Sunday, February 20, 2011

Q & A: What's the Ideal Prednisone Dose for Dogs with Addison's Disease?

I'm writing to inquire if there is a consensus among the endocrine experts on the dose and frequency of administration of oral prednisone for an Addisonian dog on monthly Percorten injections.

i usually use about 0.1mg/kg SID, but some of my colleagues use 0.2mg/kg SID, whereas others using every other day (EOD) dosing at 0.1 - 0.2mg/kg each dose EOD).

i know each dog is different, and they may require more or less depending on "stressful" situations, but wanted to see if SID or EOD is the preferred frequency. I'd also like to know what dosage you recommend.

My Response:

For dogs with spontaneous hypoadrenocorticism (Addison's disease), it makes the most sense to me to give the glucocorticoid supplementation on a daily basis.

There is no reason to give alternative day steroids to avoid adrenal suppression in these dogs, because the adrenals are already permanently atrophied or destroyed in dogs with Addison's disease. If you give alternate day prednisone, they would have no glucocorticoid reserve on the off day.

I dose prednisone or prednisolone at 0.1-0.2 mg/kg/day. If the dog develops polyuria and polydipsia (PU/PD) or any other signs of iatrogenic Cushing's syndrome, I would lower the dose as needed.  I rarely, if ever, give a higher dose than 5-mg per day to ANY dog. The 5-mg dose is the average human maintenance dose, and we see very few dogs that weigh over 70 kg.

241 comments:

1 – 200 of 241   Newer›   Newest»
David said...

Do you ever resort to using Hydrocortisone if the patient is intolerant of prednisone (PU/PD) and if so, what dose do you use?
David W. Krick, DVM

Dr. Mark E. Peterson said...

Good question. If a dog develops PU/PD on prednisone, I would certainly consider switching to another glucocorticoid. Hydrocortisone acetate is a good choice, but it has to be administered twice daily in most dogs (dose, 0.5-1.0 mg/kg, BID).

In dogs with Addison's disease, hydocortisone does have the advantage of possessing some mineralocorticoid activity, so using this drug might allow for a lowered dosage of mineralocorticoid supplementation (either Florinef or Percorten).

The other option is to use methyprednisolone (Medrol; 4 mg tablets). This is dosed similar to prednisone or prednisolone (0.1-0.2 mg/kg/day) but is often associated with less side effects.

Anonymous said...

is it ok to break up the SID dose into 2 a BID dose? For example, I have a french mastiff that will vomit if he does not recieve his pred within that 24 hour time period. if his pill is given anytime after the 24th hour, he vomits. Can I give him half of that same dose twice daily to spread out the medication?

Dr. Mark E. Peterson said...

It's perfectly fine to divide the total daily maintenance dosage of prednisone into a BID dose, given about 12 hours apart.

The only disadvantage to going BID is that is might be more difficult to give smaller dogs the divided dose. Other than that, giving BID prednisone is probably better since adequate glucocorticoid will always be available in the circulation.

Erica Heftmann said...

How can we determine the lowest appropriate dose of prednisone? Our 42 lb. Basset is on 2mg per day. A blood test for elective surgery led our vet to suspect, then confirm atypical Addison's before any noticeable symptoms developed. She had visible catabolic wasting during Prednisone "loading" of 10 mg/day. We reduced it to 5mg, then 2mg per day. She still has not recovered all of her muscle (but her behavior is normal and energetic). She has mild but noticeable PU/PD. Given the potential for side effects to occur after long-term use, we want to find an objective way to determine the lowest limit of prednisone dosage that will still provide adequate glucocorticoid replacement.
Your blog has been of tremendous value to us. It is a very generous use of your time to make your expertise so available.

Dr. Mark E. Peterson said...

Unfortunately, there is not a test to determine the ideal or lowest dose of prednisone or prednisone in dogs (or cats) for glucocorticoid replacement. We must base the dose of how the dog feels, as well as looking at side effects.

Given that your dog is mildly PU/PD, I'd try to lower the daily dosage or change to methylprednisolone (Medrol). The tablet comes in a 4-mg tablet so I'd start with 1/2 tablet once a day (or 1/4 twice daily).

Katherine said...

