Long term prednisolone

RE: Long term prednisolone

Miriam Lodewyks — Fri, 30 Dec 2016 12:30:39 GMT

Not a silly question at all: I remember being confounded by the same thing when I was a newbie.

Over the years I've learnt to regard steroids as a "friend" rather than "foe", but still use them judiciously. I've had cause to mix NSAIDs and Steroids and never yet had any issues, though I try avoid doing this if I can. I've also at times had to stop steroids "cold"... never really had any clinically appreciable issues, but again, would generally attempt to wean slowly - lower dose, then frequency, then dose, then frequency... usually over 2-3 weeks.

Would attempt to wean and be clear of steroids for 2-4 weeks before doing elective surgeries and vaccinations. Have found Apoquel really useful to help bridge the gap if it's pruritis-related: start use when symptoms warrant.

Hope that helps.

RE: Long term prednisolone

Clive Ansell — Fri, 30 Dec 2016 10:51:23 GMT

One of my practices has an on going case of an elderly SBT with severe spinal spondylosis, that is being managed fairly well on a combination of half dose Metacam and low dose pred (Not dissimilar to PLT). It seems to work better than either drug alone, almost a synergistic effect. No side effects noted and dog otherwise fine, recent pre op bloods for dental work were nad.

RE: Long term prednisolone

Martin Atkinson — Fri, 30 Dec 2016 10:17:32 GMT

[quote user="Kate Richardson"]

[quote user="Martin Atkinson"]why would you need both?[/quote]

Dog on NSAIDS for arthritis presenting with an acute allergic reaction maybe?

[/quote]Antihistamine +/- adrenaline if it is that acute. Cell mediated allergic conditions that require corticosteroids are never 'acute'.

RE: Long term prednisolone

Bob Russell — Thu, 29 Dec 2016 18:33:21 GMT

[quote user="Kate Richardson"]

[quote user="Martin Atkinson"]why would you need both?[/quote]

Dog on NSAIDS for arthritis presenting with an acute allergic reaction maybe?

[/quote]

Arthritic cat with acute asthma for example.

Not something I would do often and I do warn owners of the risk. I would also advise NSAI's are temporarily withdrawn.

RE: Long term prednisolone

Kate Richardson — Thu, 29 Dec 2016 17:34:49 GMT

[quote user="Martin Atkinson"]why would you need both?[/quote]

Dog on NSAIDS for arthritis presenting with an acute allergic reaction maybe?

RE: Long term prednisolone

Martin Atkinson — Thu, 29 Dec 2016 17:27:39 GMT

Wot Bob says but I would be very wary of using corticosteroids concurrently in a patient on NSAIDs and I'd certainly stop the them for at least 24 hrs before giving steroids. The clue is in the name: 'non-steroidal anti-inflammatory' - corticosteroids are a far better anti-inflammatory/anlagesic than NSAIDs so why would you need both?

RE: Long term prednisolone

Anthony Todd — Thu, 29 Dec 2016 17:17:59 GMT

[quote user="An On MRCVS"]For patients on long term prednisolone e.g. for atopic skin disease:[/quote]

[You'd expect me to jump in because this is fundamental and relates heavily to the adverse reputation of steroids, yet is still the gospel, no matter how often I repeat it]

1. Do not dose daily, ever.

1a Best to start with an injectable as much to get the owner on board as to give the animal quick relief, and to "test" the therapy. [er. demodex etc will show little response...]

1b Do not start orals until signs recur then:

2. Give the animal a dose at the higher end of the dose-rate and repeat only when necessary, initially at the same dose.

This is because;

a. often the allergen exposure is not continuous and may be intermittent, eg flea bites or pollen

b. you avoid the side effects of continuous dosage

c. very often the owner can try a slightly lower dose to see if it is just effective enough.

d. Your concurrent allergy removal efforts [fleas, diet etc] may be reducing or stopping the allergic response and on continuous dosages, however light or tapered, you'll never know when to stop!

e. one dose doesn't need a taper.

3. Of course sometimes you'll have to keep the animal on the same, or even higher, dose if the allergic reaction is worse but this regime makes it easier to adjust and quicker.

4. With a single dose the response may be enough to avoid another dose until the next allergic insult. [often with flea control, until the owner forgets to apply the insecticide....!]

5. This regime is very effective and avoids most, if not all side effects.

5a It does take some owners some time to get the idea!!!

Usual steroidophobic one star will surely follow, but having done this successfully for x years I'm not deterred.

RE: Long term prednisolone

Kate Richardson — Thu, 29 Dec 2016 17:06:08 GMT

[quote user="Bob Russell"]

Not a silly question at all. Actually a very sensible one.

I keep the daily dose the same but reduce the frequency to every other day. Then reduce the dose itself. Generally take my time to make sure the dose is still adequate to control symptoms.

[/quote]

Ditto. I probably make a dose reduction approximately every 2 weeks, but does depend how long the animal has been on prednisolone and at what dose.

RE: Long term prednisolone

Bob Russell — Thu, 29 Dec 2016 16:03:22 GMT

Not a silly question at all. Actually a very sensible one.

I keep the daily dose the same but reduce the frequency to every other day. Then reduce the dose itself. Generally take my time to make sure the dose is still adequate to control symptoms.

Apoquel can be used with prednisolone short term so I start that and reduce the preds steadily to minimise the risk of iatrogenic Addisons (but not actually seen this in 30 years).

Don't worry about surgery unless pred doses are immunosuppressive. Never found anti-inflammatory doses to be a problem and doubtful if they would interfere that much with healing.

I have used short term steroids in dogs on NSAID's but generally these have been patients with big problems anyway. Not something I do often but never seen an issue. Might raise a few eyebrows should a client go onto Dr Google though.

Patients are a lot tougher than your teaching may have suggested. It is not that unlikely that some older patients on medication for arthritis may also have Cushings!

Avoid these combinations if you can but explain to owners that there may be a degree of risk of adverse reactions where (particularly) welfare issues exist.