The Story of Percorten-V

If your dog is on Percorten-V, you may be interested to know how this product became available in the first place. In fact, desoxycorticosterone pivalate, or DOCP, was first developed to save human lives. Although Addison’s is uncommon, the seriousness of the disease (i.e. it results in death) prompted research into the disorder.

Glucocorticoids and mineralocorticoids were developed in the 1930s to treat Addison’s disease in humans. Shortly after, DOCP became commercially available. Addison’s sufferer President John F Kennedy used to inject DOCP every 25 days. during the time that DOCP was being used in humans, veterinarians were using it “off label” to treat dogs. When an oral drug was developed in the 1960s for Addison’s in humans, sales of DOCP dropped so low that the drug’s manufacturer, Ciba-Geigy, discontinued manufacturing it.

When distribution of the drug stopped, veterinarians complained bitterly. It wasn’t just veterinarians who complained — President Reagan’s dog (actually his daughter’s dog) was receiving DOCP injections and he was dismayed when the drug was discontinued.

Ciba-Geigy Animal Health understood that dogs could die without the medication, so applied for a special license from the FDA, called an Investigational New Animal Drug Status. The FDA gave the company permission to dispense the drug for compassionate use. For nine years afterwards, Ciba-Geigy / Novartis conducted research trials into the drug’s effectiveness for canine hypoadrenocorticism.

In 1998, the FDA granted Novartis approval to market Percorten-V in dogs. The suffix “V” indicates the drug is for veterinary use. Florinef — the tablet developed for use in human Addison’s, is available “off-label” in the US, meaning that veterinarians sometimes prescribe it although it is not FDA approved for veterinary use.

Why is Percorten-V so expensive?

Addison’s disease affects a small number of dogs, so only a tiny amount of Percorten-V is manufactured each year. In addition, the hormone, obtained from natural sources, has to undergo a complex chemical process to become Percorten-V. Each production lot must be rigorously tested to meet strict safety standards.

Canine Addison’s Disease: Does Your Dog Need Prednisone?

When my border collie, Shakti, was first treated for canine Addison’s disease. the veterinarian recommended 20mg of prednisone daily, in addition to her monthly shots of Percorten-V.  She had adverse skin reactions to the prednisone, but after reducing her dose to 2.5mg/day, her skin healed and she’s doing great. However, that begs the question: how much prednisone does your dog need and in fact – does your dog need prednisone at all? If you search the internet, you’ll find a variety of answers. Some suggest that you don’t need to administer prednisone at all, others (like the Novartis website) state that prednisone is very necessary. Here are the facts:

1. Each dog is different, and almost every case of canine Addison’s disease is different (that’s part of the reason why canine Addison’s disease is so hard to diagnose in the first place).

2. Percorten-V (or Florinef) only replaces the mineralcorticoid hormones. In order to replace glucocorticoids, your dog must be given prednisone. According to the Novartis website, the question isn’t if but how much.

3. The only way to accurately prescribe a dose of prednisone is by having regular blood tests (to check for electrolytes). While regular blood tests in the beginning can be expensive, they are practically mandatory for finding the lowest possible “maintenance dose” for your pet. Why is it important to find a maintenance dose? Too much prednisone, and your dog could suffer a host of unpleasant side effects like hair loss and skin infections; too little prednisone and your pet could be in danger of suffering an Addisonian crash, which could be fatal.

4. Failure to give dogs with Addison’s a glucocorticoid replacement is the number one reason why treatment can fail. If your pet is depressed, lethargic or vomits and has diarrhea, those are all signs of glucocorticoid deficiency.

In essence, make sure you give your dog both glucocorticoid and mineralcorticoid replacements. It is the rare dog that is able to survive without glucocorticoid replacement. Failing to give your dog prednisone is dangerous and not advisable.

Addison’s Disease in Dogs — Update on Shakti

Our border collie, Shakti, was diagnosed with Addison’s disease in dogs about four years ago. We went through some tremendously stressful (and expensive) veterinary visits, including an Addisonian crash, several visits to a specialist to combat side effects of prednisone, and then of course there are the monthly shots.

The fact of the matter is, that Shakti’s treatment did initially not go well! Why? Well, think about the illness from the perspective of a human with Addison’s disease. If you’re taking medications and those medications are making you sick with side-effects, you’ll tell your doctor about it. Your blood work might be wonderful, but if you’re suffering from itchy skin or nausea, you’ll let your doctor know so that maybe he can adjust your meds. It took me a while to realize that although Shakti’s blood tests were great — she was certainly not. But — of course — she was unable to tell us what exactly was wrong. So it was up to me to “listen” to her.

A year or so into treatment, Shakti was getting Percorten shots every 25 days and prednisone (20mg) every day. When her hair started to fall out and red rashes appeared on her skin, her vet referred us to a specialist, who in turn referred us to a dermatologist. When the bills started to get out of hand (and Shakti’s health did not improve), I took matters into my own hands and adjusted her medications myself (after a lot of research into the meds). Slowly, we reduced the prednisone from 20mg a day to 2.5 mg a day. Her coat started to grow back, and now she has a beautifully thick, shiny and fluffy coat. She’s also got her energy back, and we frequently go on long walks (something she couldn’t do before). Additionally, I adjusted her Percorten schedule. Instead of going religiously every 25 days, I watch her for signs that she’s not feeling good. For example, she might vomit unexpectedly or act lethargic. I take her to the vet the same day for her shot, which usually means around day 28-31.

