treatment until clinical signs of hyperadrenocorticism recur. Repeat the ACTH stimulation test one month after re-starting treatment.
Interactions: The possibility of interactions with other medicinal products has not been specifically studied. Given that hyperadrenocorticism tends to occur in older dogs, many will be receiving concurrent medication.
In clinical studies, no interactions were observed. The risk of hyperkalaemia developing should be considered if Trilostane is used in conjunction with potassium-sparing diuretics or ACE inhibitors. The concurrent use of such drugs should be subject to a risk-benefit analysis by the veterinary surgeon, as there have been a few reports of deaths (including sudden death) in dogs when treated concurrently with Trilostane and an ACE inhibitor.
Overdosage:
(Information for the animal owner) If an overdose of the product is given consult your veterinary surgeon immediately.
(Information for the veterinary surgeon) Overdose may lead to signs of hypoadrenocorticism. There were no mortalities following chronic administration at 3 x the maximum recommended dose to healthy dogs, however mortalities may be expected if higher doses are administered to dogs with hyperadrenocorticism. There is no specific antidote for Trilostane. Treatment should be withdrawn and supportive therapy, including corticosteroids, correction of electrolyte imbalances and fluid therapy may be indicated depending on clinical signs.
In cases of acute overdosage, induction of emesis followed by administration of activated charcoal may be beneficial.
Any iatrogenic adrenocortical insufficiency is usually quickly reversed following cessation of treatment. However in a small percentage of dogs, effects may be prolonged. Symptomatic treatment or appropriate replacement therapy should be initiated. Following a one week withdrawal of Trilostane treatment, treatment should be reinstated at a reduced dose rate.
Symptomatic treatment of hypocortisolaemia may be required.
Operator warnings: Trilostane may decrease testosterone synthesis and has anti-progesterone properties.
Women who are pregnant or are trying to become pregnant should avoid handling the capsules.
Wash hands with soap and water following accidental exposure and after use.
The content of the capsules may cause skin and eye irritation and sensitisation. Do not divide or open capsules: in the event of accidental breakage of the capsules and contact of the granules with the eyes or skin, wash immediately with plenty of water. If irritation persists, seek medical advice.
In the event of accidental ingestion, seek medical advice immediately and show the package leaflet or label to the physician.
People with known hypersensitivity to Trilostane or any of the excipients should avoid contact with the product.
General precautions: For animal treatment only.
Pharmaceutical precautions
Symptomatic treatment of hypocortisolaemia may be required.
Do not store above 25°C. Keep out of the reach and sight of children.
Do not use after the expiry date stated on the blister.
Keep the blister pack in the carton.
Disposal: Any unused veterinary medicinal product or waste materials derived from such veterinary medicinal products should be disposed of in accordance with local requirements (in the UK consult your local waste regulation authority).
Packaging quantities
Blister packs of 30 capsules.
Further information
To be supplied only on veterinary prescription.
Veterinary medicinal product authorised for use in UK and IE.
Manufacturers: Dales Pharmaceuticals, Snaygill Industrial Estate, Keighley Road, Skipton, North Yorkshire, BD23 2RW, UK.
Penn Pharmaceutical Services, 23/24 Tafarnaubach Industrial Estate, Tredegar, South Wales, NP22 3AA, UK.
Disclaimer
This site has been created by www.MedicAnimal.com for information purposes only. MedicAnimal is a proud retailer of Vetoryl but is not affiliated with or related to the manufacturer of Vetoryl and the contents of this site are neither sponsored or endorsed by the manufacturer of Vetoryl.
