Starting with Zycortal

[Keith@Yorkshire]

Hi,
Max our 11yrs old Black Labrador as been on Florineff for the last 8yrs for his Addison's, plus preds. as and when required - fireworks, thunder, noisy jet areoplanes.  11 days ago he had his first injection of Zycortal, at the time is lytes ratio was 31, yesterday, after 10 days we had his lytes checked again, this time 40.  He is in good fettle and seems to be doing well, we are at present giving him 2 x 21/2  mg preds a day.
Anyone with experience of Zycortal?
Keith@Yorkshire

[Jo CIMDA]

Hi Keith and thank you so much for this information.  It is very useful.  Can you find out what dose Max received, and how much does he weigh?

FYI, here is some info about another dog who has just started on Zycortal.  Keeping records like this will help others. 

Macey is a Weimaraner

Initial injection of Zycortal (don't know the dose)

31 days:  41.5

38 days:  37.2

45 days:  41.2

You may find this paper interesting.  http://www.ncbi.nlm.nih.gov/pubmed/23438457

I am so glad Max is doing well because it is a worrying time for all those with an Addisonian dog.

Jo

[Keith@Yorkshire]

Hi Jo,
Max was 40kgs when he had his first injection of Zycortal, the amount administered was 2.2 mgs per kg --  88mgs.

Keith.

[Jo CIMDA]

Many thanks for the info Keith.

Jo

[Walcop]

Hi all,

I attended the vets today to collect Walters florinef tablets. The vet obviously made me aware of the change to Zycortal. After a discussion and although I have some florinef still to use, I opted to have Walter injected with the Zycortal. Blood test in 10 days time so hopefully all will go well. I will of course now give Walter the required amount of preds on a daily basis as per the advice on this forum (separate thread).

Walter is a bearded Collie, weighs 26.3kilo. I will find out the dose given today and update this post tomorrow.

My vet charges £80.00 for the Zycortal and £25.00 for the injection to be given= £105.00 per month plus the additional cost for preds. I will definitely be having the chat re sourcing Zycortal and giving the injection myself....lets hope the vet is in agreement with this but I won't hold my breath.

Fingers crossed all goes well for everyone and their dogs switching to Zycortal.

Steve

[Jo CIMDA]

Hi Steve

Thanks for the info.  I am disturbed by how much your vet is charging.  I know a beardie boy, so similar weight to Walter give or take a few pounds, and his vet charged £53.00 for Zycortal injection, including vet fees. I wonder what dose Walter was given and if this is reflected in the price your vet is charging for the Zycortal?

The feedback, from the owners that I am in contact with, regarding their dog's response has been good, although I have heard that some dogs have had a few problems and have needed fluid therapy. 

The dogs seem to be able to go a lot longer than 25 days and perhaps the dose has to be lowered to establish the optimum dose for the individual dog.  Once the dose is established there should be no need for this frequent monitoring necessary at this early stage of the new treatment.  It is a learning curve for the vet as well as the owner. 

There is a white paper that suggests that the optimum dose of DOCP (the US equivalent)  is a lot less than the drug sheet recommendations. I think we will find this to be so as data from individual dogs is collated.

I would like to record details of dose and response and duration between subsequent injections of Zycortal, so thank you for the information.

I hope Walter responds well to the new medication.

Jo

[Walcop]

Hi Jo/all,

Unfortunately the high cost of the drugs are due to where we live, it is common for high cost of all professionals services. The only way I can reduce the cost is to obtain the drug and inject it myself. I will however mention your info regarding another UK vet charging £53.00 total.

I can't find the advice sheet I previously read re. the amount of preds to now give daily. Walter weighs 26.3 kilo, could you kindly advise what the dose should be as he is due to get it today. I will check again and  update this post if I find the advice sheet.

Walter weighs 26.3 kilo and was given 25mg/4ml of Zycortal.

Regards

Steve

[Walcop]

Just found the advice sheet.....Walter was on .1mg X 10 a day,  so looks like that's 2.5mg preds to now give per day.

