Pros and Cons of Percorten vs. Florinef


The information provided below is a hopefully unbiased compilation of the pros and cons of  Percorten-V and Florinef. Please note that the intention of this document should not be interpreted as a recommendation of either medication over the other but to provide as much information as possible, enabling you to arrive at your own (informed) decision.  There is no “one size fits all” and treatment choices best suited for a particular dog must be determined after careful consideration and open discussion between the owner/caretaker and their veterinarian.

Percorten-V is a slow-release suspension and is administered by IM (intramuscular) or SubQ (subcutaneous) injection every 25 - 31 days. Florinef and the generic equivalent, fludrocortisone acetate must be given daily since it has a half-life of 18 - 36 hours.

Percorten-V, also known as "DOCP" or desoxycorticosterone pivalate, is a mineralocorticoid (aldosterone analog). It’s only function is to balance and control serum electrolyte (sodium and potassium) levels. Therefore a separate glucocorticoid (cortisol analog) is also necessary, usually provided in the form of a very small daily dose of prednisone.
Prednisone is widely available in strengths of 1.0, 2.5, 5.0, 10, 20, and 50 mg tablets and although prednisolone has the same properties as prednisone, it can be purchased in a pediatric liquid form (brand name “Pediapred”: 5 mg/5ml) with a calibrated dropper and is very useful for measuring the very small dosage amounts necessary for the maintenance of toy breeds.
Percorten-V is only available in the U.S., Canada, Australia ~and recently, Denmark. Percorten was originally developed for the treatment of Addison's Disease in humans but the demand for it decreased significantly once Florinef was available. Unaware that their product was being prescribed “off-label” for the treatment of canine Addison’s Disease and faced with a decreased demand for Percorten, the manufacturer *almost* discontinued production until the veterinary community rose up and voiced their distress! Field trials were run and the FDA approved the use of Percorten-V (the "v" is for veterinary) and the rest is history. For more detailed information, the entire "Fascinating Story of Percorten-V" can be found here:

Florinef is a daily oral medication and is used successfully all over the world for the management of Addison's in humans AND canines. Florinef was developed for humans and is prescribed "off- label" for the treatment of Canine Addison’s Disease.
Dogs cannot metabolize this medication as well as the species it was designed to treat. Therefore, dosage requirements for canine maintenance begin at approximately one (0.1 mg) tablet for every ten pounds of body weight, while humans require only one or two tablets daily. Electrolyte testing determines the dose and *if* the dog requires a higher dose, it MUST be increased to whatever amount is necessary to obtain the desired result. Many dogs live out their entire lives, managed quite effectively on the same dose while others may require frequent adjustments during the first year. Some (but certainly not all) dogs, after several years might require even more Florinef to maintain the same control. Whatever amount it takes to balance the electrolytes is the *correct* dose. “It takes what it takes.”
Some owners prefer the feeling of control they get by administering their dog's medications daily. Adjustments (if needed) can be made quickly and it only takes a few days to see the effect of these changes in dose reflected in electrolyte test results.

Percorten-V provides immediate and complete control over sodium and potassium levels, however you still need to adjust the amount to the dog's individual requirements. With Percorten-V, they often require LESS than their starting dose after a month or two due to a cumulative or “overlap” effect from one month to the next. The benefit is that once you determine your dog's "personal best" dosage and schedule (measured by electrolyte test results), that's pretty much all there is to it. As long as they have at least one functioning kidney, it would be highly unusual for a dog to “outgrow” Percorten-V.

The cost of maintaining a dog on Percorten-V or Florinef varies from location to location and depending on the individual veterinary practice's markup, owners of large breed dogs may have no choice but to use the oral medication, "compounded" by a pharmacist into one capsule containing an entire day's dose. For toy dogs, Percorten-V may actually be less expensive than Florinef or its generic equivalent.

Percorten-V is not available in a generic formulation and is sold by Elanco only to veterinarians or veterinary pharmacies with a veterinarian on staff. Florinef is available from any human pharmacy and also from many online and mail order sources.
Note: Percorten-V®, Florinef® and fludrocortisone acetate are available by prescription only.

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