Trilostane in dogs with Cushing's: how to start treatment
9-year-old, 8 kg Poodle with polyuria/polydipsia, polyphagia, panting and a pot belly. Pituitary-dependent hyperadrenocorticism has been confirmed and trilostane is to be started.
Which starting plan is most appropriate?
chevron_right Show answer and explanation
A. Start with a low dose, give it with food and recheck at 10–14 days with examination, electrolytes and cortisol
Correct. Low starting doses (given once or twice daily) control many dogs with fewer adverse effects. Food improves absorption, and the first recheck is done once the effect has stabilised.
B. Give it on an empty stomach to improve absorption and recheck at 3 days
It is the other way round: trilostane absorption improves with food. At 3 days the effect has not yet stabilised and a recheck is not useful for dose adjustment.
C. Start with a high dose to control signs quickly and then reduce it
High doses increase the risk of hypocortisolism and adrenal necrosis without benefit: the signs still take weeks to resolve.
D. Adjust the dose weekly until the polyuria resolves
Changing the dose too often prevents you from seeing the effect of each dose. Some signs (skin, abdomen) take months to improve; adjustments are based on signs and cortisol at spaced rechecks.
lightbulb Key takeaway
With trilostane, start low and go slow: a low dose with food, first recheck at 10–14 days and then at 4 weeks. Tell the owner to stop it and call if the dog becomes lethargic, vomits or stops eating.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.