Addison's & florinef - how much is too much??

Re: Addison's & florinef - how much is too much??

vs0u — Tue, 30 Apr 2013 16:22:12 GMT

We have one that is on 'slow sodium' tablets - they are slow release sodium chloride, for a more medical version of salt supplementation!

Re: Addison's & florinef - how much is too much??

Rob Davis — Mon, 29 Apr 2013 16:45:51 GMT

Some do seem to need additional salt long term. I have never tried BID dosing - never found it necessary, but will bear that in mind for the future.

Re: Addison's & florinef - how much is too much??

John Flynn — Sat, 27 Apr 2013 20:57:28 GMT

[quote user="Claire Fisher"]They did also suggest DOCP as an alternative but I think that needs to be imported.[/quote]

I looked into importing DOCP as a logical alternative to fludrocortisone for a dog which had adequate cortisol levels but non-detectable aldosterone levels (both pre- and post-ACTH).

Novartis Canada are set up to do this, but the cost was astronomical, especially by the time you cover all import/export bureaucracy.

Re: Addison's & florinef - how much is too much??

Elisabeth Knappett — Sat, 27 Apr 2013 19:16:05 GMT

I have 3 cases on supplemental salt - one has come off it and fully stabilised on florinef, the others are still on it. I usually split to twice daily dosing once the tablets can be split equally! But have found that pets seem to stabilise better on twice daily. I suspect that its not too important if the sodium is slightly low, but how low is too low? I think salt supplementation is worthwhile if they are still symptomatic with normal K+ levels rather than increasing florinef alone, not based on anything but personal experience - don't know whether others have a more scientific basis?!

Re: Addison's & florinef - how much is too much??

Martin Atkinson — Fri, 26 Apr 2013 18:59:19 GMT

[quote user="Holly Lee"]Interesting regarding stopping supplementing salt once sodium normal - I'd assumed it would be necessary long term if it worked. Does this vary between cases? Do most people stop or continue?[/quote] My experience is that once salt is needed it is always needed, as said earlier in the thread some dogs just don't stabilise their Na on Florinef alone but it does beg the question: does it matte if its a bit low if the Na:K ratio is OK?

Re: Addison's & florinef - how much is too much??

Holly Lee — Fri, 26 Apr 2013 18:52:36 GMT

She is just once daily at the moment - I have discussed with the owner we might try changing to twice daily.

Are most people dosing twice daily rather than once?

Re: Addison's & florinef - how much is too much??

Andrew Kent — Fri, 26 Apr 2013 18:49:24 GMT

Are you currently just dosing once daily? I would agree that most dogs are more stable on twice daily dosing and think the Bsava formulary is wrong suggesting dogs are started on once daily dosing.

Re: Addison's & florinef - how much is too much??

Holly Lee — Fri, 26 Apr 2013 18:45:37 GMT

Thank you all for your input - I definitely feel better about the case now!

Chloride has been low alongside sodium - the values haven't changed with the last 2 dose increases and potassium is at good level so I've advised her to add some salt to the diet and recheck electrolytes in 2 weeks. If that does the trick I may try to reduce the dose as the potassium was normal on lower doses of meds. Fortunately the owner is lovely and keeping blood testing and adjusting things not a problem.

Interesting regarding stopping supplementing salt once sodium normal - I'd assumed it would be necessary long term if it worked. Does this vary between cases? Do most people stop or continue?

Really appreciate the thoughts - this is the first Addisonian dog I've had that hasn't just rapidly returned to normal on starting treatment so I'm happy to hear it's not that uncommon to have this issue.

Re: Addison's & florinef - how much is too much??

Martin Atkinson — Fri, 26 Apr 2013 18:44:27 GMT

[quote user="Elisabeth Knappett"]I would agree on adding salt to the diet initially and monitoring electrolytes,I always said a teaspoon a feed if the dog tolerated it,[/quote] Same here, that dose was also the dose suggested by the RVC for a case which ended up there.

Re: Addison's & florinef - how much is too much??

David Hopper — Fri, 26 Apr 2013 18:29:12 GMT

If it's any consolation I have a standard poodle on 4 tablets of Florinef twice daily and he has been very stable for a long time except when I tried to reduce the dosage when a pharmacist suggested I was overdosing, so don't worry.

Re: Addison's & florinef - how much is too much??

Elisabeth Knappett — Fri, 26 Apr 2013 17:24:57 GMT

I would agree on adding salt to the diet initially and monitoring electrolytes, splitting the dose to twice daily can also help in awkward cases. Just make sure that it is 'normal' table salt, not the Lo salt stuff! I always said a teaspoon a feed if the dog tolerated it - not sure what doses otehrs use, and to stop the supplementation when the values normalise, what was the chloride level?

Re: Addison's & florinef - how much is too much??

Rob Davis — Fri, 26 Apr 2013 17:03:58 GMT

I have a labrador on 1.4mg daily (I use 0.4mg fludrocortisone tablets so only 4.5 rather than 14). He has been stable on the dose for 7 years now. I often find that some cases need extra salt added to the diet. I have one owner who finds this very difficult to do as she is so used to reducing the salt intake for her family - it is an ongoing battle to get her to keep adding it!

Re: Addison's & florinef - how much is too much??

Ian Mostyn — Fri, 26 Apr 2013 16:06:46 GMT

I have a weimaraner on 7 tablets daily, a border collie on 5, a staffie on 9 tablets and a 2nd border collie on 17 !! The second collie has been stable on this dose of 5 years now, also on thyroid meds and has a dodgy eye but looks absolutely fine with good bloods. All the others needed those doses to stabilise so as long as you repeat the bloods after a dose change and steadily increase as needed, I wouldn't say there is a maximum dose.

Ian

Re: Addison's & florinef - how much is too much??

Claire Fisher — Fri, 26 Apr 2013 15:48:39 GMT

We have a GSD (about 35kg) who has 14 florinef a day - 7 bid.

Splitting the dose was suggested by the medics at Liverpool to get better control, we also add salt to his diet.

They did also suggest DOCP as an alternative but I think that needs to be imported.

Re: Addison's & florinef - how much is too much??

Andrew Kent — Fri, 26 Apr 2013 15:17:54 GMT

I would second adding salt to the diet, we often do this routinely

Re: Addison's & florinef - how much is too much??

Ana Santos — Fri, 26 Apr 2013 14:38:42 GMT

I was following a 5kg Yorkie for the past months. She was diagnosed with Addison about 7 years ago and she was on 6 tablets of florinef daily (3 tablets bid)!!!! Aparently it was the only dose that she was stable on. Last electrolytes were perfect and died recently of severe hepatic failure at the age of 14yo.

So, I'm not sure how much it too much.

Re: Addison's & florinef - how much is too much??

Martin Atkinson — Fri, 26 Apr 2013 14:09:49 GMT

Never had one on as many as 7 so I do smell a rat here. How low is the Na? What is the glucose? What is your haematology telling you? if that is normal, your K is normal and Na:K ratio is >27 although preferably over 30, and the renal values are normal I wouldn't worry, indeed if these have also stayed the same through the last 3 dose increases I might be inclined to gradually reduce the dose and give a salt supplement with the food.