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:
http://canineaddisonsinfo.com/TheFascinatingStoryOfPERCORTEN.doc
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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