Table of Contents
Steroids: Pros and Cons
Steroids, such as prednisone for dogs, serve essential bodily roles. A dog produces natural steroids such as cortisol. This and other hormones help to regulate numerous processes that naturally occur in the body and maintain overall health.
However, problems arise when they are produced in excess. Thus, the proper balance between steroid production and use is critical to maintaining homeostasis (status quo).
Today we will discuss one specific steroid, prednisone. However, numerous steroids exist, and you should be familiar with them. If your veterinarian were to give your dog an injection, you should recognize that it may have been a steroid.
Heaven forbid your pet needs to go to the emergency room; your vet is closed and cannot provide records. The emergency vet needs to know if your pet recently received a steroid.
Commonly used steroids in various forms in veterinary medicine include topical, oral, and injectable options such as1
- Prednisone (dogs) & prednisolone (dogs or cats) – Oral or injectable and eye preparations
- Dexamethasone oral or injectable
- Dexamethasone Sodium Phosphate – Injectable
- Methylprednisolone – Injectable or injectable
- Triamcinolone – Injectable or oral
- Mometasone furoate – Generally found in topical products
- Hydrocortisone – Topical
- Betamethasone – Topical
Prednisone vs. Prednisolone
What does prednisone do for dogs? Prednisone and prednisolone belong to the glucocorticoid class of steroids. Aiding in fat, protein, and carbohydrate metabolism, among many other tasks. Examples of glucocorticoids include prednisone, cortisone, and methylprednisolone, which greatly benefit the immune and stress responses.
They excel at suppressing or reducing inflammation in the body but, because of the high side effect profile, aren’t always the best choice for pain/arthritis/chronic conditions.
Prednisone and prednisolone work similarly in the body. However, prednisone isn’t always well absorbed in some species, such as cats or horses.
The active metabolite (what prednisone breaks down to), prednisolone, is used in these species. Dogs can have either, but generally, vets prescribe prednisone for dogs.
Why Vets Reach for Prednisone
What is prednisone used for in dogs? Prednisone for dogs can be used for various conditions. It is a commonly used drug in both veterinary and human medicine. Common indications for prednisone use in dogs include
- Allergic reactions/Allergies
- Itchiness (pruritus)
- Ear infections – to allow inflammation within the ear canal to decrease so that the topical medications have a chance to work and reduce pain
- Immune-mediated conditions
- Neoplasia (some cancers)
- Addison’s disease (a condition where the body doesn’t produce enough steroids)
- Pain – Yes, steroids can provide pain management by decreasing inflammation
- Allergic bronchitis
- Inflammatory bowel disease (IBD)
- Hypercalcemia (elevated calcium)
Dosing of Prednisone
The prednisone dose varies depending on the end goal for use. The doses will differ dramatically if a veterinarian is treating an allergic reaction vs. an ear infection vs. an immune-mediated disease.
The dose is based on weight, but caution must be used when dosing large and giant-breed dogs. You may see doses listed in either mg/kg or meters squared (m2). Again, the dose varies dramatically based on the reason for use.
The standard dose to reduce inflammation is 0.5-1 mg/kg/day. Compare this to the dose for immunosuppression (e.g., with cancer therapy). Immunosuppressive doses may start at 2 mg/kg or higher twice daily, then be tapered to the lowest effective dose.
Thus, prednisone dosage for dogs varies with
- A pet’s weight (ideal body condition vs. current body weight if obese)
- Reason for use (inflammation vs. immunosuppression)
- Underlying conditions – Such as heart disease (steroids can be harmful to the heart)
- Side effect tolerances and owner’s schedules
Deciding on the dose of steroids can be challenging. Veterinarians must weigh the end result desired with the ultimate side effects and the ability of the pet parent to manage these ill effects.
A set dose is not recommended based on a number (weight). Each pet and the reason for using the drug need to be considered. Additionally, other medications the pet takes play a role in dosing and use.
Should You Wean or Abruptly Stop Prednisone?
Prednisone for dogs or any steroid given by mouth must be weaned. Remember, the body naturally produces steroids. The body’s steroid production slows down when we supplement them orally (even topically). It may even stop, depending on the dose.
So, we must wean the drug slowly over time so that the body recognizes that it needs to ramp up production and start making it. If we stop the medication abruptly, the dog could get sick quickly. So, annoying though it is, your vet may provide directions such as
Give 1 tab every 12 hours for 3 days; then give 1 tab every 24 hours for 3 days; then give 1/2 tab every 24 hours for 3 days; and then give 1/2 tab every other day for 3 doses.
These directions must be followed to ensure your pet remains healthy.
Side Effects of Steroids
Steroids are not without risk. Short-term prednisone use, such as with a tapering dose for an ear infection, may last 1-2 weeks and may include3,4
- Increased drinking (polydipsia)
- Increased urination (polyuria)
- Increased appetite (polyphagia) – But DO NOT feed them more, or you will see increase weight gain
- Increased panting (even at rest)
- Some dogs become a bit more restless or agitated, almost hyper (this can happen in some people as well); additional behavior signs may occur, especially if the pet already has underlying behavioral conditions
However, several additional signs may manifest when steroids are used chronically. Pes need to be monitored closely.
