My dog's Cushing's isn't getting better with Vetoryl. What now?

Vetoryl (trilostane) is the best medication for managing Cushing's disease, but I'm sorry to hear that Lacy has not been tolerating it well. I have anecdotally heard of some vets using a variety of supplements for managing Cushing's disease signs, but these supplements will not ultimately decrease the cortisol production by the adrenal glands and generally seem ineffective. I don't know how long Lacy was receiving Vetoryl, but some dogs can initially become lethargic, vomit, have diarrhea, or a decreased appetite. Fortunately, these signs typically resolve after a few days to a few weeks on the medication. It may be worth discussing a temporary dose adjustment with Lacy's vet to see if she tolerates a lower dose better before gradually increasing to her 30mg dose. Some dogs also benefit from supportive measures (anti nausea medications, bland diets, etc.) in the first few days to weeks of treatment. I hope this helps and that all goes well!

Poor Nemesis. Sometimes pets will need the medication adjusted. I recommend to call your veterinarian and ask if another test is needed to evaluate the blood levels in his body. The test is called an ACTH stimulation test. It has been found that 50% of dogs with Cushing’s disease will also have a urinary tract infection that can only be detected with a urine culture. I recommend to have this test done as well as this will cause constant drinking and urination. Other conditions such as thyroid disease, diabetes or kidney disease can also cause these signs. You must start ruling them out. Best of luck.

Hi there! Normally, if a dog being treated for Cushing's disease is still drinking and urinating excessively, this is an indication that her Vetoryl dose may need to be adjusted. We calculate a starting dose based on weight, but many dogs need further adjustments from there depending on how they respond to the medication. I would recommend calling your vet to discuss this. He/she will likely recommend bringing Ali back in for an ACTH stim test to check her cortisol levels, which will help guide the decision about whether to change her Vetoryl dose.

I would not expect the signs you are describing to be secondary to the Vetoryl and I would not recommend stopping the medication without talking to your veterinarian first. Unfortunately there are not many safe alternative treatments for Cushing’s disease. I would be concerned that Boots might be showing signs of pain or potentially neurologic disease. It would be a good idea to have your vet examine him and to discuss these concerns.

I am sorry Mouse is such a complicated girl! Unfortunately there is no way to test other than an ACTH stem test. If she responded terribly to this last time, talk to your vet about the urgency and need to perform the ACTH stem test. If she's well controlled on the Vetoryl, I'd leave it alone. Typically, Vetoryl is safer and better tolerated than Lysodren. Thanks for asking Petco Pet Education Center, formerly Petcoach!

Hello. For the most part, Vetoryl is used to control the symptoms of Cushing's by controlling the production of glucocorticoids. Overproduction of glucocorticoids is responsible for the symptoms of excessive drinking & urination but does nothing for the actual tumor growing on his pituitary gland. If Izzy's symptoms are manageable & tolerable then medication is not necessary. This would be your choice. But if his symptoms do get worse, at least consider once a day dosing. Most dogs do very well on twice daily dosing, but once a day can help in many pets. Thanks for using Petco Pet Education Center, formerly Petcoach.

Hello and thank you for your post! I am sorry to hear that Aprile is not feeling well. With the Cushing's medication, this can cause the reverse disease called Addison's disease. The Cushing's medication will decrease the steroids in the body. Sometimes this medication can decrease the steroids too much and lead to an addisonian crisis. If your vet has not checked blood work to see what the electrolytes and the rest of the blood work looks like I would certainly want to see what the CBC and chemistry look like. If your vet has examined her and deems that steroids are necessary due to the examination and clinical appearance then a dose of steroids is probably okay to administer with the suspicion that the Cushing's medication has decreased the natural steroids in the body too much. Famotidine is just Pepcid AC, so it is absolutely safe to give. If the pancreatitis is very bad, then I would suggest keeping her in the hospital on supportive care until she's feeling better. I hope this helps and that she gets better! Please let me know if you have any other questions or concerns. I'm also available via phone or text consultation.