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Most people are
familiar with the term cortisone, which is really an old fashioned word for
cortisol, the hormone produced by the adrenal cortex in times of stress. In
higher doses, cortisol has potent anti-inflammatory properties, making it a
very useful medication. Because of this property, cortisol has been
synthetically improved so as to provide an entire family of glucocorticoid
hormones that include such familiar medications as:
Prednisone and
prednisolone
Dexamethasone(AziumŪ)
Trimacinolone (VetalogŪ)
Methylprednisolone (MedrolŪ)
These medications last
longer than natural cortisol and are stronger. In fact, there are so many
therapeutic steroids that a doctor may choose the strength as well as
duration of activity.
There Has Never Been a
Class of Drug that has More Application in Disease Treatment than the
Glucocorticoid Class. Indeed, this Group is Rivaled Only by Antibiotics in
Lives Saved. Side effects from the glucocorticoid group are numerous and can
be classified into those seen with short-term use and those seen in
long-term use.
Short Term Side Effects
The pet on
glucocorticoids is likely to experience the following:
Increased hunger
Increased thirst (and
possibly urinary incontinence if there is inadequate access to an area for
appropriate urination).
Panting (dogs)
General loss of energy
Recrudescence of latent
infection
Further, pre-diabetic
animals may be "tipped over" into a diabetic state with steroid use. Often
in these cases, the diabetes resolves once the steroid wears off. Sensitive
individuals may experience upset stomach that can be serious.
Should the above issues
become problematic, generally adjusting to a lower dose of medication will
solve the problem. The goal with glucocorticoids is always to find the
lowest dose of medication that is still effective. Sometimes changing to
another steroid solves the problem.
Long
Term Side Effects
There are many
conditions that require long-term suppression of the immune system.
Glucocorticoid doses generally include an anti-inflammatory dose that is
lower and an immune suppressive dose that is higher, although with enough
long term use, lower doses will become immune suppressive. When steroid use
stretches out for more than 4 months, a new set of side effects (in addition
to those listed above) becomes a concern:
Latent Urinary Tract
Infections in up to 30% of patients
Monitoring for these is
necessary with periodic urine cultures. The patient will not have the usual
symptoms of urinary infection, as the steroid will suppress the inflammation
associated with the infection. Culture may be the only way to detect the
infection.
Development of Thin
Skin, Blackheads, and Poor Ability to Heal Wounds or Grow Hair
Development of Obesity
and Muscle Weakness
Hard Plaques of
Diseased Skin called Calcinosis cutis These plaques actually represent the
deposition of calcium in the skin.
Development of
Opportunistic Infections
Fungal infections of
the nasal cavity and development of adult onset demodectic mange have been
classically described with immune suppression from chronic steroid use.
Development of Diabetes
Mellitus
Animals on
glucocorticoids will drink and urinate excessively but a rapid weight loss
is a big clue that something new may have developed and some additional
blood work should be performed.
The animal on long-term
high doses of glucocorticoids may well develop Cushing's syndrome, which is
largely described by the list of symptoms above. This may be unavoidable but
is certainly undesirable and in many cases, an additional medication can be
added to the regimen to "spare" the amount of steroid needed to control the
disease being treated.
Glucocorticoid hormones
are not bad and it is not inherently bad to use them. They should be
respected and not over-used. Pet owners should be aware of steroid side
effects and that it is usually possible to alter the regimen to minimize
side effects.
Do not use
glucocorticoids on a daily basis except when your veterinarian specifically
tells you to.Life-threatening immune-mediated diseases often require daily
steroid use. Most steroid protocols require daily use at first only. If
using steroids to control itchy skin or for musculoskeletal pain, it is
important at least to use an every other day schedule. If you feel your pet
is not comfortable except with daily steroid use, the regimen will need to
be altered so inform your veterinarian.
Do not stock large
quantities of glucocorticoids at home.It may seem frustrating to have to get
multiple refills when it may be less expensive to buy in bulk, but your
veterinarian will need to periodically check in with you about how you are
using your medication and will likely not allow for large quantities to go
so as to be sure to keep in contact with you and to prevent over-use.
Usually no more than 4
months of every other day steroid use is prescribed annually before having a
consultation to review the therapy and consider alternatives. Animals that
require long-term use of steroids are usually monitored with quarterly urine
cultures and annual blood panels/check ups. If your pet appears to require
steroids more than 4 months out of the year and you do not have a specific
monitoring schedule, ask your veterinarian for a recommendation and plan
ahead for monitoring tests.
It is
recommended that a stomach protectant such as Zantac is also given to
prevent irritation to the stomach lining
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