zycortal and addisons

[kathyl1]

Reuben has been on Zycortal for his Addisons for nearly 2 months and is extremely well.  We have only one recent problem and that he has some leakage of his bladder towards the late afternoon and into the evening.  He doesn't seem to have any pain and is just slightly embarrassed by it.  He does seem to pass quite a lot of urine but his drinking is completely normal.  He has only one prednisolone per day.

I took a sample of urine to my vet and his protein levels were slightly raised indicating there might be some infection so he is treating him as if it is cystitis but I am not convinced. He has given him a short course of antibiotics to see if that sorts the problem but I wondered if anyone else has had this problem with their Addison dog either before or after commencing Zycortal.

[Jo CIMDA]

Hi

It is good to know that Reuben is doing well and this problem with his urine might be an infection and the antibiotics could solve the problem.

How much does Reuben weigh and is the prednisolone a 5mg tablet?

A part from a urine infection, the usual reason why a dog with Addison's urinates  a lot is because the prednisolone dose is too high. It is odd that he isn't drinking more than normal though.

Jo

[Lil]

Hi my dog started on Zycortal 2 months ago, as well as the injection he was put on 5mg prednisone one daily. Side effect drinking at least 3 litres of water a daily and subsequently peeing all day. Vet suggested to half the dose of prednisone, which we did, this didn't make any difference. He had his second Zycortal last week and vet then suggested we quarter the dose. At this moment in time his drinking and peeing has not reduced, he also pants a lot.
Anybody else have this problem?

[Jo CIMDA]

Hi

It does sound like your dog is having too much prednisolone, and if he is then the symptoms you describe can be expected.  How much does he weigh?

The recommended replacement glucocorticoid  hormone dose is 0.2-0.3mg/kg bodyweight (BSAVA Formulary, 6th Edition) However the Zycortal drug sheet varies slightly.    Hormone replacement (whatever hormones) are always tailored to the individual and this is why the dose will vary from one dog to another.

Extract from the Zycortal Drug Sheet:

ZYCORTAL Suspension replaces the mineralocorticoid hormones only. Dogs with combined glucocorticoid and mineralocorticoid deficiency should also be treated with prednisone or prednisolone at an initial dosage of 0.2-0.4 mg/kg/day (0.1-0.2 mg/lb/day).

Excess pred is the usual reason for drinking and weeing too much but if you look at the Zycortal Drug Sheet you will see that some dogs may also have this reaction to Zycortal itself. See this extract:

ADVERSE REACTIONS:

One hundred fifty-two dogs were included in the field safety analysis. Adverse reactions are summarized in Table 2. Table 2: Percentage of Dogs with Adverse Reactions in ...

Table 2: Percentage of Dogs with Adverse Reactions in the Field Study

Adverse Reaction   

ZYCORTAL Suspension (n = 113 dogs) 

Polyuria  (Urinating more than normal) 15% (17 dogs)

Polydipsia (Drinking more than normal)  13% (15 dogs)

Active Control  (n = 39 dogs)

Polyuria  (Urinating more than normal)  12.8% (5 dogs)

Polydipsia (Drinking more than normal) 15.4% (6 dogs)


To have a look at this study and all the adverse reactions go to this link:

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

I hope this helps

Jo

[Jo CIMDA]

Hi

I wonder if the dose of Zycortal is too high?  The drug sheet recommends 2.2mg/kg Zycortal, but all the dogs that I know with the exception of one tiny dog, have all gone on for two months or more before the next Zycortal injection is needed.  This is because the sodium and potassium ratio has been high throughout this time.  The aim is to establish the correct dose of Zycortal to last through one month and this means, in most cases, that subsequent doses have to be lowered until the ratio after 25 days is between 27-32.   

The other method is to delay the next dose of Zycortal and monitor until the ratio is between 27-32 and then give the next injection, but how does one know when the desired ratio has been reached when duration hasn't been determined?   All this information is on the Zycortal drug sheet.  The link is in the previous posting.

Jo

[Sue Rowlands]

Hi,
My std Poodle Lenny is just undergoing his first cycle of Zycortal.  Previously he was on 9 Florinef and 5mg prednicare on alternate days (this regime was found to work really well)  My vet has dosed Zycortal at 2.2 per kg of body weight (26 kg) but hasn't replaced the prednicare, which I am very concerned about. (Vet is a very linear thinker, and tried to convince me that preds were not needed) Lenny is showing signs of becoming unwell - some sickness, loose stools, lethargy and minor lameness over the past few days.  He had his 10 day electrolytes on Thursday (ratio was 40) and revisited the vet on Friday after becoming unwell (ratio was 38 on retest) and prescribed antibiotics for gastrointestinal 'infection'.  My normally naughty and lively boy is very under the weather, and we think he needs preds.  We calculate that his pred dose should be nearly double what he was on before.

Clearly early days, and obvious that Zycortal dose needs to be adjusted downwards.
He is also on Thyforon for hypothyroidism.

It is interesting reading other owner's comments.  Thanks!

[Jo CIMDA]

Hi Sue

Your vet is wrong - very wrong.  It is essential that Lennie has glucocorticoid supplementation because there is none within the Zycortal treatment.

This extract is taken from the Zycortal drug sheet:


•   DOSAGE AND ADMINISTRATION:
Prior to each use, thoroughly shake the vial to resuspend the product.
ZYCORTAL Suspension replaces the mineralocorticoid hormones only. Dogs with combined glucocorticoid and mineralocorticoid deficiency should also be treated with prednisone or prednisolone at an initial dosage of 0.2-0.4 mg/kg/day (0.1-0.2 mg/lb/day).


