Always provide the Client Information Sheet with prescription. The starting dose for the treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size (see Table 1). VETORYL Capsules should be administered with food.
Table 1: Starting Dose
|Weight range (pounds) ||Weight range (kg) ||Starting dose (mg) ONCE DAILY |
|10 to 22 ||4.5 to 10 ||30 |
|22 to <44 ||10 to 20 ||60 |
|44 to 88 ||20 to 40 ||120 (2 x 60 mg) |
|88 to132 ||40 to 60 ||180 (3 x 60 mg) |
|Dogs over 132 pounds (60 kg) should be administered the appropriate combination of capsules. |
After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test. If physical examination is acceptable, take action according to Table 2.
Table 2: Action at 10-14 day evaluation
|Post-ACTH serum cortisol || |
|µg/dL ||nmol/L ||Action |
|<1.45 || <40 ||Stop treatment. Re-start at decreased dose |
|1.45 to 5.4 ||40 to 150 ||Continue on same dose |
|>5.4 to 9.1 ||>150 to 250 ||EITHER :Continue on current dose if clinical signs are well controlled |
: Increase dose if clinical signs of hyperadrenocorticism are still evident*
|>9.1 ||>250 ||Increase initial dose |
|*Combinations of capsule sizes should be used to slowly increase the once daily dose. |
Individual dose adjustments and close monitoring are essential. Re-examine and conduct an ACTH stimulation test 10-14 days after every dose alteration. Care must be taken during dose increases to monitor the dog's clinical signs and serum electrolyte concentrations. Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.
Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every 3 months thereafter. At a minimum, this monitoring should include a thorough history and physical examination, ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration), and serum biochemical tests (with particular attention to electrolytes, renal and hepatic function). A post-ACTH stimulation test resulting in a cortisol of 1.45 µg/dL (40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of hypoadrenocorticism. Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 µg/dL (40-250 nmol/L). If the ACTH stimulation test is 1.45 µg/dL (40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 µg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.
Owners should be instructed to stop therapy and contact their veterinarian immediately in the event of adverse reactions or unusual developments.