Traditional Cushings Treatment

After your vet clinic has concluded their blood and urine tests and diagnosed your pet with Cushings disease they will now discuss treatment options. Different vets have different treatment approaches. Some only offer one solution and others will give you choices. Remember you can always get a second opinion if something doesn't feel quite right or if you don't think the vet has sufficient experience treating Cushings.

Be wary of any "national vet" chain stores, they are typically referred to as the "Mcdonalds of vets" for a good reason, their vets tend to be young and fresh out of school with limited hands-on experience and tend to only make decisions based on what they read in a book. There are some good ones to be found, but you have to do your research on each individual clinic. Ask questions, it's your pets life on the line and you want someone with experience.

TREATMENT OPTIONS CAN INCLUDE:

1) Anipryl (Selegiline, L-deprenyl)
Dosage: Given 1 to 2 times daily
This drug is used for both cognitive dysfunction (brain fog) and occasionally for Cushings disease. If you know somebody with Parkinsons or Alzheimers disease you've probably heard of this drug since it's typically used to treat those conditions as well. Anipryl basically prevents dopamine from breaking down, which in turn blocks the creation of ACTH, whiich then prevents the creation of cortisol in the adrenal glands. It sounds like a great solution, but we have to mention that Anipryl is typically not recommended because most Cushings disease cases involve pituitary tumors and unfortunately the tumor is rarely seen in the part of the pituitary gland that is dependant on dopamine. Therefore Anipryl tends to have a low success rate for Cushings disease, although in many cases the dog will appear perkier but this is a false sense of success since the Cushings body symptoms are still there and nothing is solved. This is a shame since of all the treatment drugs Anipryl seems to have the least amount of negative side effects, hopefully they can improve upon it in the future.

2) Lysodren (Mitotane)
Dosage: Given once or twice a week
in a nutshell this is probably the most common treatment offered. It's a rather harsh drug that essentially erodes part the adrenal glands which forces cortisol production to decrease. It's a form of chemotherapy, literally destroying a part of the adrenal gland and for that reason some people prefer to first try other treatment options with less side effects. Lysodren requires a lot more blood monitoring than other options because if too much of the gland is destroyed you have a whole new set of medical problems (such as Addison's disease). On the plus side typically after one month on Lysodren pet owners will begin to see positive results. Their pets hair will start growing back, thirst decreased (and urination decreased), energy levels will rise, and muscle tone improvement will be seen. Also on the plus side it doesn't have to be given as often as other drugs. In summary, this strong drug does work for treating Cushings disease, but it's vital that you find a vet with Cushings experience and are able to watch your pet closely for any sudden changes. Side effects can include nausea, vomiting, diarrhea, gas, stomach pain, and loss of appetite.
Average weekly cost of medication:
Lysodren 500mg Tab (sold per tablet) $6.00 - $9.00
(Tip: price shop various pet pharmacies because prices vary widely for all of these drugs!)

3) Vetoryl (Trilostane)
Dosage: Given daily with food
This drug works by inhibiting an enzyme (3-beta-hydroxysteroid dehydrogenase) that in turn blocks the production of cortisol. As with Lysodren permanent adrenal damage is possible so it's important that you follow your vets directions on returning to the clinic for follow-up ACTH stim tests (typically done 10-14 days after beginning Vetoryl, and again at approximately 4 weeks and 12 weeks, this is to monitor how well the drug is performing so the vet can increase/decrease dosage accordingly). Once the proper dosage is found you can plan on going back to the vet every 3-6 months for the routine test to make sure everything is coming along nicely. Side effects to watch for include loss of appetite, dehydration, diarrhea, and depression.
Average monthly cost of medication:
$50-$75 for 30 capsules 30mg (20 lb dog)
$70-100 for 30 capsules 60mg (50lb dog)
(Tip: price shop various pet pharmacies because prices vary widely for all of these drugs!)

4) Ketoconazole (Feoris, Nizoral)
This drug is occasional prescribed for dogs that have ad adverse reaction to Lysodren. It's actually an antifungal medication used to treat things such as yeast infections that has the interesting side effect of reducting cortisol production. It's known to not be as effective for long term treatment of Cushings and can be hard on the liver in some pets, but it is at least another option available and isn't known to damage adrenal tissues like Lysodren and Vetoryl can.

 

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