A dog with primary Addison's disease who needs mineralocorticoid treatment is also deficient in glucocorticoid and needs supplementation with both Zycortal and prednisolone at the above dose.  A dog cannot live without glucocorticoid therapy and I am not surprised he is feeling very unwell.

I would usually recommend that you contact your vet but it is a bank holiday and it is essential for Lenny to have preds on a daily basis NOW, so I recommend you give him the appropriate amount.  I believe when you have done this you will see a marked improvement.  Often the initial dose is higher than the recommended maintenance dose because the dog is very deficient in this hormone.  If Lennie were mine I would give him at least the highest recommended amount of 0.4mg/kg pred, and then when your vet is open, I would most definitely have a word.  Even if you give him a bit more than is needed it won't harm him.

Please don't delay in giving him the pred.
Jo

[Lovemedogs]

Many vets are prescribing much too high a dose of pred for dogs on Zycortal. The dose needed is a replacement dose not a therapeutic dose and should mirror the amount of glucocorticoid a dog was getting from the florinef. Comparisons of glucocorticoids indicate that florinef had the approximate glucocorticoid activity to 0.25 mg pred, so if for example a dog was having 0.6 mg florinef per day, it should easily have enough pred with 1.5 mg pred to start with and then try to reduce that until you fond the best lowest dose, nut as Jo said, some pred must be given every day.

Just to add that it has been documented by a vet in the US and also noted anecdotally, that some dogs as big as 100 lb only need 1 mg pred per day.

Lastly, Zycortal at too high a dose, can cause urination and thirst issues as well as pred. It is really important that the vet aims to get the best lowest dose of both meds for our dogs with Addison's.

Pam

[kclark]

Has anyone switched their dog with Addison's from once a month injections of Percortin/1mm to Zycortal?  I have a new vet for my pit/boxer mix who was diagnosed with Addison's 2 yrs. ago.  She is wanting to give my dog Zycortal instead of the Percortin.
My dog has been getting a 1mm Percortin shot every 28-30 days and takes 1/2 of a 5 ml Prednison tablet a day which seems to work fine.  The Percortin shots are painful for her though.  I'm concerned about switching the meds.

[Jo CIMDA]

Hi and welcome

Are you based in the USA?  I ask this because Percorten-V has been used to control Addison's in the US for many years.  Zycortal is the same as Percorten-V.  The generic name for both is  Desoxycorticosterone pivalate (DOCP)

Here is the recommended dosage for Percorten:

https://www.percorten.com/

*For use as replacement therapy for the mineralocorticoid deficit in dogs with primary adrenocortical insufficiency.

**The initial starting dose of Percorten-V is 1 mg/lb intramuscular injection every 25 days. For most dogs, a dose range of 0.75 mg/lb to 1.0 mg/lb (1.65 mg/kg to 2.2 mg/kg) given every 21 to 30 days is effective. Glucocorticoid replacement must be supplied by small daily doses of glucocorticoid hormones (e.g., prednisone or prednisolone at 0.2 to 0.4 mg/kg). Dosage requirements are variable and must be individualized on the basis of the response of the patient to therapy.


Zycortal has only been used in the UK and some European countries since April 2016. 

See this website and download the packet sheet for dosage etc.

https://www.dechra-us.com/products/dog/zycortal

The recommended starting dose is:  'Initial dose of ZYCORTAL Suspension: The initial dose is 2.2 mg/kg (1 mg/lb) body weight'

So as you see both products are the same  Desoxycorticosterone pivalate the starting recommended dosage is also the same for both products.  Your vet can use either product but in the same dose your dog is currently on.  It shouldn't make a difference to the effect.

I have heard that it is a painful injection for some dogs, and because of this these dogs now don't want to go to the vet because they anticipate  it being a painful experience.  I can only suggest that perhaps the injection can be given in a different location - in the car for example, and perhaps you can distract your dog with food or a favourite toy whilst the vet gives the injection.

There is a tablet form of mineralocorticoid called Florinef  that was used  prior to Zycortal being licenced for animal use.  This human licenced tablet is still available for use on dogs with permission from the Drug Licencing Authority, so if your dog really has a problem with the injections then this might be another option.

I hope you feel more confident about switching to Zycortal now.

Jo

[barrden]

Hi, not sure if I'm posting this correctly - but here goes.  My dog was diagnosed with Addison's in April.  He's doing really well on Zycortal and prednisolone.  However, since October we've had drastic hair loss of the undercoat.  He does not have Hyperthyroidism.  Has anyone else experienced this?  Will the coat come back in eventually?  Any advice gratefully received.  Thanks. 

[Jo CIMDA]

Hi

It is good to know that your dog is doing well on Zycortal.

The most obvious thing to check is the dose of prednisolone. If the dose is too high then it might cause hair loss.  If the hair loss is drug induced and the dose of preds is adjusted to the right level then the hair will start to grow back again.  Could it be linked to a seasonal shed of coat - for example in the summer?

The glucocorticoid  replacement dose of prednisolone for Addisonian dogs is: 

ZYCORTAL Suspension replaces the mineralocorticoid hormones only. Dogs with combined glucocorticoid and mineralocorticoid deficiency should also be treated with prednisone or prednisolone at an initial dosage of 0.2-0.4 mg/kg/day (0.1-0.2 mg/lb/day). 

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

Jo