What are the common side effects of long-term prednisone use. How can patients manage weight gain associated with prednisone. What are the serious side effects that require immediate medical attention. How does prednisone affect mood and mental health. What strategies can help mitigate sleep disturbances caused by prednisone.

Understanding Prednisone and Its Long-Term Effects

Prednisone, a corticosteroid medication, is widely prescribed for various inflammatory and autoimmune conditions. While it can be highly effective, long-term use often comes with a range of side effects. The severity and likelihood of these effects typically increase with higher doses and prolonged use.

Patients taking relatively low daily doses of prednisone are less likely to experience significant side effects. However, it’s crucial to understand that even at lower doses, some side effects may occur. It’s also important to note that abruptly stopping prednisone after extended use can lead to withdrawal symptoms, making it essential to consult a healthcare provider before discontinuing the medication.

Immediate vs. Delayed Side Effects

Some prednisone side effects, such as stomach upset or mood changes, may manifest shortly after beginning treatment. Others, like facial rounding (often referred to as “moon face”), typically develop over weeks or months of continued use.

Common Side Effects of Long-Term Prednisone Use

While prednisone can be a life-saving medication for many, it’s important to be aware of its potential side effects. Here are some of the most common issues patients may encounter:

• Weight gain
• Indigestion
• Insomnia
• Restlessness
• Excessive sweating
• Mood changes

These side effects occur in more than 1 in 100 people taking prednisone. Fortunately, there are strategies to help manage these issues.

Managing Weight Gain

Weight gain is a common concern for those on long-term prednisone therapy. This can occur due to increased appetite and fluid retention. How can patients manage this side effect?

• Maintain a balanced diet without increasing portion sizes
• Engage in regular exercise to help stabilize weight
• Monitor fluid intake and reduce sodium consumption to minimize water retention
• Consult with a nutritionist for personalized dietary advice

It’s important to note that once prednisone treatment ends, appetite and fluid balance typically return to normal, often resulting in weight loss.

Coping with Digestive Issues

Indigestion is another frequent complaint among prednisone users. To reduce the risk of stomach problems:

• Take prednisone with food
• Avoid rich or spicy foods
• Consider asking your doctor about additional medications to protect your stomach if symptoms persist

Addressing Sleep Disturbances

Insomnia and restlessness can significantly impact quality of life. How can patients improve their sleep while on prednisone?

• Take prednisone in the morning to ensure lower levels at bedtime
• Establish a consistent sleep schedule
• Create a relaxing bedtime routine
• Avoid caffeine and electronic devices before bed
• Consider discussing sleep aids with your healthcare provider if problems persist

Managing Excessive Sweating

Increased perspiration can be uncomfortable and embarrassing. Patients can try the following strategies:

• Wear loose, breathable clothing
• Use strong antiperspirants
• Stay hydrated
• Avoid triggers such as spicy foods or hot beverages

If these measures don’t provide relief, consult your doctor about alternative medications or treatments.

Serious Side Effects Requiring Immediate Attention

While less common, some side effects of long-term prednisone use can be severe and require prompt medical intervention. Patients should be aware of these potential complications and seek immediate medical attention if they occur.

Symptoms of Infection

Prednisone can suppress the immune system, increasing susceptibility to infections. What signs should prompt immediate medical evaluation?

• High fever or chills
• Severe sore throat, ear pain, or sinus pain
• Persistent cough or changes in sputum
• Painful urination
• Non-healing wounds or mouth sores

Signs of Blood Sugar Imbalance

Prednisone can affect blood sugar levels. Patients, especially those with diabetes, should watch for:

• Excessive thirst or hunger
• Frequent urination
• Confusion or drowsiness
• Rapid breathing or fruity breath odor

Indications of Cushing’s Syndrome

Prolonged use of high-dose prednisone can lead to Cushing’s syndrome. What are the telltale signs?