Steve

[Jo CIMDA]

Hi Steve

This link gives you all the information you need, including the dose of replacement glucocorticoid therapy.  However,  hormones are fickle things and the treatment has to be tailored to the individual.  Some dogs will need more to be stable whilst others will need less. And it is likely he will need more pred in a stressful situation.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c9b766a-c36b-44aa-bbd8-24fab24ca97c

Thanks for the info on Walter. Can you please check this for me?   The initial dose of Zycortal recommended by the drug sheet is 2.2mg per kg of bodyweight.   If you take Walter's weight, 26.3kg and multiply this by 2.2mg you determine the recommended dose,  according to the Drug Label Information sheet, of  57.86mg.   

If you then look on the packaging it states that 1ml of Zycortal solution contains 25mg desoxycorticosterone pivalate . So by my calculations a dog weighing 26.3kg should receive 57.86mg which equates to 2.31 ml of Zycortal.  I believe, if your information is correct, that Walter has received 4ml which is equivalent to 100mg of Zycortal.

If this is so then you may need to watch his electrolyte levels. 

Jo

[Walcop]

Hi Jo,

I called the vet this morning and obtained from the admin staff the info re 25mg/4ml Zycortal given to Walter. After your post below I phoned the practice and asked them to check with the vet for the actual amount given to Walter as I feel the admin staff can only see that the vet charged me for a full vile opened i.e. a full vile is 25g/4ml........well I hope that's the case. Still awaiting a response from the vet.

Steve

[Keith@Yorkshire]

Max had his lytes checked this morning, 25 days since is first injection (2.2mg per kg.)  The 10 day ratio was 40, today it was 43'
Keith@ Yorkshire.

[Jo CIMDA]

Hi

Thanks for the update. That is very interesting and the results support the low dose study papers which the vets seem very reluctant to take notice of.

I have had some other results today from another dog and 10 days following a dose of 2.2.mg/kg Zycortal the ratio was 38.7. 

The electrolytes were taken every week and here are the results:

38.7 at 10 days 28th/4/2016
41.5 
41.5
47.2
41.2
36.2
30.1  17/6/2016 second injection given , but vet didn't lower the dose.

I presume you will be taking Max back in seven days?

Jo


Check out the Drug Information Sheet (link below).  It gives tables of what dose the vet should administer based on electrolyte results.


https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c9b766a-c36b-44aa-bbd8-24fab24ca97c

[Walcop]

Hi Jo / all,

Walter had his "ten day" blood test after the first dose of Zycortal was administered. Also to confirm the vet initially administered 2.37mil of Zycortal .... 2.2mg per kilo.

Blood results today
Na= 151
K= 3.6
Ratio= 41.94

I will read up on the information via the links above.

Thanks as always

Steve

[Jo CIMDA]

Hi Steve.

I am so glad that Walter didn't have an overdose.  It seems from the data so far, that all dogs I have contact with, have received 2.2mg/kg, and after 10 days the ratio is greater than 34, which according to the drug sheet, indicates a decrease dose at 25 days to 2.0mg/kg.  If the ratio is greater than 32 at day 25 then the dosing can be prolonged.

I'm sure it will all become second nature in time but for now there is a lot to learn.

Thanks for the update

Jo

[Keith@Yorkshire]

Hi,
Max our 11yrs old Black Labrador as been on Florineff for the last 8yrs for his Addison's, plus preds. as and when required - fireworks, thunder, noisy jet areoplanes.  11 days ago he had his first injection of Zycortal, at the time is lytes ratio was 31, yesterday, after 10 days we had his lytes checked again, this time 40.  He is in good fettle and seems to be doing well, we are at present giving him 2 x 21/2  mg preds a day.
Anyone with experience of Zycortal?
Keith@Yorkshire

We carry on with the treatment,  25days-- 43,  31days -- 41, 38days--40,  43days--39.   Max as a very good appetite, initially was drinking, and peeing more than usual, but this as dropped off. I would say that he is in as good health now as he as been since diegnosed with Addisons.  The ratios are droping slow, is this the same with others?, and do they continue this way, or do they drop quickly? Good to read other experience. Keith.