My vet is in agreement with this schedule. It sounds a little drastic (to wait until she looks unwell or vomits) to take her for a shot, but consider what she was acting like years ago before we made the decision to adjust her schedule so that she received the minimum amount of medications to remain healthy. Despite great blood work and a consistent drug regime, she was exhibiting classic signs of Addison’s disease in dogs and side effects from her medications:

• Stomach problems including diarrhea, frequent trips to the bathroom, nausea and vomiting. These episodes were frequent — sometimes weekly (especially the vomiting).
• Hair loss, bald patches, red rashes on skin

Now we’re down to a single side effect — very infrequent (perhaps once a month) nausea and vomiting.

You know your pet best. Take note of how they are acting, what their signs and symptoms are, and research all of the medications they are taking for Addison’s disease. Addison’s disease in dogs is not a common disease for veterinarians to deal with. They perhaps have one or two clients on their books with the disease. So they have to resort to literature to decide on a treatment plan, rather than their own experience or expertise. You know your pet best! By all means work with your vet to decide on a treatment plan, but ultimately, your pet is depending on you to feel better!

Dental Care for Addison’s Disease in Dogs

Dental care is important for your pet. A dental cleaning — both above and below your pet’s gum line — leaves your pet with health gums and clean teeth. The procedure can prevent serious bacterial infections resulting from tooth decay and periodontitis.  In addition, some pets may need immediate dental treatment, for broken teeth or abscesses.  However, procedures that require general anesthesia can be dangerous for dogs with Addison’s disease.

Why is General Anesthesia Dangerous for Addison’s Disease in Dogs?

During a stressful event like surgery, the adrenal glands will increase cortisol production as a defense mechanism against the stress. For dogs with Addison’s disease, this increase in cortisol does not happen, which can lead to dangerous fluid imbalances, heart rhythm problems or even an Addisonian crisis. While injections of hydrocortisone and saline can help your pet deal with the stress of surgery, it isn’t an exact science and can therefore be a risky undertaking.

What if my Dog Really Needs Dental Treatment?

If you live on the West Coast or mid-central United States, check out this website, which has a list of holistic veterinarians that perform dental cleanings and some dental procedures without general anesthesia. Instruments and techniques are introduced gradually so that your pet remains comfortable throughout the procedure — this is vital for dogs with Addison’s disease, as stress can kill. If you aren’t in these areas, call around your local veterinary offices to try to locate an independent holistic vet in your area.

Some dogs may need general anesthesia, especially if they have advanced oral health problems like gum disease, oral tumors or stomatitis — an inflammation of the mucous lining in the mouth. In these severe cases, you need to weigh the risks of dental treatment with the risks of general anesthesia for your pet. At a minimum, the vet performing the oral surgery should be intimately familiar with Addison’s disease in dogs.

Canine Addison’s: How to Switch from Florinef to Percorten V

Florinef is a drug for Addison’s disease that is approved by the FDA for treating Addison’s disease in humans. It isn’t approved for use in canine Addison’s, although it is used “off label” by veterinarians for use in canine Addison’s disease. As Florinef isn’t supposed to be used in dogs, it can be difficult to find a maintenance dose — a dose that will keep your dog’s electrolytes stable. For that reason, many owner’s who have a pet with canine Addison’s choose to switch from Florinef to Percorten-V, the only drug on the market that is specifically geared towards dogs with canine Addison’s disease. Switching from Florinef to Percorten-V is relatively easy, although one you’ve made the switch, you’ll have to have a veterinarian check your pet’s electrolytes to establish that maintenance dose.
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How to Switch from Percorten V to Florinef

It used to be that Percorten-V was the only medicine available to treat canine Addison’s disease. Then along came Florinef, which is a human treatment for Addison’s disease; it is used “off-label” to treat Addison’s in dogs. While prices for both medications can vary wildly, owners of toy dogs might find it cheaper to switch from Percorten V to Florinef. Percorten-V is only available in the U.S., Denmark, Canada and Australia.
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Herbal Remedies for Canine Addison’s Disease

Although there is no herbal cure for canine Addison’s disease, there are several herbal supplements than can help lower your dog’s need for steroids and improve their overall health status. Lowering your dog’s need for DOCP and/or Florinef not only means a lower chance of side effects for your pet, but also can make a huge difference in your pocketbook. This article outlines the major herbal and plant remedies for Addison’s disease.
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How and where to give percorten-V shots on Addison’s dogs

You can give Percorten-V shots to Addison;s dogs at home. If you’ve never given a dog a shot before, ask your veterinarian to show you how to do it. This is especially important with Percorten-V, because accidental injection into a vein can cause collapse and shock (if you do inject accidentally into a vein, your dog should be taken to a vet immediately for life saving IV fluids and steroids).
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