ZYCORTAL Suspension contains desoxycorticosterone pivalate which is a mineralocorticoid hormone indicated for use as replacement therapy for mineralocorticoid deficiency in dogs with primary hypoadrenocorticism (Addison’s disease). ZYCORTAL Suspension was formulated and approved specifically for subcutaneous use. The desoxycorticosterone pivalate (DOCP) in ZYCORTAL Suspension is a pure mineralocorticoid hormone that regulates electrolytes and water balance, which are impaired in cases of mineralocorticoid deficiency in Addison’s disease. only. Dogs with combined glucocorticoid and mineralocorticoid deficiency should also be treated with prednisone or prednisolone at an initial dosage of 0.2-0.4 mg/kg/day (0.1-0.2 mg/lb/day). Use ZYCORTAL Suspension with caution in dogs with congestive heart disease, edema, severe renal disease or primary hepatic failure. Refer to the prescribing information for complete details at booth #2327 or visit www.dechra-us.com\zycortal Released March 2016.
- What are some of the diagnostic clues to Addison's disease?
- How should hypoadrenocorticism be treated?
- How should ZYCORTAL Suspension be used? How safe and effective is the drug?
- Chronic signs of hypoadrenocorticism are often intermittent and nonspecific so it's important for veterinarians to keep it on their rule-out list.
- DOCP is the standard of care for treating dogs with hypoadrenocorticism
- The prognosis for affected dogs is excellent with appropriate treatment and owner education.
- ZYCORTAL Suspension is a safe, effective, and cost-effective option for treating hypoadrenocorticism.
- Dechra is the leading industry expert in veterinary endocrinology and provides many tools to help veterinarians with their endocrinology patients.
Q: Could you start by reviewing Addison’s disease for us?
A: Sure. As veterinarians know, hypoadrenocorticism (or Addison’s disease) is an endocrine disease where the adrenal glands do not produce enough glucocorticoid (mainly cortisol), mineralocorticoid (mainly aldosterone), or both hormones. Most cases of hypoadrenocorticism are a result of primary adrenal failure resulting in a deficiency of both cortisol and aldosterone. Chronic signs of hypoadrenocorticism are often intermittent, vague and non-specific such as lethargy, inappetence, weakness, vomiting, diarrhea and weight loss. These can be exacerbated or induced by stress and can often be mistaken for other diseases such as gastroenteritis or kidney disease. Acute signs of hypoadrenocorticism are often due to hypovolemic shock. These dogs typically present with vomiting, diarrhea and collapse and have life-threatening hypovolemia. This condition is also known as Addisonian crisis. For these dogs, it’s critical they be quickly rehydrated with intravenous fluid therapy.
Q: What are some of the indications that a veterinarian might see in clinical history that might get them thinking about Addison’s disease?
A: A few scenarios that should raise the index of suspicion of hypoadrenocorticism include a normal or slow heart rate in the presence of circulatory shock, a prior positive response to corticosteroid or fluid therapy, and "waxing and waning" signs such as lethargy, inappetence, weakness vomiting and/or diarrhea prior to collapse.
Q: Is there a preferred diagnostic test to confirm suspected Addison’s disease?
A: The ACTH stimulation test is the gold standard for diagnosing hypoadrenocorticism in dogs. The pre and post-ACTH cortisol concentration in most dogs is < 1 µg/dL; however, a post-ACTH cortisol of < 2 µg/dL is considered positive for the disease.
Q: Since veterinarians might not come by an Addison’s case every day, or even every week, are there any tools available that vets and techs might keep on hand to help them through the diagnosis process?
A: Absolutely. Dechra is the leading industry expert in endocrinology. We know that topics such as adrenal disorders can be tricky to navigate. So, in addition to our highly-trained team of veterinarians and technicians that are always on-hand to assist veterinarians and their staff, we are constantly developing new tools to help out at the clinic level. One such tool is our Diagnosis Flow Chart to help veterinarians who may suspect hypoadrenocorticism which can be found on our website. This tool is perfect to keep on hand in the treatment area of any hospital.
Q: What is the prognosis for dogs with hypoadrenocorticism?
