On Trilostane use for Cushing's in a diabetic dog

[k9diabetes]

Have mentioned a few times that treating Cushing's disease in a diabetic dog would tend to favor twice daily dosing of Trilostane because the duration of Trilostane is considered to often be less than 12 hours. Dr. Peterson, a veterinary endocrinologist, makes reference to this in discussing a study on twice-daily dosing of Trilostane by Dr. Feldman.

http://endocrinevet.blogspot.com/201...rilostane.html

So what do I recommend? Until it is proven that SID (once a day) or BID (twice a day) treatment is better, I prefer to start with a twice-daily regimen —if feasible and the owner agrees —because controlling cortisol concentrations throughout as much of the day as possible makes sense to me. In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day (1,2). With once-daily trilostane administration, adequate diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.