• Weight gain in the upper back or abdomen
• Rounded, “moon” face
• Severe headaches
• Slow wound healing
• Thinning skin and easy bruising

Symptoms of Adrenal Insufficiency

Abrupt discontinuation of prednisone can lead to adrenal insufficiency. What symptoms should prompt immediate medical attention?

• Severe fatigue
• Nausea and vomiting
• Dizziness or fainting
• Muscle weakness
• Mood changes
• Loss of appetite and weight loss

The Impact of Prednisone on Mental Health

Prednisone can significantly affect mood and mental health. These changes can range from mild to severe and may include:

• Depression
• Anxiety
• Mood swings
• Irritability
• Insomnia
• In rare cases, psychosis or mania

The intensity of these effects often correlates with the dosage, with higher doses potentially leading to more pronounced mood changes. It’s crucial for patients and their loved ones to be aware of these potential effects and to communicate any concerning changes to their healthcare provider promptly.

Strategies for Managing Mood Changes

While mood changes can be challenging, there are strategies to help cope with them:

• Maintain open communication with your healthcare provider
• Practice stress-reduction techniques like meditation or deep breathing
• Engage in regular physical activity, as approved by your doctor
• Ensure adequate sleep and maintain a consistent sleep schedule
• Consider joining a support group for individuals on corticosteroid therapy
• Discuss the possibility of adjusting your dosage or adding mood-stabilizing medications with your doctor

Long-Term Effects on Bone Health

Prolonged use of prednisone can have significant impacts on bone health, potentially leading to osteoporosis. How does prednisone affect bone density?

• Reduces calcium absorption in the intestines
• Increases calcium excretion through the kidneys
• Decreases bone formation
• Increases bone resorption

These effects can lead to an increased risk of fractures, especially in older adults or those with pre-existing bone health issues.

Protecting Bone Health During Prednisone Therapy

To mitigate the risk of osteoporosis and fractures, patients on long-term prednisone therapy should consider the following measures:

• Ensure adequate calcium and vitamin D intake through diet or supplements
• Engage in weight-bearing exercises as approved by your healthcare provider
• Avoid smoking and limit alcohol consumption
• Discuss bone density testing with your doctor
• Consider bisphosphonate therapy or other bone-protecting medications if recommended by your healthcare provider

Cardiovascular and Metabolic Effects of Long-Term Prednisone Use

Prolonged use of prednisone can have significant impacts on the cardiovascular system and metabolism. What are some of the potential effects?

• Increased blood pressure
• Elevated cholesterol levels
• Increased risk of diabetes
• Fluid retention and edema
• Increased risk of cardiovascular events

These effects underscore the importance of regular monitoring and a comprehensive approach to health management for patients on long-term prednisone therapy.

Strategies for Cardiovascular and Metabolic Health

To mitigate these risks, patients and healthcare providers should consider the following approaches:

• Regular monitoring of blood pressure, cholesterol, and blood sugar levels
• Implementing a heart-healthy diet low in sodium and saturated fats
• Engaging in regular cardiovascular exercise as approved by your doctor
• Maintaining a healthy weight
• Discussing the use of medications to manage blood pressure, cholesterol, or blood sugar if necessary
• Considering the use of the lowest effective dose of prednisone

Balancing Benefits and Risks: Making Informed Decisions

While the potential side effects of long-term prednisone use can seem daunting, it’s crucial to remember that for many patients, the benefits of this medication outweigh the risks. How can patients and healthcare providers navigate this complex decision-making process?

• Thoroughly discuss the potential benefits and risks of prednisone therapy
• Consider alternative treatments or combination therapies that may allow for lower prednisone doses
• Implement a comprehensive monitoring plan to catch and address side effects early
• Regularly reassess the need for continued prednisone therapy
• Explore strategies to minimize side effects while maximizing therapeutic benefit

By maintaining open communication and taking a proactive approach to managing potential side effects, many patients can successfully navigate long-term prednisone therapy while minimizing risks and maintaining quality of life.

