? Trilostane dosage for Cushing Cat

[Evey]

Hi Everyone~ Evey is diagnosed of Cushing back in July. She is currently taking Trilostane (5mg, twice a day). Her post-ACTH cortisol level is 15ng/ml and the vet suggested to increase the dosage to 7.5mg, BID. There isn't much information or studies about trilostane on cat online. I'm kind of worried that this dosage might be too high since Trilostane might cause Adison syndrome. Does anyone have any suggestions about the Trilostane dosage? Thanks~

 

[Wendy&Neko]

I'll see what I can find on some papers I have on Cushings/Trilostane on dosing. You might want to read the post on Ladybug's surgery, as she has adrenal gland Cushings.

 

[Wendy&Neko]

Here are a couple articles for you: Peculiarities of felinehyperadrenocorticism Update on diagnosis and treatment by Lara Boland and Vanessa Bars (2017). Quote in there, page 940 Trilostane dosing is 30-40 mg per 12 or 24 hours, though more recently starting with 1-2 mg/kg of cat. At 4.2 kg, that would be 4.2-8.4 mg. Sounds like the 7.5 would be OK as cats have done much higher.

This 2021 article: Feline comorbidities: Recognition, diagnosis and management of the cushingoid diabetic by Audrey Cook and Jeremy Evans mentions starting dose of 10 mg twice a day (see section on treatment). There is an interesting paragraph referring to dosing for cats with diabetes, that suggests twice a day dosing is best:

A starting dose of 10 mg/cat q12h PO is generally appropriate. Although q24h therapy may be adequate in non-diabetic Cushingoid cats, q12h administration ensures that each dose of insulin is ‘matched’ by the same dose of trilostane. Owners should be advised to discontinue the medication if the cat is anorexic or lethargic, as these may be signs of (relative) cortisol deficiency. Owners should be provided with a short-acting glucocorticoid and instructed to administer a dose (eg, prednisolone 0.5 mg/kg PO) if the cat seems unwell. This will rapidly reverse the signs of hypocortisolemia and protect again insulin-induced hypoglycemia.

I read another article saying that lowering the blood sugar values (and insulin dose) are indicators that the excess cortisol is being controlled. Have Evey's insulin dose lowered since starting Trilostane? If not, maybe that is a sign she needs an increase?

 

[Evey]

Here are a couple articles for you: Peculiarities of felinehyperadrenocorticism Update on diagnosis and treatment by Lara Boland and Vanessa Bars (2017). Quote in there, page 940 Trilostane dosing is 30-40 mg per 12 or 24 hours, though more recently starting with 1-2 mg/kg of cat. At 4.2 kg, that would be 4.2-8.4 mg. Sounds like the 7.5 would be OK as cats have done much higher.

This 2021 article: Feline comorbidities: Recognition, diagnosis and management of the cushingoid diabetic by Audrey Cook and Jeremy Evans mentions starting dose of 10 mg twice a day (see section on treatment). There is an interesting paragraph referring to dosing for cats with diabetes, that suggests twice a day dosing is best:


I read another article saying that lowering the blood sugar values (and insulin dose) are indicators that the excess cortisol is being controlled. Have Evey's insulin dose lowered since starting Trilostane? If not, maybe that is a sign she needs an increase?

Thank you for the articles. Since I rarely tested her BG after the torn-skin accident (about the same time starting the Trilostane), I had been giving her 1.5U. The vet did a FRU test and FRU was 262umol/L on Oct 25. It seems it's on the lower side so I started to try to test her recently and I decided to lowered it down to 1.25U just to be safe. I made up the missing data in her spreadsheet. She started to get lots of yellow in May and June. It seems her BG is more under control now.

 

[Evey]

@Wendy&Neko

I found these links from the LABOKLIN website and this article. Do you mind take a look at these because I'm not sure if I understand it correctly. does it mean her post-pill cortisol level is within normal range? Thanks

Trilostane Therapy Control
Vetoryl Therapy Control (1 x cortisol) - LABOKLIN Europe

Vetoryl Therapy Control (2 x cortisol) - LABOKLIN Europe

Trilostane Treatment and Monitoring: Is the ACTH Stimulation Test Gone for Good? Trilostane Treatment and Monitoring: Is the ACTH Stimulation Test Gone for Good? - WSAVA 2019 Congress - VIN

 

[Wendy&Neko]

Sorry, you should ask the vet this question. The first two links refer to dogs, don't know if the same can be said for cats.

 

[Evey]

Sorry, you should ask the vet this question. The first two links refer to dogs, don't know if the same can be said for cats.

oops, i didn't even realize the LABOKLIN number are for dogs. I asked the vet. the vet said there's no accurate foundings or research about cat's dosage. but in general, cats need higher dosage than dogs.