FAQs
Many of our support group members have similar questions when their dogs are first diagnosed. First you’re trying to understand the medications, and test results, and a whole new vocabulary. Then, as you’re becoming more comfortable with your dog’s diagnosis, you might be interested in exploring treatment in more detail, or perhaps you’re experiencing symptoms and you aren’t sure what they mean.
We’ve compiled a listing of the most frequently discussed topics from the addisondogs.org discussion group. If you’d like to see a topic addressed that isn’t covered here, please e-mail us. Or if you’d like to see information added to a current question, please let us know
Questions:
- My newly diagnosed dog is suffering from incontinence, is this normal?
- How much do the medications cost?
- Where can I get Florinef (fludrocortisone) for less?
- What are glucocorticoids and what’s the difference between them.
- Is Addison's disease genetic or inherited?
My newly diagnosed dog is suffering from incontinence, is this normal?
Incontinence can be a symptom of unbalanced electrolytes. Some dogs suffer from PU/PD prior to the Addison’s diagnosis, or if the medications aren’t keeping the electrolytes at the optimal levels. The first step is to check electrolytes and make sure that they are at normal levels. It can also be valuable to check for a bladder or urinary tract infection at this point, which typically doesn’t cause excessive drinking but may cause incontinence.
The next step is to look at glucocorticoid dose. Often when a dog is first diagnosed, the vet will prescribe doses of prednisone (or other glucocorticoids) that cause side-effects such as excessive drinking and urination – often referred to by the technical term PU/PD for polyuria/polydipsia. Lowering the dose of prednisone, after your dog is properly stabilized, will often resolve this type of incontinence. If this is causing the problem for your dog, he may also be exhibiting other symptoms of too much prednisone such as excessive appetite and/or irritability.
If these two items don’t seem to be causing the incontinence, and your dog is a spayed female, she may have a weak sphincter muscle caused from a lack of estrogen. There are a number of ways to approach this problem. Many conventional vets prescribe estrogen (usually DES) or PPA (phenylproanolamine) to combat the problem. Holistic vets will often recommend herbs such as wild yam or corn silk, glandulars like bovine ovary or blends of the two such as Resources Incontinence Formula, made by Genesis.
How much do the medications cost?
Prices can vary tremendously for the medication options. As an example, let's look at the costs for a 50-pound dog on the average dose of 0.1 mg/10 lbs for Florinef = 0.5 mgs of Florinef per day or 1 mg/1 lbs for Percorten (DOCP) = 2 mls of Percorten every 28 days to illustrate the differences.
Brand name 0.1 mg Florinef tablets typically cost between $0.50 - $1.00 each at a standard pharmacy. The monthly cost would be between $75 - $100.
Brand name Florinef purchased from online Canadian pharmacy Pet Pharm costs about $0.23 per tablet (depending on the exchange rate). The monthly cost would be about $35.
Compounded fludrocortisone (generic Florinef) in 0.5 mg capsules costs about $13.50 per month, which is equivalent to about $.09 per 0.1 mg.
Percorten prices vary even more. The wholesale cost of Percorten to the vet is about $24 per ml. In most cases, there is a mark-up from the vet, and then there's the possible cost of the injection or office visit. Therefore, the standard dose of 2 ml for a 50-pound dog would probably cost between $48 and $100+ per monthly injection.
Prednisone and hydrocortisone are relatively inexpensive medications, and usually only add a few dollars a month onto the total medication bill.
* Compounded Florinef Price Update 2009. Cost is roughly $30 to $35 per month regardless of size of capsule.
** Percorten V (DOCP) Price Update 2009. Wholesale cost is $116 per vial.
Where can I get Florinef (fludrocortisone) for less?
Most US pharmacies charge between $0.50 - 1.00/ 0.1 mg tablet of brand name Florinef. There are some online pharmacies that sell brand name Florinef for much less, one of such is The Pet Pharmacy. It is a Canadian company and costs about $0.29 per tablet (depending on the exchange rate). 100 tabs costs $28.50 (as of May 2013).