I see that you say that you rarely, if ever, give more than 5mg/day to ANY dog. Yikes. My dog was prescribed 20mg/day (1x) a few days ago (he was prescribed daily Gabapentin, 100mg/1xday at the same time). He has cancer and it was prescribed to stimulate his appetite, as well as for its anti-inflammatory effect (but especially for his appetite). Today will be his fourth day on that dose. I notice little if any improvement. Today (so far; it's still morning) he actually seems more lethargic, weak and sleepy, and less interested in his usual daily pleasures in spite of having had a small meal last night, which was more than he'd eaten in several days. Is it possible my veterinary oncologist prescribed too high a dose of prednisone? She called it a "medium dose", "the amount necessary to get the anti-inflammatory effect." Now I'm worried that I'm poisoning him. I should also note that she started him on the prednisone only 2.5 days after his last Rimadyl dose, because of the urgency of his situation. FYI, he is also on Tramadol (50mg/2-3xday), Pepcid (10mg/2xday), Mirtazapine (15mg/1xday), and Clindamycin (300mg/2xday), in addition to the Gabapentin.) Any insight, hunch, gut feeling or advice you might be able to offer would be greatly appreciated! I know I don't have much longer with my boy, but I want him to be as comfortable as possible.

Katherine said...

P.S. My dog weighs ~50lbs.

Dr. Mark E. Peterson said...

Well, you are correct in that I don't generally treat any dog with Addison's disease (or hypoadrenocorticism) with a total daily dose of prednisone (or prednisolone) higher than 5 mg.

But this is the physiologic dose needed to replace the dog's deficient cortisol secretion characteristic of Addison's disease. We only give a small dose to those dogs because we provide this amount of prednisone to them every day for the rest of their lives (generally daily for months to years).

Veterinarians commonly use much larger doses of prednisone and other glucocorticoid drugs for a variety of other reasons. For example, we may use higher doses of the drugs because of their anti-inflammatory or immunosuppressive properties. Or sometimes we use the drug just simply to help stimulate the appetite.

In these instances, these higher doses are not generally given for longer than a few days or weeks because the higher doses will lead to signs of iatrogenic Cushing's syndrome. But sometimes in dogs with severe disease (such as cancer), we don't have any choice other than to use these drugs to make our dogs feel better.

Hope this is all clear. My best to you and your dog Yikes.

Katherine said...

Thank you; that helps. I was thrown by the word "any." Didn't mean to barge in on a discussion of Addison's disease. ("Your dog Yikes." Heh.)

Greg said...

I have an 3 yr old atypical Adisonian Labrador that I compete in Hunt Tests and will Pheasant hunt over. What is the best way to monitor him? A glucometer? And is there a level I should shoot for or try to maintain?
Should I do this at all times even when not in high activity periods? Alsom since electrolytes can be important in this situation, is there a good way to insure these levels stay where they should? Can I assume one of the Performance dog foods with the higher protein and fat content would be best?

Thanks
Greg

Dr. Mark E. Peterson said...

Dogs with atypical Addison's generally don't have serum electrolyte abnormalities. So I would have a serum chemistry panel monitored 3-4 times a year but that should not be an acute problem in your dog.

During times of hunts or other strenuous exercise, it would be useful to monitor blood glucose values, especially if he is showing signs of low blood sugar (weakness, lethargy).

It may be useful to provide extra glucocorticoid supplementation during those times of work, and of course, a high quality diet is essential. So yes, a performance dog food with higher protein and fat content would be good.

And of course, if he develops lethargy, weakness or disorientation, it would be a good idea to feed him extra at that time, even if you cannot measure a blood sugar immediately.

Greg said...

Thank you for your reply.

My concern then would be what blood sugar range should I look for and attempt to maintain normally and during high stress?

Thank you for your time.
Greg

Dr. Mark E. Peterson said...

You would want to maintain the blood glucose within the normal reference range limits.

In the dog, that's generally between 80-120 mg/dl.

sexymercedes said...

My dog has been diagnosed with Addisons disease (I believe primary) a month ago. She is taking 1/4 a tablet of 20MG of prednisone daily unless I feel she is stressed out. She goes in today to get her Percorten shot. She is 85lbs(a german shepard/lab/retriever mix). Would it be cheaper to put her on florinef daily than to get the shot monthly. Also do you feel the prednisone is to high of a dose?

T said...

Recently my lab was diagnosed with Addison’s disease after she had a crisis. She is a year old weighed 70 lbs before the crisis. She stayed at the hospital for 6 days they were not sure what was wrong and thought her kidneys were failing when he stumbled upon Addison’s disease. He prescribed her 10mgs of prednisone every day and Percorten every 28 days. It has been 14 days now since the crisis and she had her blood test with good results but I am concerned about how much prednisone she is getting. She did loose lots of weigh during her week of not knowing what was wrong with her as she weighed only 58 lbs on the day we took her home. She now is crazy about her food and drinks lots of water and has tons of energy. I am feeding her 4 cups a day instead of the 3 cups she should get and weighs 62 lbs now. If I do not limit her food she would eat until she is sick. I think she has a really high metabolism because she is always skinny. I respect the Doctors because he saved her life but when I asked him if she would ever get her prednisone dose lowed he said no. I just wanted to see what you thought.