With long-term use, we can see:
- Muscle wasting
- Muscle weakness
- Gastrointestinal ulceration/ bleeding
- Changes to the skin – thinner, less elastic, even infections
- Kidney disease
- Liver disease
- Diabetes mellitus
- Heart disease (steroids increase salt retention; animals with known or yet unmasked heart disease may develop fluid retention and worsening heart disease, even heart failure)
- Increased risk of infections (especially with long-term use)
- Hair thinning or loss (alopecia)
- Weight gain (because they are hungrier, owners often overfeed)
- Bloodwork changes (e.g., elevated alkaline phosphatase, ALKP, or elevated cholesterol)
- Iatrogenic Cushing’s disease – Cushing’s disease is an overproduction of steroids by either a pituitary tumor or the adrenal gland. It causes a classic potbelly appearance; these dogs drink, urinate, eat a ton, pant a lot, have skin changes and infections, and are prone to infections. Suppose a pet receives steroids exogenously (oral prednisone, topically, or injectable) for long periods. In that case, it can develop this Cushing’s disease even without the tumors.
Contraindications to Steroid Use
Contraindications to steroid use include
- Current use of non-steroidal anti-inflammatory pain medication drugs (NSAIDs)
- Diagnosed heart disease
- Certain medications and pre-existing conditions, like endocrine disorders
- Those with active fungal and some viral or bacterial infections (such as a urinary tract infection)
- Hypersensitivity (allergy/adverse reactions) to it or abnormal reactions (behavioral changes)
- Cannot tolerate side effects of prednisone
Additionally, caution must be used in pets with diabetes, respiratory disease, cataracts, kidney disease, and even high blood pressure.
Always ensure any veterinarian you see, especially if not your regular vet, knows all medications your pet is receiving.
No NSAIDs and Steroids together
This is very important and warrants repeating. NSAIDs and Steroids cannot be used concurrently, and NSAIDs like Deramaxx®, Rimadyl®, Onsior®, and others cannot be used simultaneously with steroids in dogs.
While physicians may commonly prescribe steroids and NSAIDs together in people, this is a no-no in dogs. Sadly, emergency veterinarians see complications because veterinarians still prescribe them together, which results in drug interactions.
Dogs and cats are highly susceptible to the adverse reactions of GI ill effects of steroids (diarrhea, vomiting, ulceration, and even GI rupture).
A washout period (ideally 7-14 days) should be used when shifting from one drug to another (NSAID to steroid vs. steroid to NSAID) to avoid drug interactions. While sometimes we have to switch more rapidly than that, we must then take precautions to protect the GI tract from ulceration, bleeding, and more.
If your dog has been on a prescription NSAID for pain management, even if you give it as needed, make sure your vet knows/remembers.
Suppose you have given your dog aspirin (which is not recommended, a topic for another day). In that case, you must also tell them you gave aspirin. Aspirin combined with a steroid is even more dangerous than a dog-specific NSAID.
Steroids Pros and Cons
Steroids, like prednisone, have their place in veterinary medicine. Prednisone for dogs can be safe when used for the appropriate conditions and when monitored closely.
Being properly informed about how to administer the dog prednisone, recognizing it cannot be abruptly stopped and must be weaned, and knowing what side effects to expect, help prepare you for steroid use in your dog.
Safe is a relative term. Steroids have side effects and can cause significant problems when used long-term. Generally, most dogs tolerate short-term tapering doses for acute illnesses like ear infections.
Dog prednisone can be used to treat pain as it helps decrease inflammation. However, the side effects of prednisone often outweigh the benefit, and it is not recommended for chronic pain management in dogs.
Prednisone for dogs starts working quickly, just an hour or two. For short-term use, like an ear infection or viral infection, the quick onset allows us to do a relatively short tapering dose of the drug. This permits rapidly weaning the pet off the med to minimize the side effects of prednisone.
1. Sauvé F. Use of topical glucocorticoids in veterinary dermatology. Can Vet J. 2019;60(7):785-788. Accessed December 30, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563888/
2. Edwards SH. Corticosteroids in Animals. Merck Veterinary Manual. Published November 2022. Accessed December 30, 2022. https://www.merckvetmanual.com/pharmacology/inflammation/corticosteroids-in-animals?query=steroids
3. Notari L, Burman O, Mills D. Behavioural changes in dogs treated with corticosteroids. Physiology & Behavior. 2015;151:609-616. doi:10.1016/j.physbeh.2015.08.041
4. Brooks W. Steroid Use in Dogs and Cats. Veterinary Partner by VIN. Published November 18, 2021. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952031
5. Gollakner R. Prednisolone/Prednisone. VCA Animal Hospital. Accessed December 30, 2022. https://vcahospitals.com/know-your-pet/prednisoloneprednisone
6. Whittemore JC, Mooney AP, Price JM, Thomason J. Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double-blind randomized trial. Journal of Veterinary Internal Medicine. 2019;33(5):1977-1987. doi:10.1111/jvim.15577