Steroids are perhaps one of the most ubiquitous medications in the veterinary world. They can be used for a host of problems ranging from inflammation and allergies to autoimmune disease. While they are incredibly useful and diverse medications, steroids are not without significant side effects...
Several cancers respond to steroids by shrinking. Lymphoma is a frequent cancer of dogs. The earliest symptoms are usually general malaise and enlarged peripheral lymph nodes (found underneath the jaw, in front of the shoulder blade, in the groin area, and behind the knee).
Lymphoma is highly sensitive to chemotherapy and carries a good prognosis if treated aggressively. Many owners opt for palliative care however, for a variety of reasons, including cost and concern for quality of life.
Prednisone is an excellent palliative agent for lymphoma and can often keep it in remission for weeks to months. However, it is important to know that prednisone will interfere with chemotherapy. If your dog has been diagnosed with lymphoma, and you are considering chemotherapy, prednisone should not be started until speaking with an oncologist.
Many other cancers are often treated with oral steroids, as well. These are usually used adjunct to chemotherapy and/or radiation. Doses are higher than with anti-inflammation and anti-pruritus, usually in the range of 2 mg/kg of body weight per day or higher.
When Should Steroids Not Be Used on Dogs?
There are many cases where steroids are not an appropriate treatment. For some of the following examples, steroids remain controversial. Some veterinarians continue to use them based on years of experience (anecdotal), while others have discontinued use based on the same reasoning. Scientific data is somewhat conflicting and lacking on the subject, but these are the most current thoughts on steroid in certain situations:
Steroids were once a common and well-accepted treatment in cases of shock. For example, if a dog was hit by a car, one of the first ministrations would be a large dose of steroids given by injection.
Over the years, it has become apparent in human medicine that steroids during shock are not helpful and are likely detrimental. They can downregulate important enzymes throughout the body, leading to worsening of low oxygen conditions (hypoxia, present during shock).This can lead to kidney and gastrointestinal damage as evidenced by bloody diarrhea and vomiting.
Steroids should no longer be used to treat shock. Instead, treatment should focus on oxygen therapy, pain relief, control of hemorrhage, and intravenous (IV) fluids.
In Combination with NSAIDs
Non-steroidal anti-inflammatory drugs are very common in veterinary medicine and have a similar action in certain parts of the body. NSAIDs include meloxicam, carprofen, deracoxib, firocoxib, and several others. Using them with steroids can compound negative side effects and lead to gastrointestinal ulcers, hemorrhage, kidney damage, and in extreme cases, death. They should almost never be administered in tandem.
The one exception is in the case of immune-mediated hemolytic anemia (IMHA). Patients with IMHA are prone to blood clot formation, so while steroids are used for immuno-suppression, very low dose aspirin also may be used to prevent clot formation.
If a switch is required between these drugs, a wash-out period of at least two to three days is recommended to avoid these interactions. It is also critical to tell your veterinarian if you are administering any medications to your dog, especially over-the-counter pain relievers like canine aspirin (or human aspirin).
Even today, steroids are still used to treat snakebite victims. It has become apparent through research that steroids do not provide much (if any) benefit for these patients. The cases in which they might be useful are upper airway swelling as occurs with a bite to the mouth or neck or during an allergic reaction to antivenin. Otherwise, steroids are not indicated.
Side Effects of Steroids on Dogs
There are many well-known side effects of steroids. In the short term, dogs will drink and urinate excessively. A previously house-trained dog may start having accidents in the house. Dogs also will eat more. Often, heavy panting occurs. Restlessness and pacing are also side effects.
Occasionally, dogs will behave in an agitated or aggressive way (the well-known “‘roid rage” syndrome noted in humans). If steroids are used long term, symptoms become more pronounced, and your dog may develop iatrogenic (caused by medication) Cushing’s disease
Cushing’s disease occurs naturally when the adrenal glands overproduce cortisol (it is the opposite of Addison’s disease), the body’s natural steroid. This can occur due to either a brain tumor called a pituitary adenoma or an adrenal tumor.
The symptoms of Cushing’s are weight gain, hair loss, panting, restlessness, frequent skin and urinary tract infections, and dramatic increases in urination and drinking. If oral or injectable steroids are administered frequently over extended periods of time, this syndrome can occur. Discontinuation of the steroids will reverse this.
Steroids should never be stopped abruptly. When steroids are taken orally or by injection, the body’s natural steroid levels drop. If the exogenous (originating from outside the body) source is stopped, the body needs time to recover and resume making its own (endogenous) cortisol. In this gap, patients can develop a steroid insufficiency and exhibit signs of Addison’s disease: vomiting, diarrhea, weight loss, and anorexia. Because of this, steroids should always be tapered slowly. Most courses will go from twice a day, to once a day, to every other day.
Steroids are very useful and important medications. But, as with any medication, using them correctly is critical to success. They have many side effects. Make sure to work closely with your veterinarian to ensure that steroids are the best option, as many medications are now available to take their place.
STEROIDS FOR DOGS: OVERVIEW
1. If your veterinarian recommends or prescribes a corticosteroid, make sure you have informed her about every drug and supplement you give your dog, to ensure there are no adverse drug reactions caused by incompatible medications.
2. Be sure you understand the dosing amounts and schedule, particularly when it comes to “weaning” your dog off of the medication.
3. Don’t ask or allow your veterinarian to prescribe steroids for the long-term management of allergies; this use in particular can cause the development of other, even more serious health problems. Allergies are better addressed by applying oneself to discovering the offending allergen(s) and managing your dog’s exposure, and using steroids only to control an acute flare-up of a “hot spot,” for example, and just on a short-term basis.
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