The Importance of Personalized Care

Every patient’s experience with prednisone is unique, influenced by factors such as dosage, duration of use, underlying health conditions, and individual physiology. This underscores the importance of personalized care and regular follow-ups with healthcare providers.

Patients should feel empowered to discuss their concerns, report any new symptoms, and work collaboratively with their healthcare team to optimize their treatment plan. This may involve adjusting dosages, exploring alternative medications, or implementing additional supportive therapies to manage side effects.

Emerging Research and Future Directions

As our understanding of corticosteroid therapy continues to evolve, researchers are exploring new ways to maximize the benefits of medications like prednisone while minimizing side effects. What are some promising areas of research?

• Development of more targeted corticosteroids with fewer systemic effects
• Exploration of alternative drug delivery methods to reduce side effects
• Investigation of combination therapies that may allow for lower steroid doses
• Research into genetic factors that influence individual responses to corticosteroid therapy
• Studies on long-term outcomes and strategies for mitigating risks in chronic users

These ongoing research efforts hold promise for improving the long-term safety and efficacy of corticosteroid therapy, potentially offering better outcomes for patients who require extended treatment.

The Role of Patient Advocacy and Education

As research progresses, patient advocacy and education play crucial roles in improving outcomes for those on long-term prednisone therapy. How can patients become more empowered in their care?

• Stay informed about your condition and treatment options
• Participate in patient support groups and educational programs
• Advocate for comprehensive care that addresses all aspects of health affected by prednisone use
• Collaborate with healthcare providers to set realistic treatment goals and expectations
• Consider participating in clinical trials or research studies when appropriate

By taking an active role in their care and staying informed about the latest developments in corticosteroid therapy, patients can work more effectively with their healthcare team to optimize their treatment and quality of life.

Side effects of prednisolone tablets and liquid

The higher the dose of prednisolone that you take and the longer you take it for, the greater the chance of side effects. You’re less likely to get side effects if you take a relatively low dose of prednisolone daily.

If you have been taking prednisolone for more than a few weeks, check with your doctor before stopping it suddenly to reduce your chances of withdrawal side effects.

Some side effects, such as stomach upset or mood changes, can happen straight away. Others, such as getting a rounder face, happen after weeks or months.

Common side effects

These common side effects of prednisolone happen in more than 1 in 100 people. There are things you can do to help cope with them:

Weight gain

If you have to take prednisolone for more than a few weeks, it’s likely that you’ll put on weight. Prednisolone can make you hungrier and also can make you retain more water in your body.

Try to eat well without increasing your portion sizes. Regular exercise will also help to keep your weight stable.

Once you stop taking prednisolone, your appetite and the way your body retains water should return to normal.

Indigestion

Take prednisolone with food to reduce the chances of stomach problems. It may also help if you avoid rich or spicy food while you’re taking this medicine.

If symptoms carry on, ask your doctor if you may benefit from taking an additional medicine to protect your stomach.

Problems sleeping (insomnia)

Take prednisolone in the morning so the levels are the lowest at bedtime.

Feeling restless

If you’re feeling restless when you’re trying to sleep, take prednisolone in the morning so the levels are the lowest at bedtime.

Sweating a lot

Try wearing loose clothing and use a strong anti-perspirant. If this does not help, talk to your doctor as you may be able to try a different medicine.

Mild mood changes

Prednisolone can affect your mood in different ways. Talk to your doctor if you are finding it hard to cope.

Speak to a doctor or pharmacist if the advice on how to cope does not help and any of these side effects bother you or last more than a few days.

Serious side effects

You are more likely to have a serious side effect if you take a higher dose of prednisolone or if you have been taking it for more than a few weeks.