Dr. Mark E. Peterson said...

Mercedes: although the daily prednisone dose for a dog with Addison's disease is variable, giving a 5mg dose to an 85lb dog seems appropriate. Brand name florinef would be very expensive but your vet could look into getting a compounded florinef made up that may be cheaper.

Dr. Mark E. Peterson said...

T- The maintenance dose of prednisone for dogs with Addison's disease ranges from 0.1 - 0.2 mg/kg/day. So for your dog, that calculates out to be about 2.5 to 5 mg/day. You may want to speak to your vet about lowering the dose, which would help the excessive thirst and urination.

Digital Blá said...

Hi Dr. Mark,

I just graduated from vet school. My grandpa's Dachshund was just diagnosed with Addison's. He was having "episodes" of malaise, lethargy, shivering, lack of appetite, he just seemed "out of it" for a day or 2 and then would get better...and then a couple weeks later the same thing would happen again. I live in Brazil and the first test they did was the basal ACTH instead of the gold standard Acth stim test. His basal ACTh was very low, so he was diagnosed with secondary addisons. They now plan on making the acth stim test. Before the diagnosis the vet prescribed prednisolone 2.5mg PO BID. Now, even after the test results, the vet didn't lower his dose. I think the 5mg daily dose of pred is too high for him. At first his behavior got better and he seemed happier, but now he is lethargic again, is PU/PD and increased appetite.
My question is: How long does it take on a high pred dose for iatrogenic Cushing's to develop? He has been on 5mg pred for about 2 weeks now.
I would like to lower his dose to 0.1-0.2mg/kg. He weighs around 7kg. what's the best way to taper his dose? They sold us 5mg pills. Can I lower it from 2.5mg BID to 2.5mg SID for a week, and then then next week lower to 1/4pill (1.25mg) SID? And see how he does on the lower dose?
Thanks so much!

Digital Blá said...

Hi Dr Peterson,
What would be the correct way of switching a dog on prednisolone to dexamethasone, so that an acth stim test can be performed? How long before the test should the switch be made? What dose of dexamethasone would you use? And after the test is there a specific way to switch back to maintenance pred?
Thank you!

Dr. Mark E. Peterson said...

You don't really need to do the switch to dexamethasone to do an ACTH stimulation test. Just stop the maintenance prednsione for 24-48 hours before the ACTH stimulation test is done. That is enough time for a dog to clear or metabolize the prednisone from his or her bloodstream.

Dr. Mark E. Peterson said...

Actually, I now see you had two questions. For a 7 kg dog, I would taper the maintenance predisone down to about 1 mg per day for a week or so. Then do an ACTH stimulation test after withholding the prednisone for 24 hours.

Dog Lover said...

I have a 45# dog with typical Addison's disease that is doing well on 1 ml Percorton evert month. Her vet feels she doesn't need any prednisone. Do all dogs with typical Addison's need prednisone? If so, what information can I provide to the vet to add prednisone to her treatment plan?

Dog Lover said...

PS - What are the negatives to not providing prednisone to a dog with typical Addison's disease.

Dr. Mark E. Peterson said...

No, some dogs do fine without daily prednisone. Under times of stress or illness, your dog may need some glucocorticoid coverage. Your vet would know this or could look up the information in any standard internal medicine textbook.

Dog Lover said...

Can Percorton be given either IM or SQ when treating a dog with Addison's disease?

Dr. Mark E. Peterson said...

Yes, Percorten-V can be administered either SC or IM to dogs.

ryan willbee said...

Can u give some insight as to the symptoms of too much prednisone. I have noticed from time to time my dog shaking/shivering.

Lab mix, 5mgs a day

Dr. Mark E. Peterson said...

The most common signs of overdosage of prednisone (or any other glucocorticoid or cortisone-type drug) that we see in dogs include the following:
1. Increased thirst and urination;
2. Increased appetite;
3. Weight gain

Shaking or shivering are not generally signs we see with too much prednisone. If your dog has Addison's, it's more common to see shaking or shivering if the prednisone is being underdosed. That said, sometimes dogs will show these signs but otherwise be normal and we can not determine why they shake!

These are very unspecific signs.

Miranda said...

