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MEDS - Glucocorticoids
MEDS - Glucocorticoids
Glucocorticoids
Lauren Trepanier, DVM, PhD,
DACVIM, DACVCP
University of Wisconsin–Madison
Dosages that are approximately 3-fold higher Prednisone, prednisolone, and methylpred-
have been recommended for stress (eg, hospi- nisolone all have some mineralocorticoid
talization or surgery) in animals that have effects,6 and moderate-to-high dosages
endogenous GC deficiencies.8,9 This is sup- should be avoided in patients with hyperten-
ported by studies of cortisol secretion in dogs sion, heart failure, ascites, or hypokalemia.
under experimental stress conditions.8,9 Further, methylprednisolone acetate can lead
to acute plasma volume expansion and even
For anti-inflammatory effects, oral dosages of congestive heart failure in cats, although this
0.5 to 1.0 mg/kg per day for dogs and 1.0 to has been attributed to intercellular fluid
2.0 mg/kg per day in cats are recommended; shifts rather than overall water retention.10,11
for immunosuppression, 2.0 mg/kg per day
or 50 mg/m2 in dogs or up to 4.0 mg/kg per GCs typically induce serum alkaline phos-
day in cats is suggested. phatase (ALP) activity in dogs, with lesser
increases in alanine aminotransferase (ALT).
For large- and giant-breed dogs, the use of no These changes are not clinically actionable
more than 50 mg/m2 (maximum dosage of 30 on their own unless ALT activity approaches
to 40 mg twice per day) is suggested by the or exceeds ALP or if hyperbilirubinemia is
author to decrease the incidence of severe present, each of which suggests a different
adverse effects (eg, muscle wasting, second- disease process.
ary infections). In overweight cats, the dos-
age of prednisolone should likely be based on In contrast, ALP does not appear to be readily
estimated lean body weight, as plasma pred- induced by GCs in cats7; small increases in
nisolone concentrations are approximately ALP compared to baseline have been reported
2-fold higher in obese cats when compared in cats given methylprednisolone acetate,
with normal-weight cats given the same but no values were outside of range.8 Any
dosage/kg.3 increase in serum ALP outside of the refer-
ence range is clinically important in cats,
regardless of whether they are being treated
with GCs.
TABLE
*Dosing on m2 basis is recommended anecdotally in large dogs to avoid debilitating adverse effects.
dexamethasone or prednisone in dogs. Tri- Like oral GCs, these injectable GCs can cause
amcinolone is more commonly used in its debilitating adverse effects, which are more
long acting injectable formulation (Vetalog, difficult to reverse because of prolonged dura-
bi-vetmedica.com) in dogs. tion of action.
can cause debilitating adverse can precipitate overt diabetes mellitus. Any
cat treated with a GC—particularly those
effects, which are more difficult to given intermittent long-acting injectables—
Bacteriuria without clinical signs in GC-treated dogs. However, cur- Video Otoscope
develop in about 20% to 40% of rent evidence in humans does not The smartScope System
dogs treated with GCs chronically; support the treatment of asymp-
females appear to be at a higher tomatic bacteriuria, even in immu-
risk than males.19,20 Bacteriuria nocompromised patients. 14,15
can be seen even with alternate-day Therefore, periodic urine cultures VetOvation’s
therapy, and monitoring urine sed- are probably not indicated in dogs affordable
iment alone is unreliable because and cats treated with GCs, unless smartScope
half of positive cultures lack pyuria urinary signs are noted. n connects to
an iPhone™,
using its camera
technology to
process videos and still images to
References pinpoint recurrent or underlying
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