Desoxycorticosterone Pivalate (DOCP)

What is desoxycorticosterone pivalate?

Desoxycorticosterone pivalate (DOCP) (brand name Percorten-V®, Zycortal®) is a steroid hormone replacement therapy used to treat primary hypoadrenocorticism (Addison’s disease) in dogs. Addison’s disease is a condition in which inadequate levels of steroid hormone (cortisol) are present in the body.

DOCP is a hormone replacement therapy that mimics the effects of the hormone aldosterone by increasing the kidney’s rate of sodium absorption and retention, and enhancing the kidney’s ability to excrete potassium. The balance of these electrolytes in the bloodstream is crucial to the control of Addison’s disease.

Off-label (extra-label) lower dosages of DOCP (i.e., lower dose, longer dosing interval, or both) can be used to control the balance of blood electrolyte levels. DOCP has also been used extra-label to treat hypoadrenocorticism in cats. Higher doses of DOCP may be required in cats as compared to dogs, although experience is limited, as this condition is rare in this species.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet desoxycorticosterone pivalate (DOCP)?

Desoxycorticosterone pivalate (DOCP) is an injectable medication that is given either under the skin (subcutaneously, SQ) or into the muscle (intramuscularly, IM). This drug is not meant to be injected into a vein (IV). If DOCP is injected intravenously, collapse due to shock may occur. If this happens, contact your veterinarian immediately.

If you choose to give these injections at home, be sure you fully understand how to draw the correct amount of the drug into the syringe, and the proper places to inject this medication (SQ or IM). The recommended time between doses, upon starting this medication, is once every 20 to 30 days. Your veterinarian will adjust the dose amount and time between doses based on your dog’s response to therapy.

• Shake the vial vigorously before drawing into the syringe.
• Use a new needle and syringe for each injection.
• Do not reuse old needles and syringes.
• Dispose of used needles and syringes in a sharps disposal container immediately after they have been used.
• Your veterinarian or pharmacist will help you obtain these containers.
• Handle the needles carefully to avoid hurting yourself; do not attempt to disconnect the needle from the syringe.
• Keep containers out of reach of children and pets.
• Check with your local trash removal services or health department (listed online and in the city or county government pages in your phone book) to see which disposal methods are available in your area and dispose of sharps containers when they are three-quarters full.

DOCP has a rapid onset of action and is effective within a few hours of injection. However, effects may not be noted outwardly, and laboratory tests are required to evaluate this medication’s effectiveness.

What if I miss giving my pet the medication?

It is imperative that you strictly follow your veterinarian’s dosing schedule for this drug for treatment to be effective. If you miss a dose, contact your veterinarian before giving another dose. Do not give the pet two doses at once.

Are there any potential side effects?

DOCP may cause the following side effects: 

• Irritation at the injection site (usually not severe; contact your veterinarian if it worsens)

Serious adverse reactions may occur. If any of the following signs develop, stop giving DOCP and contact your veterinarian immediately:

• Greater thirst and need to urinate
• Swelling of the limbs or face
• Skin changes
• Weakness
• Lack of energy
• Shaking
• Collapse
• Loss of appetite
• Weight loss
• Vomiting
• Diarrhea

The following reactions are rare and must be determined by your veterinarian:

• Cardiac enlargement
• Congestive heart failure
• Anemia (low red blood cell levels)

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment and notify your veterinarian if you have any concerns. Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately.

Are there any risk factors for this medication?

DO NOT USE DOCP in:

• Pets that are allergic to it
• Pets with congestive heart failure
• Pets with advanced kidney disease
• Pets with swelling of the limbs (edema)
• Pets that are pregnant (safety has not been established)

USE WITH CAUTION in:

• Pets with heart disease
• Pets with elevated blood pressure

Are there any drug interactions I should be aware of?

Several medications should be used WITH CAUTION when given with DOCP, including:

• Potassium-sparing diuretics (e.g., spironolactone; may decrease efficacy of DOCP) 

Be sure to tell your veterinarian about any medications (including vitamins, supplements, and herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Blood monitoring of electrolytes and kidney values is required every 10 to 14 days to start and then, once stabilized, every 3 to 4 months. This monitoring, along with assessment of your dog’s clinical signs, allows your veterinarian to determine the best dose and frequency for your dog.
• Body weight and physical examination is required, to look for evidence of edema (swelling) in the limbs and lungs.
• At home, monitor for improvement of clinical signs and for any side effects such as those noted above. If any side effects occur, discontinue the medication, and contact your veterinarian.
• Your veterinarian may recommend steroid hormone therapy (e.g., prednisolone) in addition to DOCP treatment, although the use of DOCP will reduce the amount of steroid required in these patients. 

How do I store desoxycorticosterone pivalate (DOCP)?

• Store this injectable solution at room temperature.
• Protect from light.
• Protect from freezing.
• Shake the solution in the vial thoroughly before injecting.
• Once a vial has been started, it should be used within 4 months.
• Keep medication out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms. Adverse effects should be reported to the FDA or Health Canada.