Call a doctor or call 111 straight away if you get:

• a high temperature, chills, a very sore throat, ear or sinus pain, a cough, more saliva or a change in colour of saliva (yellowish and possibly with streaks of blood), pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• sleepy or confused, feeling very thirsty or hungry, peeing more often, flushing, breathing quickly or breath that smells like fruit – these can be signs of high blood sugar
• weight gain in your upper back or belly, “moon face” (a puffy, rounded face), very bad headaches and slow wound healing – these can be signs of Cushing’s syndrome
• a very upset stomach or you’re being sick (vomiting), very bad dizziness or passing out, muscle weakness, feeling very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
• muscle pain or weakness, muscle cramps, or changes in your heart rate – these can be signs of low potassium levels
• severe stomach pain, severe back pain, severe upset stomach or you’re being sick – these can be signs of pancreas problems
• breathlessness
• swelling in your arms or legs
• changes in your eyesight
• any bruising or bleeding that is not normal
• red or black poo

Immediate action required: Call 999 or go to A&E if:

Mood changes

You may notice mood changes and mental health problems while taking prednisolone.

Talk to your doctor or contact 111 if you have any mood changes including:

• feeling depressed
• feeling high, or moods that go up and down
• feeling anxious, having problems sleeping, difficulty in thinking, or being confused and losing your memory
• feeling, seeing or hearing things that do not exist (hallucinations)
• having strange and frightening thoughts, changing how you act, or having feelings of being alone

The higher the dose, the more intense the mood changes can be.

Go to 111.nhs.uk or call 111.

Immediate action required: Call 999 or go to A&E if:

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to prednisolone.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Long-term side effects

Taking prednisolone for a long time can lead to side effects such as:

• thinner bones (osteoporosis)
• poorly controlled diabetes
• eyesight problems
• high blood pressure (hypertension)

Children and teenagers

Taking prednisolone at higher doses for a long time can slow down the normal growth of children and teenagers.

Your child’s doctor will monitor their height and weight carefully for as long as they’re taking this medicine. This will help them spot any slowing down of your child’s growth and change their treatment if needed.

Even if your child’s growth slows down, it does not seem to have much effect on their eventual adult height.

Talk to your doctor if you’re worried. They’ll be able to explain the benefits and risks of giving your child prednisolone.

Other side effects

These are not all the side effects of prednisolone. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 24 February 2022

Next review due: 24 February 2025

What are the side effects of low dose prednisone?

Ask the Expert, Treatment — Sep 21, 2020

Ask the Expert: What are the side effects of taking a low dose prednisone every day? It’s the only thing that helps with my pain, but I hear it’s not a long-term solution?

Prednisone belongs to the class of medications known as corticosteroids (or anti-inflammatory agents). These medications provide relief of inflammation and are used to treat a variety of medical conditions including pain, asthma, Sjögren’s and rheumatoid arthritis. As with all medications, corticosteroids have some adverse side effects related to the dose and the duration in which the medication is taken. Side effects associated with low dose (7.5 mg/day or less) daily prednisone are less severe than those seen with higher doses (greater than 30mg/day) and can usually be managed with precautions. Common side effects of daily low dose prednisone include elevated blood pressure, swelling, changes in blood sugar, increased appetite, weight gain, insomnia, osteoporosis (thinning of bones), irregular menstrual periods, and mood changes. Serious side effects associated with higher doses and long-term use (greater than 1 month) are impaired wound healing, decreased growth (in children), decreased muscle production, fat deposits, stomach ulcers or bleeding, vision problems, higher risk for infection, and in rare cases life-threatening allergic reactions.

Although the list of side effects may make you wonder whether you should take this medication or not, please be reassured that many people take daily low dose prednisone with minor or no side effects. The following self-care tips may help minimize some of the side effects associated with prednisone. For those experiencing swelling and/or elevated blood pressure, a healthy low sodium diet, regular exercise, and stress management can help to keep your blood pressure under control while taking daily low dose prednisone. If you have diabetes, it is important to monitor your blood sugar and report any severe fluctuations in blood sugar to your provider. It is recommended that prednisone be taken with food or milk to minimize stomach upset and reduce the chance of stomach ulceration. Schedule yearly eye exams and report any new changes in vision to your eye doctor. Long term corticosteroid therapy may cause thinning of bones (osteoporosis) which increases the risk of bone fracture. Talk to your doctor or pharmacist about vitamin D and calcium supplementation to help protect your bones. Since long term prednisone use can increase your risk for infection, ask your doctor or pharmacist to review your vaccination history and be sure to stay up to date on all of your recommended vaccines. Alert your family members and friends about the possibility of mood changes associated with this medication, so they can help detect any unusual changes in your behavior. Report any changes in mood or behavior to your doctor.

