Prednisone is a synthetic corticosteroid used for many conditions. 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. 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 orthopedicdiseases: 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.
Horses: 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 studies show that horses do not absorb oral prednisone, but they do absorb oral prednisolone. Other corticosteroids are preferred for intra-articular
2.5 mg per 10 lb (4.5 kg) body weight per day. Average total daily oral doses for dogs are as follows:
The total daily dose should be given in divided doses, 6 to 10 hours apart.
- 5 to 20 lb (2 to 9 kg) body weight: 1.25 to 5 mg
- 20 to 40 lb (9 to 18 kg) body weight: 5 to 10 mg
- 40 to 80 lb (18 to 36 kg) body weight: 10 to 20 ng
- 80 to 160 lb (36 to 73 kg) body weight: 20 to 40 mg
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.
Chronic or inappropriate use of corticosteroids can cause life threatening hormonal and
metabolic changes. Adverse effects due to corticosteroid treatment usually occur with long-term administration of the drug, especially when high doses are used. Alternate day therapy with short acting preparations is preferred. Animals who have received long-term therapy should be withdrawn slowly by tapering the dosage and prolonging the interval between doses. Corticosteroids suppress immune response. Animals receiving systemic corticosteroids may be more susceptible to bacterial or viral infections. Systemic corticosteroids can mask
signs of infection, such as an elevated temperature. Systemic corticosteroids are contraindicated in patients with systemic fungal infections. (The treatment of Addison's disease may be considered an exception.)
Animals in hepatic failure should receive prednisolone rather than prednisone. Corticosteroids should be avoided or used very carefully in young animals both because of immune suppression and the risk of GI ulcers. Corticosteroids have been implicated as a cause of laminitis in horses and ponies. Corticosteroids should be avoided during pregnancy and lactation unless the benefits outweigh the risks. Large doses in early pregnancy may be teratogenic. Corticosteroids can induce labor in cattle and have been used to terminate pregnancy in dogs.
- When amphotericin B or diuretics such as furosemide are given with
corticosteroids, there is an increased risk of electrolyte imbalances due to
calcium and potassium losses.
- Digitalis and potassium levels should be closely monitored in animals
- Corticosteroids may increase insulin requirements. Estrogen may
potentiate the effects of corticosteroids.
- Drugs that may cause drug interactions with prednisone include
salicylate, phenytoin, phenobarbital, rifampin, cyclosporin, erythromycin,
mitotane and anticholinesterase drugs such as neostigmine and pyridostigmine.
- The immune response to vaccination may be reduced when corticosteroids
are given at the same time.
- The risk of GI ulcers may be increased if corticosteroids and other
drugs prone to causing ulcers such as nonsteroidal anti-inflammatory drugs
are given at the same time.
Short-term administration of even large doses is unlikely to cause serious harmful systemic
effects due to adrenal suppression. Problems associated with long-term administration of prednisone relate to suppression of normal adrenal function, iatrogenic Cushing's disease and metabolic crisis due to abrupt withdrawal.
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