Hello Dr. Peterson --

Thank you so much for all the information. I have an Addisonain GSP who weighs about 55-60lbs. He is currently on 10mg prednisone a day. He was rescued from a shelter, so I do not know his "normal" behavior. But he is excessivly hyper and anxious, drools, is losing hair, and is insatiably hungry. I would like to decrease the pred to see if that helps. Any suggestions on the safest schedule to taper down?

Thank you!

Dr. Mark E. Peterson said...

First of all, it would be very safe to simply start by cutting the daily dose of the prednisone by half, down to 5 mg per day. If the signs continue after a week or two, you can then continue to taper down to 2.5 mg per day.

If your dog is also on Florinef, remember that it also has great glucocorticoid properties and actions, so you might have to stop the prednisone completely if that is the case. On the other hand, Percorten-V doesn't have any glucocorticoid activity, so a low dose of prednisone is generally needed.

Sandra Palasti said...

This is a great forum! I have a Cavalier with Addison's on prednisone and PCV. I also foster dogs for 2 week intervals for the local shelter. This seems to really stress her out and I therefore increase her dose while the fosters are in my home. Am I harming her by doing this? Do I need to avoid stressing her? I would love to adopt another dog but I see she is quite uncomfortable when the fosters are around. Might she adjust or should I just give up on fostering and my dreams of another pup.

Dr. Mark E. Peterson said...

Dear Sandra,

A short-tern increase in the prednisone dose should do no harm, but doing this quite often is not a great idea.

It sounds like the fostering of shelter dogs may not be in her best interest if she finds it that upsetting. However, if you did get another dog (that you would adopt, not foster), it's likely that she would adjust and do well, but it certainly could take a few weeks for that to occur.

evan bussi said...

My Schnoodle was diagnosed with Addison's Disease in the spring of 2012. He we is a full Addisonian crisis three times. He is on Florinef 0.1mg(3 tabs) in the am and then 3 more tabs at dinner time. If he vomits or show any symptoms of his Addisons I supplement him with 2.5my of Prednisone. Now he has severe leg spasms (if thats what they are called)where his legs are severely stiff and he cries. He walks like he is a brand new baby horse where his legs are stiff, can't bend and he falls. I don't know if he needs more prednisone? More Florinef? Now the vet want him on thyroxine due to low thyroid. He seems to get weaker everyday and he has barely any fur left. I feels as if I am torturing this dog to a slow death. Any advice would be great!!!

Katie Poodle said...

i have a standard poodle with addisons. she is on prednisone (1mg) and florinef (.4 mg). We have had numerous visitors with dogs and she is now showing sleeping incontinence as her only changed behaviour. need advice on how much to change her dosages.

Dr. Mark E. Peterson said...

Severe leg spasms, stiff legs and falling aren't signs that we see with either Addison's or hypothyroidism. And Addison's doesn't cause hair loss.

Obviously, I can't make a diagnosis but I would be concerned about too much prednisone or florinef which is causing your dog to have iatrogenic hyperadrenocorticism (Cushing's disease). Talk to your veterinarian about that. I'd start looking for other problems (other than Addison's) now.

Dr. Mark E. Peterson said...

Katie,

Is your Standard Poodle drinking and urinating more? The doses of prednisone (1mg) and florinef (0.4 mg). seems appropriate. If she is indeed drinking more, you can try stopping the prednisone for a few day to see the response. If that doesn't work, we could try switching the florinef to Percorten-V monthly injections.

If she is drinking a normal amount, the sleeping incontinence may not be related to the Addison's or the medication. Older spayed females dogs can develop urinary incontinence, which can respond well to female hormone replacement. Talk to your vet about that.

jerry smith said...

Dr Peterson
my 3 yr old great pyrenees mix (85lbs) was diagosed w/addisons 5 months ago. the vets put her on 5mg of pred daily & percorten 2.5 shot every 25-28 days. the 1st 3 months went great but the last 2 months we have had "events" 24-48 hrs after the percorten shot. month 4 she developed a urinary infection. and month 5 she had 2 very violent seizure episodes. the vets now have uped the pred to 7.5 mg daily and will on the next shot lower the percorten to 2.0. she is lethargic, drinks massive amts of water and pees every 2 hours. she is obessed w/food. are they going down the right path? is there anything they r missing or shud we be doing something else. i'm very concerned she just isnt the same happy 3 yr old she was prior to the seizures.
thnk you jerry

Dr. Mark E. Peterson said...

An 85 pound dog should never need more than 5-mg of prednisone or prednisolone a day. That's the human adult maintenance dose (so even a 175 pound man would not be treated with higher doses than that). The high pred doses explain the increase in hunger, thirst, and urination. The high doses can also cause lethargy and weakness with time.