Although experiencing side effects is unpleasant, it is crucial to avoid sudden discontinuation of this medication. Never stop or decrease your dose unless instructed by your doctor. Your doctor can instruct you on how to slowly decrease your dose if you need to stop taking this medication for any reason.

By Ajay John, Pharmacy Intern and Kayli Smith, Pharm.D

This article was first printed in  the Foundation’s patient newsletter for members. Click here to learn more about becoming a member. 

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Prednisolone – what you need to know about taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many people think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisolone that is considered an obligatory and necessary drug of first choice in the treatment of a disease (for example, nephrotic syndrome, which you can read about here).

We are not talking about the drug itself and for what diseases it should be prescribed, but our information block about what doctors usually forget when they prescribe prednisolone. Usually, children come for a consultation while taking prednisolone in combination with asparkam. Believe me, hypokalemia (decrease in the level of potassium in the blood), in connection with which asparks are prescribed, is not the most common complication when prescribing prednisolone.

In our practice, almost 90% of patients receiving this drug are diagnosed with nephrotic syndrome.

Prednisolone is prescribed for a long period of time (the full course of therapy before the drug is discontinued may last 6-12 months), additional drugs must be prescribed to prevent the side effects of prednisolone. They are:

1. In order to protect the mucosa of the upper gastrointestinal tract (esophagus, stomach, duodenum), prednisolone may cause indigestion, nausea, vomiting and more serious complications such as steroid ulcers. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e. Protection of the stomach in literal translation). These are antacids (eg Maalox, phosphalugel, etc.), H+ pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone thinning) can develop, which ultimately leads to bone fractures. But this condition can also be prevented, it is necessary to take calcium and vitamin D preparations . The dose of drugs is also selected individually.

Other things to watch out for:

1. Mandatory blood pressure monitoring
2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.
3. When taking prednisolone for a very long time, check blood glucose levels.
4. State of mental health. Children very often become capricious, sometimes even aggressive. This condition resolves on its own after discontinuation of the drug.
5. Watch your weight and diet. Against the background of taking prednisolone, the appetite increases very much. However, you, as a parent, can control the nutrition of your child, it is necessary to limit the intake of easily digestible carbohydrates.
6. In order to monitor and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by – EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes only. It is necessary to consult with your doctor.

If you have any questions about this topic or have suggestions, we are happy to answer questions and accept your suggestions.

Glucocorticoids – Nikavet Veterinary Clinic

Author: Yakimenko Anastasia Sergeevna (translated from English)

Glucocorticoids (GC) have far-reaching pharmacological effects that can vary significantly depending on the dosage and slightly depending on the type of GC prescribed (see Pharmacological effects of glucocorticoids).

Pharmacological effects of glucocorticoids:

• Reduces the production of inflammatory mediators

• Decreased leukocyte phagocytosis, chemotaxis and antigen production

• Pronounced catabolic effect on metabolism, muscle mass and bone turnover

• Changes in renal excretion of potassium, calcium and sodium

• Excitation of stress leukogram

• Induction of serum alkaline phosphatase

Prednisone, Prednisolone and Methylprednisolone

Prednisone is a prodrug of Prednisolone. In cats, oral prednisone results in much higher plasma concentrations than the same dose of oral prednisone. This may be due to the low bioavailability of prednisone in cats or its slow conversion to prednisolone. For this reason, prednisolone is the most preferred GC for cats. Whereas dogs can convert both prednisone and prednisone equally. Methylprednisolone is more effective than prednisolone in in vitro inhibition of lymphocyte proliferation in humans. But this data is not valid for dogs. Animal textbooks report that methylprednisolone, compared to prednisolone, has no mineralocorticoid effects, but there is no evidence for this. In fact, methylprednisolone activates the mineralocorticoids responsible for the renal pathways, at least in rodents.

