Ask the Veterinarian/Prednizone for auto immune disease in dog
I'm really at a loss. Our dog recently had surgery for what was thought as a cruciate ligament problem. When they opened him up it was not his cruciate ligament, they took a sample of some "SUSPICIOUS" tissue...I'm in the process of getting the pathology report, however the words fibrino suppretive and lympho plasmacitic joint inflamation were used. So I've been told it is auto immune related osteo arthritis. He got a NASTY ear infection that was bacterial in nature....they said it is all because of the auto immune thing going on. Now three weeks out of surgery they've put him on prednisone....he's great dane/black lab mixed and usually weighs 100 lbs, now because of all this he weighs 92 (95 would be a healthy weight for him).....they put him on a total of 80 mg of prednisone a day. 40 mg in morning/40 at night. That seems high though they did say they'd cut down after he was on it for 2 weeks. Is this the normal dosage or is this too much prednisone? What are the side effects for too much prednisone?
Any help you can provide would be most appreciated.
Mary & BLUE (the gr dane/lab mix with blue eyes!)
Prednisone: Good Guy - Bad Guy
Prednisone is a synthetic hormone similar to hydrocortisone, a natural hormone produced by the adrenal glands. Prednisone belongs to a large group of similar drugs known as corticosteroids, which are prescribed for literally hundreds of conditions.
With organ transplants, prednisone stops the body's normal inflammatory reaction to foreign tissue and infection. It is usually given in tablet form but can be given intravenously when necessary, such as when someone is too sick to swallow a pill. The drug usually is used in combination with other agents to suppress the immune response. It acts by decreasing swelling and inflammation of tissues.
The downside with prednisone is its many side effects. The higher the dose or the more times you have been treated for rejection, the more side effects. As the dose is gradually reduces, side effects diminish. In most cases, prednisone can be reduced to a maintenance level by the end of about one year after transplantation. Also, use of combinations of drugs has allowed physicians to prescribe lower doses of prednisone than in the past.
Regardless of complications, never stop taking prednisone unless you are instructed to do so by your transplant team. Many problems can occur if prednisone is stopped suddenly. (See "Why Can't Prednisone Be Discontinued Suddenly?" for more information.)
Side Effects of Prednisone
The most commonly encountered side effects are:
Increased fat deposits
Increased acid in your stomach
Increased sweating, especially at night
Increased hair growth
Acne on the face, back, and chest
Bone and muscle problems
Growth problems in children
Increased sugar in the blood
Increased sensitivity to the sun
Delayed wound healing
Decreased ability to fight infection
Thrush (Candida) growth in the mouth
Prednisone is a synthetic corticosteroid used for many conditions in both human and veterinary medicine. Its anti-inflammatory activity is approximately four times that of hydrocortisone. Corticosteroids are extremely effective anti-inflammatory drugs because they affect the inflammatory process at so many different levels. Prednisone is rapidly converted to prednisolone in the liver and in most instances, these drugs are considered to be roughly equivalent. Corticosteroids have strong beneficial effects but a definite potential to cause negative side effects if abused. Prednisone may be given by injection, orally or topically.
Dogs and Cats
Prednisone is used for a wide variety of conditions in both dogs and cats. It may be used in emergency situations including, anaphylactic reactions, spinal chord trauma, and many forms of shock. It is used in the management and treatment of immune mediated disease such as immune mediated hemolytic anemia, or thombocytopenia: many CNS disorders: some neoplasia: dermatologic diseases: allergic reactions such as asthma, hives, and itching: inflammatory orthopedic diseases: endocrine disorders including Addison's: respiratory disease with an inflammatory component, inflammatory bowel diseases and many other conditions.
Cats may require higher doses than dogs in order to achieve clinical response, but they are less likely to develop adverse side effects.
Prednisone is given systemically to decrease inflammatory and immune responses. For years it was used orally to treat Chronic Obstructive Pulmonary Disease (COPD), and other allergic or immune-mediated disorders. Recent work has demonstrated that horses do not absorb oral prednisone although they do absorb oral prednisolone. Other corticosteroids are preferred for intra-articular use.
• Systemic side effects to corticosteroids are generally dependent on dose and duration of treatment. Short-term use of prednisone is unlikely to cause adverse effects. Adverse effects are more common in animals on immunosuppressive doses.
• Side effects seen in dogs include polyuria, polydipsia, polyphagia, poor haircoat, GI disturbance, diarrhea, vomiting, weight gain, GI ulceration, pancreatitis, lipidemia, elevated liver enzymes, diabetes mellitus, muscle wasting, and possible behavioral changes.
• Polyuria, polydipsia, polyphagia may be seen in dogs even on short-term therapy.