Compounding pharmacies will create a capsule, chew or liquid to your vets dosing specifications for your dog and their prices are generally much lower than the brand name Florinef tablets. Go to the IACPRX ( International Academy of Compounding Pharmacist) website and enter your zip code to find compounding pharmacies in your area. You must register first however.
Alternatively, you may want to contact one of the compounding pharmacists listed at this link. Compounding Pharmacist These pharmacists ship and have AddisonDogs list members as customers.
What are glucocorticoids and what’s the difference between them.
Glucocorticoids are hormones normally produced by the adrenal glands that metabolize glucose and help the body deal with stress. The most common is cortisol. Cortisol needs to be replaced in dogs with Addison’s disease of all types (Primary, Atypical and Secondary).
Approximately 50% of dogs with Addison’s require glucocorticoid supplementation on a regular (usually daily) basis. All ADogs require glucocorticoid supplementation in times of stress. Florinef, a mineralocorticoid, has some glucocorticoid activity, so it is more likely that a dog on Florinef may not need regular supplemental glucocorticoids compared to a dog on Percorten-V (DOCP), which has no glucocorticoid activity.
There are a number of drugs available to replace glucocorticoid cortisol. Each drug is slightly different when comparing half-lives, potencies and relative level of mineralocorticoid (sodium-retention) ability. Some dogs respond better to one compared to another.
The primary pharmaceutical options are:
- Prednisone, probably the most commonly prescribed drug for a dog with Addison’s. This medication is the same steroid that is often used (usually in higher doses) to combat inflammation (such as allergies) and autoimmune conditions.
- Prednisolone, is similar to prednisone with the same half-life and relative potency, but has already been converted to the bioactive form. This saves the liver from a step, and can be a useful choice for ADogs that have elevated liver enzymes.
- Hydrocortisone, (brand name Cortef) is the pharmaceutical product closest in form to the cortisol naturally produced by the body. It is the most commonly prescribed medication for people with Addison’s disease. It has a shorter duration than prednisone and has higher relative mineralocorticoid activity.
- Methylprednisolone (brand name Medrol) it is relatively more potent and longer lasting than both prednisone and hydrocortisone. It also has little mineralocorticoid activity.
- Dexamethasone is one of the strongest of the glucocorticoids. It is fast-acting and very potent – often given as an injection in crisis situations. It is the least commonly prescribed glucocorticoid for regular day-to-day use.
Go to: DVM360 The proper use of topical and oral corticosteroids (See Table 1), for a chart that details the relative potency and half-life of these glucocorticoids.
Is Addison's disease genetic or inherited?
Research has shown that Addison's disease is genetic, but the exact method of inheritance is not yet known. It is thought that there may be an environmental trigger. There are ongoing research projects for several breeds, including Standard Poodles, Leonbergers, Great Danes and West Highland White Terriers, with hopes of identifying a genetic marker. However, at this time, there is no specific test to identify the gene, only the test to diagnose whether or not the dog’s adrenal glands are functioning properly.
If you're interested in learning more, here's some information on some of the research being done on Addison's:
If you have a dog with Addison’s disease, he or she may qualify to participate in a research study. Please visit the UC Davis website for more information.
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ADDISON'S DISEASE
EDUCATIONAL READING
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Addison Dogs Interview
With Dr. Julia A. Bates, DVM, DACVIM
Lower Initial Dose Desoxycorticosterone Pivalate for Treatment of Canine Primary Hypoadrenocorticism
Novartis Roundtable Discussion
The Great Pretender
Addison's Disease
Testing For Addison's Disease
Understanding ACTH Stimulation Test
Updates on Hypoadrenocorticism
Glossary of Terms
Types of Addison's Disease
Terms Used In Addison's Disease
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Where To Purchase
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Florinef Compounding Pharmacies
Finding Financial Help
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HELPFUL CALCULATORS
DOCP Calculator
Electrolyte Ratio Calculator
Glucocorticoid Calculator
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