(for veterinary information only)
BRAND NAME: INCURIN
Estrogens are potent female hormones produced naturally by the ovary and needed for the normal development of the female reproductive tract as well as for normal female fertility. Synthetic estrogens have, in the past, found assorted medical and industrial uses. In the 1960's researchers found that sphincter-related incontinence in post-menopausal women was alleviated with the administration of estrogens. Soon, the sphincter incontinence that is common in spayed female dogs was also being treated effectively with estrogen in the form of diethylstilbestrol (DES).
DES continues to be available to patients through compounding pharmacies; however, estriol has since received FDA approval and represents a new way to use estrogens for sphincter incontinence in female dogs.
HOW THIS MEDICATION IS USED
Several protocols have been published and tested regarding initial use of estriol for canine incontinence. They all come down to this: begin at a daily dose for approximately two weeks and, if it works, taper to a lower dose each week until the minimum effective dose for the individual dog has been determined. At least seven days at each dose adjustment are needed to assess the dose. Approximately 90% of dogs will either be completely continent or significantly improved with this medication. The maximum dose of this medication is felt to be 2mg daily but if incontinence is not resolved after two weeks of this dosage then the diagnosis and treatment plan should be reconsidered.
Never give more than 2mg of estriol in a 24 hour period. If a dose is accidentally skipped and a day has not passed, the dose can simply be given when it is remembered. If a day is accidentally skipped, simply give the next dose as scheduled. Do not double up on doses.
Estriol can be given with or without food.
The most common side effects of estriol were reduced appetite and vomiting. Appetite reduction was experienced in about 13% of dogs and vomiting in about 10%. Increased thirst is also a reported side effect. Reducing the dose generally controls these issues.
Effects related to female hormones are also seen but rarely: swollen vulva (4% of patients), sexual attractiveness (3.5% of patients), breast enlargement and behavior consistent with being in heat (1%) of patients.
Estriol is a very short-acting female hormone which affords extra safety compared with other female hormones. Bone marrow suppression has been an issue with other estrogens but this has not been reported with short acting estrogens such as estriol at the very low doses needed to correct urinary incontinence.
INTERACTIONS WITH OTHER DRUGS
The use of this medication may alter thyroid hormone levels.
This medication should not be used in combination with other estrogens or there may be an increased risk for hormone-related side effects, the worst of which being bone marrow suppression.
Concurrent use of phenobartital for may interfere with the effectiveness of estriol by enhancing its removal from the body.
Concurrent use of ketoconazole may elevate blood levels of estriol by interfering with its removal from the body. Similar issues occur with use of cimetidine (an antacid) and macrolide class antibiotics (such as clarithromycin or erythromycin).
Concurrent use of estriol and cyclosporine (an immunomodulator) may increase cyclosporine blood levels.
Thyroid supplements may not work as well in the presence of estriol.
Ursodiol may not work as well in the presence of estriol.
CONCERNS AND CAUTIONS
Two tablets daily is felt to be the maximum dose for any dog and if this is not adequate to control incontinence, another therapy or further diagnostics should be elected.
Estriol should not be used in male dogs, pregnant or lactating dogs, or dogs under age 1 year.
Pregnant or breast-feeding women should wash their hands after handling estriol.
Estriol should be used with caution in patients with liver disease.
Estriol should be stored at room temperature in blister packs, protected from light.
Page posted: 10/17/2010