• Although cats are less likely to develop side effects than dogs, occasionally polyuria, polydipsia, polyphagia, weight gain, GI disturbances and behavioral changes occur.
• Corticosteroids can cause or worsen gastric ulcers.
• It is important to identify and use the lowest possible dose of pergolide. Based on information from human Parkinson's disease patients, there is some thought that this condition may, over time, become resistant to medication.
• High doses of pergolide have been tested in laboratory animals without causing detectable harm to the fetus but this work has not been done in horses. It is not known if pergolide is excreted in milk but this type of drug may interfere with lactation. No information was found on pergolide use in breeding stallions. Pergolide should only be used in pregnant or lactating animals if the benefits outweigh the risks.
• Phenothiazine tranquilizers such as acepromazine may interfere with the action of pergolide.
• Overdose in humans causes gastrointestinal upset and hallucinations.
Canine Addison's Disease FAQ
Q. What are the symptoms of too much pred? Too much florinef? Too little florinef? Too little pred?
A. The signs of too much pred can include excessive thirst, excessive urination, ravenous appetite, panting, nervousness or restlessness, thinning skin, hair loss, elevated liver enzymes.
Signs of too little pred include loss of appetite, vomiting, diarrhea, loose stools, lethargy, weakness.
Signs of too much Florinef would show up mainly in the bloodwork as high sodium and low potassium. It can also result in edema and excessive urination.
Signs of too little Florinef also show up in the bloodwork as low sodium and high potassium. The low sodium can sometimes be seen as signs of dehydration in the dog (tacky gums, skin on the shoulder that doesn't snap back when pinched). The high potassium will frequently cause a slow heartbeat. Some people have also noticed twitching or shivering when the potassium starts to rise.
Basically you need to be sure the Florinef (or DOCP dose) is correct first and the electrolytes are in the normal range. Then you determine the optimum dose of prednisone (or other glucocorticoid). Florinef has some glucocorticoid (pred) properties and prednisone has some mineralocorticoid (Florinef) properties. So giving a lot of prednisone can make up somewhat for a deficit in Florinef, but it's not the best way to control the electrolytes in the long run. Similarly, if the Florinef dose is adequate, sometimes it's not even necessary to supplement with prednisone because the Florinef has enough glucocorticoid properties on its own.
So whether you stay with Florinef or switch to DOCP, it would make sense to be sure that the dose is adequate to keep the electrolytes normal. Then it becomes relatively easy to find the lowest dose of prednisone that keeps the dog happy, hungry and with good stools.
Prednisone. Prednisone is the most common and generally most effective drug used in the treatment of immune-mediated polyarthritis. When given at high dosages, it causes suppression of the immune response. Improvement of the clinical signs is usually seen quickly, within 48 hours. To induce remission, high doses are given at the start of therapy. If remission occurs, dosages are gradually decreased and eventually stopped, over 4 to 9 months. If remission is difficult to achieve, a relapse has occurred, or there are unwanted side effects from the prednisone, additional immunosuppressive drugs are required.
Azathioprine (Imuran). Imuran is usually the next immunosuppressive drug used in the treatment of the disease. It is usually used together with prednisone, allowing for lower prednisone dosages, but can be used as a maintenance drug. The drug requires 2 to 3 weeks to become effective. Azathioprine can cause bone marrow suppression, but used with caution, it can be very effective.
Generally, prednisone and Imuran are the most effective drugs used to treat the disease. In refractory cases, the following drugs may be of benefit:
Cyclophosphamide (Cytoxan). This drug causes potent immunosuppression, but needs to be used with care due to potent bone marrow suppression.
Chrysotherapy (gold salt therapy). Gold containing compounds have anti-inflammatory properties that may be useful in treatment. Intramuscular injection (sodium aurothiomalate) or oral preparations (auranofin) are available, but the drug may take a month or more to be effective.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not improve rapidly. Administer all medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Even after your pet has gone into remission, careful observation is required. The signs of polyarthritis may recur even while on medication. Early recognition improves the chances of a second remission. This is especially important as immunosuppressive drugs are decreased.
Routine follow-up veterinary examinations are important while your pet is being treated. Subtle changes in joint size, shape or conformation may be noted.
Monthly blood tests are required (CBC and platelet counts) if your pet is receiving Imuran. The tests may be required more frequently if receiving Cytoxan.
If your pet is experiencing unusual behavior, it may be a side effect from the prednisone. The most common side effects include: increased thirst, urination and appetite; panting; lethargy; weakness; and muscle atrophy. Depending on the severity of these signs, the dosage may need to be adjusted and/or additional immunosuppressive drugs started.
I hope this has been helpful and I wish you the best of luck!Please keep me posted and give Blue millions of kisses for me!Sending wagging tails your way!