Prednisol, Prednisolone, and Methylprednisolone dosing

Commonly used HA doses have been extrapolated from previous studies in humans and supported by clinical experience in dogs and cats (see empiric recommendations for glucocorticoid dosing). For physiological replacement, the recommended starting dose is 0.2 mg/kg orally once a day. The time of manifestation is not important, at least in cats.

Doses approximately 3 times normal are recommended for stress (eg, hospitalization or surgery) in animals that are endogenously deficient in HA. This is supported by studies of cortisol secretion in dogs under experimental conditions of stress. For anti-inflammatory effects, oral doses of 0.5 to 1.0 mg/kg per day for dogs and 1.0 to 2.0 mg/kg per day for cats are recommended; for immunosuppression, 2.0 mg/kg per day or 50 mg/m2 for dogs or up to 4.0 mg/kg per day for cats is suggested.

For large and giant breed dogs, the use of no more than 50 mg/m2 (maximum dose 30-40 mg twice daily) is suggested by the author to reduce the incidence of serious side effects (eg, muscle atrophy, secondary infections). In obese cats, the dose of prednisolone should be given based on an assessment of lean body mass, as plasma concentrations of prednisolone in obese cats are twice as high as the same dose per kg in normal cats.

Prednisolone is the preferred glucocorticoid for cats.

Positive and negative effects

Glucocorticoids commonly cause dose-dependent polyuria and polydipsia, muscle atrophy and alopecia in dogs. Cats are more resistant to many of the side effects of GC, possibly due to fewer and lower affinity GC receptors in the liver and skin. Acquired diabetes mellitus is a major complication of chronic GC treatment in cats and requires careful clinical monitoring for polydipsia, weight loss, or glucosuria. Prednisone, prednisolone, and methylprednisolone have mineralocorticoid effects, and moderate to high doses should be avoided in patients with hypertension, heart failure, ascites, or hypokalemia. In addition, methylprednisolone acetate can lead to acute plasma volume expansion and even congestive heart failure in cats, although this may be attributed to interstitial fluid changes rather than overall water retention. GCs generally induce serum alkaline phosphatase (AP) activity in dogs, with alanine aminotransferase (ALT) inhibition. These changes are not clinically effective unless ALT or ALP activity is exceeded, or hyperbilirubinemia is present, which in itself suggests the presence of the disease.

ALP is not easily induced GC in cats; A slight increase in ALP from baseline was reported with methylprednisolone acetate given to the cat, but the values ​​were not out of range. Any increase in serum ALP beyond the reference range is clinically significant in cats, regardless of whether GCs are present in their treatment.

Two weeks of treatment with an anti-inflammatory dosage of prednisolone suppresses the hypothalamic-pituitary-adrenal (HPA) system. After one month of treatment, it may take 2 weeks for adrenal function to recover. Because of this, the patient should ideally be isolated from chronic GCs for at least 2-3 weeks prior to elective anesthesia or surgery, if possible; however, if negative consequences of discontinuing treatment are possible, then each patient should be considered separately.

Dexamethasone

Dexamethasone is approximately 5 to 10 times more potent than prednisone, with a duration of action of approximately 32 to 48 hours. Dexamethasone has no mineralocorticoid activity due to the substituted methyl ring and does not promote salt and water retention.

Indications and Dosage

Dexamethasone is the preferred GC for patients with hypertension, heart failure, hypoalbuminemia, edema, or ascites. Based on the increase in dexamethasone potency, its dosages can be determined empirically by calculating the basic doses of prednisone and dividing by 7 or 8 to obtain an equivalent dose of dexamethasone.

