Comparison Chart: Vetoryl vs. Compounded Trilostane

Below is a comparison of Vetoryl and compounded trilostane. If you are trying to decide which treatment option to pursue for your dog, it may help you make a more informed choice. Please note, if you haven’t read our other article on this topic, Compounded Drugs: another option for Cushing’s, you might want to consider doing so before reading this one.

Active Ingredient

• Vetoryl: contains trilostane as its active ingredient, which reduces cortisol production by the adrenal glands

• Compounded trilostane: contains trilostane as its active ingredient.

Producer

• Vetoryl: manufactured by Dechra, a veterinary pharmaceutical company. Dechra has multiple manufacturing sites in Europe and the United States.

• Compounded trilostane: made by compounding pharmacists. To make compounded trilostane, a pharmacist will start with Vetoryl and reformulate it. This could consist of adding flavoring, changing the drug from a capsule to a liquid, removing allergens, or other modifications.

Approval

• Vetoryl: approved by the U.S. Food and Drug Administration (FDA) in 2008 for the treatment of pituitary dependent and adrenal dependent Cushing’s disease in dogs.

• Compounded trilostane: compounded drugs do not go through an FDA approval process. This is one way that they differ from Vetoryl and other drugs made by pharmaceutical companies.

Safety

• Vetoryl: FDA evaluated Vetoryl for safety prior to approving it in 2008. Additionally, the facilities that produce Vetoryl are required to comply with FDA’s rigorous quality control standards to prevent contamination and ensure every batch is safe for use.

• Compounded trilostane: compounded drugs are not subject to the same degree of oversight as approved drugs. FDA does not evaluate the safety of compounded drugs or regulate the production practices of most compounding pharmacies. Rather, compounding is usually regulated by state boards of pharmacy, which vary in their amount of supervision. This doesn’t mean that compounded trilostane is necessarily harmful. However, to keep your dog safe, it’s important to be cautious and always purchase from a reputable pharmacy.

Effectiveness

• Vetoryl: FDA evaluated Vetoryl for effectiveness prior to approving it in 2008. Further, the facilities that produce Vetoryl are required to comply with FDA’s good manufacturing practices, which help ensure that each and every capsule of medication will work as expected.

• Compounded trilostane: as noted in the “safety” section above, compounded drugs are not subject to the same degree of oversight as approved drugs. FDA does not review compounded drugs for effectiveness or regulate the production practices of most compounding pharmacies. It’s mostly up to the individual pharmacy to put quality controls in place and ensure that all compounded drugs are free from errors, such as being weaker or stronger than they should be. This is why it’s important to source compounded trilostane from a reputable pharmacy, preferably one that is transparent about its processes.

Physical Form

• Vetoryl: capsule

• Compounded trilostane: available forms include liquid, chewable, and capsule

Strengths (mg)

• Vetoryl: available in 5 mg, 10 mg, 20 mg, 30 mg, 60 mg, and 120 mg capsules

• Compounded trilostane: available in a broader range of strengths than Vetoryl. If your dog needs under 5 mg of medication or another dose that Vetoryl doesn’t come in, you might want to consider compounded trilostane.

Cost

• Vetoryl: cost depends on the dosage strength and retailer.

• Compounded trilostane: tends to be much cheaper than Vetoryl. Cushing’s dogs usually need medication and testing for the rest of their lives, and treating with compounded trilostane can help save money.

Monitoring

• Vetoryl: after starting Vetoryl, your dog will need frequent blood tests to measure cortisol levels and make sure he or she is on the right dose. The traditional monitoring test is an ACTH stimulation test, but some veterinarians also offer a new method called a pre-Vetoryl cortisol test. More details can be found in our article, All About Vetoryl.

• Compounded trilostane: dogs on compounded trilostane are monitored the same as dogs on Vetoryl.