Medical Treatment Options

Always discuss all options with your vet, as there are many factors that should be considered before administering medical treatment for Cushing’s syndrome in dogs. Here are some common medicines used to treat the disease.

Surgery

Cushings disease is usually caused by either a tumor on the adrenal gland or a tumor on the pituitary gland.  In the case of pituitary gland tumors, which is the cause of 80% of Cushing’s cases, surgery is not an option because brain surgery on dogs is not recommended. This is due to the high risk and exorbitant cost. In the case of adrenal gland tumors, it may be possible to surgically remove the tumor, but it is rare for veterinarians to choose this option.  The usual treatments are typically chemotherapy drugs, or medications designed to damage the adrenal gland just enough to slow down the production of cortisol. There are several holistic treatments for Cushings in dogs, which are far less severe and can be found on our Holistic Treatment Options Page, but below we explore some of the drugs used to treat Cushing’s.

Ketoconazole

Ketoconazole is a common choice for Cushings disease treatment, but because of its potentially severe side effects, it is not always the first choice for many veterinarians. Nevertheless, this anti-fungal drug has seen success for many cases by blocking adrenal androgen biosynthesis (making it especially effective with the adrenal form of Cushing’s) and reducing symptoms of Cushing’s in around 50% of dogs. Ketoconazole is administered orally and should only be taken in small doses until the affected dog has demonstrated sufficient toleration.

Lysodren

Lysodren (also called Mitotane), is one of the most popular treatments for Cushings. It is also a high risk medication. It is the longest used treatment for Cushing’s in dogs and, in many veterinarians’ opinions, it is the most effective; however, with a long list of possible negative side effects, the severity of the case is often a major factor in determining whether or not Lysodren is the best option. Benefits include:

• Fast Recovery Time: Lysoderen can be an effective Cushings disease treatment within a 4-6 month time period. This makes it a popular choice when the Cushings case is severe.
• Low Cost: Though far more expensive than natural Cushings treatment options, Lysodren is less expensive in comparison to other medical treatments. Always make sure to talk to your veterinarian about prices when discussing Cushings treatment options.
• Easily Administered: Because Lysodren is a chewable tablet, it is one of the easiest medications to administer on this list. If you receive the medicine from your veterinarian, follow all directions (do not over or under-dose) and use disposable gloves when handling.

Even with these benefits, many hesitate to use Lysodren due to the numerous harmful side effects often associated with the medication. These include vomiting, diarrhea, lack of coordination, loss of appetite, and a rapid drop of cortisol levels. If Lysodren is used, it is recommended to have your veterinarian give you an appropriate amount of Prednisone tablets to counteract an emergency situation just in case.

Trilostane

Trilostane, though new to the US, is quickly becoming a popular treatment for Cushing’s in dogs. Trilostane is recommended for dogs that do not tolerate Lysodren well. It is an effective—albeit a more expensive—alternative for Cushings. Although dogs that have severe side effects with Lysodren might not experience the same ones with Trilostane, this does not mean that Trilostane is side effect free. Trilostane comes with its own list of potentially harmful side effects for dogs and can often cause vomiting, listlessness, loss of appetite and diarrhea. Trilostane also carries the possibility of an increased rate of growth in pituitary tumors. Always keep potential side effects in mind before switching to Trilostane and be sure to ask your veterinarian before doing so.

Other downsides to Trilostane:

• High Cost: Trilostane, being a new drug for Cushings disease treatment, is quite expensive, especially compared to Lysodren. The drug must also be administered more often and the price can become prohibitive for many pet owners.
• Must Wait a Month Before Switching: If a dog began treatment with Lysodren, there should be a month of downtime between stopping the old medication and starting the new Trilostane treatment (for safety reasons). This would mean a full month without any sort of treatment for the dog; whereas natural, holistic options can be used right after stopping the old treatment, or even while weening the dog off the current medication.
• Not as Effective: Though Trilostane works in many cases, it is reported that Lysodren is more effective far more often. With this in mind, Trilostane should be used as an alternative rather than a first option.

Benefits:

• May be Less Severe on Adrenal Tissue than Lysodren: Lysodren causes mild to severe damage to adrenal tissue. Trilostane is not quite as damaging.
• Good Alternative if your Dog Cannot Handle Lysodren: If Lysodren causes too severe of side effects for dogs with Cushings, Trilostane may be a less harsh Cushings disease treatment. Remember to ask your veterinarian about other options if Lysodren or Trilostane cause severe side effects.

Anipryl

Anipryl works only if the dog’s Cushing’s is a result of a pituitary tumor (rather than an adrenal gland tumor). Anipryl may be a good option as it is a Cushing disease treatment that causes fewer side effects. Causing gastrointestinal upsets in less than 5% of pets receiving it, it is a milder drug and can still be effective in many cases. However, because it is more mild, it is less effective, and there is always the possibility of having to return to Trilostane or Lysodren if Anipryl does not do enough for the affected dog.

Holistic Treatments

Lignans and melatonin are recommended more frequently as natural options become more and more favorable to many veterinarians. This is due to their low cost, minimal to no side effects, and high success rate. Lignans and melatonin are gentle on aging dogs. They lower cortisol simply by balancing hormones, instead of by damaging the outer cortex of the adrenal gland. Both lignans and melatonin inhibit enzymes needed in the production of cortisol and as a result, counteract the effects of an overproductive adrenal gland. Lignans also reduce estradiol and there is no potential damage to the adrenal gland when using lignans and melatonin. Unlike the harsher chemotherapy drug options, lignans and melatonin can not cause Addison’s disease, which can occur from excess damage to the adrenal gland, in which case cortisol production could stop all together. While it can take 2-4 months to see results, it is possible to see results in as little as 2-4 weeks. The majority of those using lignans and melatonin for their dogs with Cushings see symptoms improve in an average of 2 months. Click here for more information on natural treatment options