Dexamethasone is also available in injectable form, which is useful for administering HA to bypass severe malabsorption in the treatment of protein-losing enteropathy or lymphangiectasia.

Positive and negative effects

Dexamethasone (0.55 mg/kg po/day) is more diabetogenic in healthy cats than eight-fold prednisone (4. 4 mg/kg po/day). This suggests that dexamethasone is at least 8 times more potent than prednisone in cats.

Dexamethasone is not suitable for alternative single therapy due to its long duration of action. For chronic tapering courses, dexamethasone may be substituted for prednisone or prednisolone at lower doses (eg, equivalent to 0.5 to 1.0 mg/kg po prednisolone per day) or a single alternative therapy.

Budesonide

Budesonide is a high starting oral HA for humans. In dogs, budesonide is unlikely to increase liver enzymes or cause a stress leukogram.

Indications and Dosage

Budesonide is an alternative to prednisone or prednisolone for the treatment of inflammatory bowel disease and possibly inflammatory liver disease. This proves his concentration on local effects; this makes it an attractive alternative in the treatment of inflammatory bowel disease, with equivalent efficacy compared to prednisone in dogs.

In dogs, budesonide is less likely to increase liver enzymes or cause a stress leukogram. Although the published empirical single dose is 3 mg/m2 per day, it can cause severe polyuria/polydipsia and breathing difficulties in some dogs and may completely suppress the HPA system. Lowering the starting dose (eg, 1–2 mg/m2 or 1–2 mcg/30 kg [dogs]; 0.5–0.75 mg [cats]) may be better tolerated and may achieve clinical benefit.

Triamcinolone

The efficacy of triamcinolone relative to prednisolone varies widely, from 10:1 to 1:1; however, in studies in cats with pruritic skin conditions, triamcinolone at one seventh dose of methylprednisolone (0.18 mg/kg/day po) showed comparable efficacy (1.41 mg/kg/day po), suggesting that triamcinolone may be 7 times more potent than methylprednisolone for cats. This study also showed a lower incidence of polydipsia in cats treated with triamcinolone compared with methylprednisolone, although the number of cats in the study was small. This conclusion is consistent with the understanding that triamcinolone, like dexamethasone, has a substitution ring and removes mineralocorticoid activity.

The potency and efficacy of oral triamcinolone does not compare with dexamethasone or prednisolone in dogs. Triamcinolone is more commonly used for long-term injectable use (Vetalog, bi-vetmedica.com) in dogs.

Long Release Injection

Long Release HA Injection provides sustained release by slowly dissolving the acetonide and acetate preparations. These GCs are convenient for patients who find it difficult to give drugs by mouth, but with prolonged use they can lead to suppression of the HPA system and functional insufficiency of the adrenal cortex in stressful situations. For example, triamcinolone acetonide (Vetalog, bi-vetmedica.com) lasts weeks, and a single injection can suppress adrenal function in dogs for up to 4 weeks.

As oral HAs, these HA injections can lead to debilitating side effects that are more complex due to the long duration of action.

Both triamcinolone acetonide and methylprednisolone acetate (Depomedrol, henryschein.com) can cause congestive heart failure in susceptible cats. This is explained by an increase in plasma volume of up to 40% in cats during the first week after GC administration. This is secondary to osmotic shifts between cellular and plasma constituents.

These long-acting HAs should be avoided in patients with heart failure and should only be used with educated clients and close clinical monitoring of patients with heart murmurs.

Similarly, methylprednisolone acetate increases blood glucose levels in cats and can cause diabetes mellitus. In any cat treated with GCs – especially given the prolonged action of the drugs – polydipsia, weight loss, glucosuria, or an increase in serum fructosamine concentrations should be carefully monitored.

Bacteriuria without clinical signs develops in approximately 20-40% of dogs chronically treated with GC; females are more susceptible than males. Bacteriuria is seen even after single therapy, and monitoring of urine sediment alone is unreliable because half of the positive cultures are absent in pyuria in GC-treated dogs.