A: The prognosis is excellent providing owner education is adequate and the patient is well-controlled with glucocorticoid and mineralocorticoid products. It may take several visits and multiple monitoring blood tests to find the optimal maintenance dose of both products, but in general, dogs being treated properly should be happy dogs with a normal appetite and have a high quality of life. Owners need to be educated about the life-long commitment to medicate and monitor these patients and that additional glucocorticoid supplementation is needed during stressful situations such as surgery or a simultaneous medical illness, boarding, traveling and 4th of July firework shows.
Q: What is the current drug of choice for long-term mineralocorticoid replacement?
A: Desoxycorticosterone pivalate is the standard of care for dogs with hypoadrenocorticism.
Q: So DECHRA now makes a DOCP injectable. Can you tell us a little about it?
A: ZYCORTAL Suspension is an FDA veterinary approved drug containing 25 mg/mL of desoxycorticosterone pivalate. It is a synthetically produced steroid hormone very similar to the natural hormone aldosterone. It works in the same way as aldosterone to retain sufficient fluid in the body by retaining sodium and eliminating potassium. ZYCORTAL Suspension should be administered on a long-term basis approximately once a month. How is it used? Before each use, the vial should be thoroughly shaken to resuspend the product. ZYCORTAL Suspension is injected subcutaneously at an initial dose of 2.2 mg/kg. The serum Na+ and K+ electrolyte concentrations should be evaluated approximately 10 and 25 days after the first dose. The package insert provides details on adjusting the second dose of Zycortal Suspension. Because ZYCORTAL Suspension replaces the mineralocorticoid hormones only, dogs with combined glucocorticoid and mineralocorticoid deficiency should also be treated with prednisone or prednisolone at an initial dosage of 0.2 to 0.4 mg/kg/day. ZYCORTAL Suspension is intended for long-term administration at intervals and doses dependent upon individual response. The dose of both ZYCORTAL Suspension and glucocorticoid replacement should be tailored to the individual dog based on clinical response and normalization of Na+ and K+ concentrations. For most, a lower final dose of both products will be needed. ZYCORTAL Suspension has a three-year shelf life from the date of manufacture and should be used within 120 days of first broaching a vial.
Q: How effective is ZYCORTAL Suspension?
A: The effectiveness of ZYCORTAL Suspension was investigated in a field study involving 152 dogs with hypoadrenocorticism. ZYCORTAL Suspension was administered subcutaneously to 113 dogs and a similar product containing desoxycortone pivalate was administered intramuscularly to 39 dogs. All dogs also received corticosteroids orally. In this study, ZYCORTAL Suspension was shown to be at least as effective as the other similar product with 82% of Zycortal-treated dogs having improved clinical signs and normal Na+ and K+ concentrations after 90 days of therapy.
Q: Is it safe?
A: Yes. But as with all drugs, side effects may occur. The most common adverse events in the field study were polydipsia, polyuria, vomiting and lethargy. ZYCORTAL Suspension administration for up to 180 days was well tolerated. ZYCORTAL Suspension should be used with caution in dogs with congestive heart disease, edema, severe renal disease or primary hepatic failure. Veterinarians should refer to the prescribing information for complete details.
Q: What is the cost?
A: ZYCORTAL Suspension is the lowest cost option currently on the market. It can typically be found through your favorite distributor at about 8% below the competition, which is around $128. And each bottle of ZYCORTAL Suspension is 15% off through the end of March.
Q: Do you recommend any tools for the management of Addison’s?
A: Yes. We developed a Monitoring and Dose Adjustment Flow Chart that is similar to the Diagnosis flowchart I mentioned earlier to help guide veterinarians through the treatment process. It is very important to achieve the proper dose of ZYCORTAL Suspension and this chart will help with that. And because it’s vital that clients understand the importance of monitoring their dogs and keeping their scheduled follow-up visits, Dechra also supplies client brochures to help veterinarians communicate with the pet owners. All of these tools can be found on Dechra’s website.
Q: Where can veterinarians find more information about Zycortal Suspension?
A: Our website, www.dechra-us.com contains the full prescribing information and any additional information they might need. The website also offers Dechra Academy, which is a great resource for continuing education. Our featured course is a two part series on Addison’s disease presented by Dr. Audrey Cook from Texas A&M University. Veterinarians can also contact their Dechra representative or Dechra’s Veterinary Technical service team. Their phone number can be found on our website. During WVC, attendees can also stop by our booth. We are booth # 2327.
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