NSAID and steroids in addison's disease

RE: NSAID and steroids in addison's disease

Emily Rainbow — Tue, 11 Feb 2020 20:08:22 GMT

Fludro has quite a hefty glucocorticoid action (hence why a lot of dogs have done better on zycortal as you can titrate the pred dose much more accurately as it’s seperate!).

I’d probably avoid NSAIDs in your position as there’s a lot of other options you could try first - paracetamol? Gabapentin? Yes it’s not got the anti-inflammatory action but with appropriate antibiotics (ideally with a culture on a cysto sample) the cystitis should settle pretty quick!

I think I’ve seen Ian Ramsey (The king of addisons) on here so he may comment too!

RE: NSAID and steroids in addison's disease

Andreas Ege — Tue, 11 Feb 2020 14:28:34 GMT

I'm not having sleepless nights and I just authorised more predni for that dog. I only realized I actually not having any facts basing my decision on than my understanding of the drugs (inter)actions and pathology/ physiology. That's enough for me to go by, but not enough not wanting to know any more. ;-)

Similar with wash-out periods for nsaids. When I first learned about that I realized I never spent much thought about that and had a look around. Apparently, "opinion leaders" recommend 5-7 days. Which, actually, is indeed based on "opinion" as according to a review from last year, there has been exactly 1 study on the topic that found increased gastric lesions when swapping from injectable carprofen to oral carprofen or oral deracoxib both. I usually don't bother and couldn't say I've seen any problems. Not being an "opinion leader" I don't see why my opinion (or experiences) should be less valuable than the one of a "leader", as long as they can't base their opinion on any verifiable evidence. So I am still doing it, but now I know that other people giving different advice don't know much more about it than me either. :-))

My (human medicine) interaction checker says to Meloxicam + fludrocortisone: either increases toxicity of the other by pharmacodynamic syngergism. Use caution/ monitor. Increased risk of gastric ulceration.

For meloxicam + predni or dexa the same but GI ulceration. I'm not sure I'd class that as "recognised as safe". ;-)

RE: NSAID and steroids in addison's disease

David Mills — Tue, 11 Feb 2020 13:07:50 GMT

The profession uses nsaids in many many many Cushingoid dogs and do any die or grow 5 heads or keep us awake at night?

Use of NSAID and preds recognised for years in human medicine as safe.

This would be a lovely collaborative project for vetsurgeon