Reduction of Prednisone

Keymaster

Hi Elizabeth,
Here is an AIHA Terms with our recommendations for prednisone reduction.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

You can see this is a relatively conservative approach that seems to help prevent sudden relapses. Not all dogs relapse, but a number of them do. We have found that these relapses further weaken an already sick dog, and though usually treatable with returning to higher doses of immunosuppressive drugs, it’s just another insult to their little bodies. A few dogs do not recover from sudden and horrific relapses.

There are some instances where a vet will put a dog on a more rapid reduction. There are cases where the dog has extremely severe side effects, such as horrendous liver values (in the range of 10-30x normal), pancreatitis or rarer cases of prednisone induced diabetes where it is urgent to halt the progression of diabetes. I urge owners to let their vet make these more rapid decreases. It’s a balance between trying to eliminate the nasty side effects and dealing with the risks involved with rapid reductions such as relapse or a severe condition called an Addisonian Crisis (read about this on the link I pasted above.)

When you reduce the prednisone to much lower immunosuppressive doses (such as 10mg day) you will reach a point where the dose is more or less equivalent to the amount of cortisol the body would make in a normal day. At this point you can begin dosing alternative days, attempting to reach a dose that is about 25-33% less OVER A FULL WEEK’S DOSAGE. (In other words don’t use the same daily dose you have been giving or even a lower dose and suddenly make it every other day, you have to make the every other day dose higher to start!) This requires a little math and is not an exact science, so don’t stress over this. You are trying to coax the shriveled adrenal glands to wake up and the every other day dose is like taking the training wheels off a tricycle.

So let’s say you went from dosing 15mg two times daily to 15mg x 66% = 10 mg two times a day.

You want to go to a once a day dose. 20mg x66% = 15mg once a day. This is best given at the start of the day when the dog needs more cortisone to supply cortisol for routine stress, the mailman needs to be barked at, there is running in the yard etc. Alternatively you could give this as 10mg in the AM and 5mg in the PM.

Now you are at a daily 15mg and you want to go to 10mg daily. This is easy, 15mgx66% = 10mg once per day in the AM.

Now you want to reduce to every other day (eod). 10×8=80mg per week. (I use an 8 day week to make the math easier.) 80mgx66% = 52.8. You can go to 50mg per week. 50mg/4 = 12.5. Make this either 15mg eod or 10 mg eod on M-W-F-Sun, dosed in the morning.

I would make these changes about every 2 weeks. Precede each change with a simple PCV at the vets to ensure there are no LARGE drops. Small fluctuations will be quite acceptable. This test should not cost you more than $20. Do not repeat a full CBC each time. If you are worried about liver enzymes during this time, ask you vet if they will do just a liver panel, not the full chemical screen.

During this time you must be alert for the side effects that are natural when reducing prednisone such as weakness and tiring easily, taken to the extreme you are worried about sudden collapse and other serious side effects that require an emergency visit to the vet.

In addition, dogs that had prior disease conditions such as arthritis or digestive problems or other autoimmune condition such as allergies will suddenly appear to get worse. The prednisone was performing antiinflammatory benefits and reducing the prednisone makes the pain worse and the allergies or the digestive symptoms worse. Some dogs just do better on a little bit of daily prednisone the rest of their lives to prevent relapses and if the secondary benefit is less joint pain or less bothersome allergic reactions, this is a very reasonable approach.

When our very ill dogs begin to get better we wonder if they will return to full good health. I can tell you from experience that we often go into these horrible diseases with one dog and come out with a slightly different dog. Their personalities usually remain intact, but they are a bit more fragile than they once were. Accept this and move forward. If giving a small amount of prednisone each day makes them feel better and they are less prone to a relapse then you are choosing quality of life for them.

Many dogs go on to live for many years after they recover. We always recommend a more carefully guarded approach to their lives. Less stress is the goal. This can be medical (such as too many vaccinations or unnecessary operations), environmental (exposure to chemicals, pollution, other dogs, other canine diseases, bad water, dangerous insects such as mosquitoes and ticks), dietary (such as feeding kibble), hormonal (if they are still intact, spay or neuter, and no puppies.) See your vet every 6 months for a checkup.

Do you have any questions about how I have explained the prednisone reductions?
my best, Patrice

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