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|Drug Name and Strength||Deoxycortone (desoxycorticosterone, deoxycorticosterone) pivalate (DOCP) 25 mg/mL|
|Indication||Replacement therapy for the mineralocorticoid deficit in dogs with primary adrenocortical insufficiency.|
|Contraindications||Administration to pregnant or lactating dogs, or to dogs suffering from congestive heart disease, severe renal disease or oedema.|
|Actions||DOCP is a long acting ester of deoxycortone acetate (DOCA), which is recognised as having the same qualitative effects as the natural mineralocorticoid hormone aldosterone. The most important effect of DOCP is to increase the rate of renal tubular absorption of sodium, particularly in the thick portion of the ascending limb of the loop of Henlé. Chloride follows the sodium out of the renal tubule. Another important effect of DOCP is enhanced renal excretion of potassium. This effect is driven by the resorption of sodium, which pulls potassium from the extracellular fluid into the renal tubules, thus promoting potassium excretion. DOCP also acts to increase extracellular fluid volume.The enhanced retention of sodium, chloride and bicarbonate creates an osmotic gradient that promotes water absorption from the renal tubules. The extracellular fluid volume is supported, which expands the blood volume and improves the venous return to the heart and cardiac output. The expanded blood volume and increased cardiac output may result in elevated blood pressure. Percorten-V prevents the life threatening hypotensive shock and prerenal azotaemia observed in animals suffering from hypoadrenocorticism.|
|Warnings||The effects of Percorten-V on electrolytes and extracellular fluid volume are dependent on a functioning kidney. Animals suffering from hypovolaemia, prerenal azotaemia and inadequate tissue perfusion must be rehydrated with intravenous fluid (saline) therapy, before starting Percorten-V therapy. Primary renal disease should be ruled out before starting Percorten-V therapy.|
|Precautions||Take care to prevent inadvertent intravenous injection, which may cause acute collapse and shock. Animals receiving inadvertent intravenous injection should immediately be treated for shock with intravenous fluids and glucocorticoids.First Aid For advice, contact a doctor or Poisons Information Centre (phone Australia 131 126) or a doctor at once.Disposal Dispose of empty vial by wrapping with paper and putting in garbage.|
|Dosage and Administration||General directions. An accurate diagnosis of primary canine adrenocortical insufficiency is of paramount importance for treatment success, and should be established before initiation of Percorten-V therapy by conducting an ACTH stimulation test. At diagnosis, classic cases of canine adrenocortical insufficiency typically may include clinical signs (anorexia, lethargy, depression, weakness, vomiting and/or regurgitation, weight loss, diarrhoea and collapse), serum sodium values < 135 mEq/L, serum potassium > 6 mEq/L, sodium/potassium ratios below 25:1, and a plasma or serum cortisol concentration < 4 microgram/dL before and after ACTH administration.Once the diagnosis is made, immediate therapy must be given to normalise electrolyte imbalance, correct hypovolaemic shock and re-establish normal homeostasis. Such therapy should include large volumes of intravenous physiological saline, glucocorticoids (i.e. prednisolone or dexamethasone) at shock doses and Percorten-V. Once the acute crisis has passed, renal and cardiovascular function should return to normal. Then begin chronic lifelong therapy with Percorten-V and glucocorticoids. Administration. Before injection, shake the vial thoroughly to mix the microcrystals with the suspension vehicle. Ensure sterile technique is used. Inject intramuscularly only. Begin treatment with Percorten-V at a dose of 2.2 mg/kg bodyweight every 25 days. In some patients the dose may be reduced. Serum sodium and potassium levels should be monitored to ensure the animal is properly compensated. Most patients are well controlled with a dose range of 1.7 to 2.2 mg/kg, given every 21 to 30 days.Dosage requirements are variable and must be individualised on the basis of the response of the patient to therapy. The well controlled patient will have normal electrolytes 14 days after administration, or may exhibit slight hyponatraemia and hyperkalaemia, and will be clinically normal (active and eating well). If the dog is not clinically normal or serum electrolytes are abnormal, then decrease the dosage interval by two to three days.In treating canine hypoadrenocorticism, Percorten-V replaces the mineralocorticoid hormones only. Glucocorticoid replacement must be supplied by small daily doses of glucocorticoid hormones (e.g. prednisone or prednisolone 0.2 to 0.4 mg/kg/day). Failure to administer glucocorticoids is the most common reason for treatment failure. Signs of glucocorticoid deficiency include depression, lethargy, vomiting and diarrhoea. Such signs should be treated with high doses of injectable glucocorticoids (prednisolone or dexamethasone), followed by continued oral therapy as above.Polyuria and polydipsia (PU/PD) in dogs on Percorten-V and glucocorticoid therapy usually indicates excess glucocorticoid, but may also indicate a Percorten-V excess. Begin by decreasing the glucocorticoid dose first; if PU/PD persists, then decrease the dose of Percorten-V. Refer to product leaflet for full directions for use.Oral supplementation with salt (NaCl) is not necessary for animals receiving Percorten-V.|
|Storage||Store below 25°C (air conditioning). Protect from light. Do not freeze.|
|MSDS (external link)||Percorten-V MSDS|
|Label (external link)||Percorten-V Label|
|Manufacturer||Elanco Animal Health|