Veterinary Medicine - February 2008 - (Page 111) tarily removed from the market in 1994. Work done in the late 1990s in Europe demonstrated trilostane’s ef cacy in managing canine adrenal disease, and it is presently an approved therapy for dogs with adrenal- and pituitary-dependent hyperadrenocorticism in the United Kingdom and Ireland. Trilostane is administered orally and appears to be rapidly absorbed. Peak serum concentrations occur one-anda-half to two hours after dosing and return to baseline within 18 hours; inhibition of steroid synthesis is reported to last less than 20 hours.8 Trilostane undergoes hepatic metabolism, and the pharmacokinetics may be altered in patients with liver dysfunction. The manufacturers state that trilostane should not be used in patients with primary hepatic disease or renal insuf ciency.9 It should be used with caution in anemic patients and avoided in pregnant or nursing bitches or any animal intended for breeding. Starting therapy Trilostane is supplied in 10-, 30-, 60-, and 120-mg capsules. The initial dosage is based on body weight (Table 6) and is given once a day with food.9 The dose is then adjusted based on clinical response and ACTH stimulation test results. Most patients show clinical improvement within seven days, with resolution of polydipsia and polyphagia. Re-evaluate all patients, irrespective of clinical status, within the rst two weeks. At this time, perform a physical examination, serum chemistry pro le including electrolytes, and an ACTH stimulation test. The timing of the ACTH stimulation test is crucial; for the results to be meaningful, it must be started four to six hours after trilostane administration.10 Monitoring Dose adjustments are based on the patient’s clinical status and post-ACTH stimulation cortisol concentrations. Several different target ranges have been described, but the general consenVETERINARY MEDICINE 111 http://www.prnpharmacal.com
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