Neurologic "events" and seizures are not part of Addison's disease, however. I don't know how the diagnosis of Addison's was made in your dog, but these signs are due to some other disease process. I would recommend that you see a neurologist for another opinion about what's causing the seizures and how to control them.

jerry smith said...

i dont know why this is not posting. but i just have a few more questions. so you dont think the seizure which happens 24-48 hours after the percorten shot has any thing to do w/the percorten shot. they are going to lower the dose this next shot from 2.5 to 2.0. is this good, bad or what.
ty jerry

Dr. Mark E. Peterson said...

To my knowledge, seizures have not been described as a side effect of Percorten therapy. I certainly have not seen this as an adverse effect. If the seizures was an allergic reaction to the Percorten, I would expect it to occur sooner than 2 days after the injection.

If you really believe that Percorten is the cause, it may be best to stop that drug and change to daily oral Florinef. I'd talk to your vet about that. If the seizures continue after you stop the Percorten, then you dog probably has a primary seizure disorder.


Kate said...

Hello,

Thanks for putting together this great resource. My dog was diagnosed with addisons last year, and this page has been a great help.

I'm writing with two questions. First, to ask about her prednisone dose. She is a deerhound, around 85lb, and on 10mg of prednisone per day, along with florineff. From a few of the comments above, this seems like quite a high dose. It's made her extremely food motivated, even after a big meal. And though I'm doing little things to improve this - breaking her meals into smaller ones, healthy treats etc - I don't like the idea that she is actually feeling hungry. I'll speak to the vet about this side effect, but am writing to ask whether it's usual to start the dose high and perhaps reduce it down through trial and improvement?

Second, I'm writing to ask about whether addisons might be limiting her ability to run? I used to let her out in a field, where she'd spontaneously burst into a spiralling sprint. It was a lovely thing! She's stopped doing this, although of course it's still early days (diagnosed about 9 months ago). I'm writing to ask whether being reliant on synthetic gluccocorticoids means she may not be able to rapidly fuel this kind of highly energetic/sudden activity? Or will it come back when she's back to full fitness?

Thank you for your time,
Kate

Dr. Mark E. Peterson said...

Remember that the 5-mg tablet size is the daily maintenance dose for the average-sized human patient. So at 85 pounds, that's at least twice the amount that you should be giving.

Administrating too much glucocorticoid will cause increased hunger and can contribute to muscle atrophy and muscle weakness. It can also lead to lethargy.

So cutting down on the dose to 2.5-5.0 mg per day may help all of your dog's problems.

Kate said...

Thanks Dr Mark,

That helps. I've booked an appointment to talk this over with our vet,

Kate

Dr. Mark E. Peterson said...

Dear Kate,

Remember that I'm not saying that your veterinarian has done anything "wrong." Vets have been taught that these doses of prednisone are appropriate to give to dogs. That is certainly true in the short-term, but not for life-time use.

Pia Pet said...

Dr. Peterson, first thank you for the wealth of information and guidance. I have a 12-yr-old male neutered Vizsla approx 60lbs who has been on Percorten V (1.6mg/kg/30 days) and low dose prednisone (2.5mg daily) since 2006 and has a very stable and happy life. In recent past months I am noticing that he is getting some sleep incontinence. I decided to cut the prednisone dose back to 1.25mg (1/4 of 5 mg tablet) to see if that would help, and then went to every other day @ 1.25mg provided there were no major stress events. (A neighbor of mine also has a senior Addisonian terrier experiencing the same symptom). My dog seems to be stable on 1.25mg, but on days he gets prednisone (even this reduced amount) there is some sleep incontinence. I saw your reply to another post suggesting that perhaps a switch to hydocortisone could be a solution (which I will discuss with my vet) and if it results in the ability to administer less Percorten V ($$) that's even better. Or can I go even lower on the prednisone? (he's only getting 0.05mg/kg/EOD) My other question is: I was reading about natural remedies for dog incontinence because I do not want to put the dog on Proin. I am curious about trying corn silk since many have reported that there is success. However, my reading indicated that potassium supplementation may be needed when giving corn silk because a side effect is depletion of serum potassium (even in humans) - which I don't think would be something to play around with in an Addisonian. Although most/all Addisonians when not properly medicated have too low a Na:K ratio (and in theory losing potassium would trend the ratio higher), I don't want to introduce another "active" (to control incontinence)that will potentially cause harm to or complicate his Addison's therapy, or harm another organ system dependent on proper serum K. Any recommendations would be most appreciated, thank you!

Dr. Mark E. Peterson said...

You could certainly try going lower on the prednisone to help control PU/PD. About half of dogs do fine on no glucocorticoid supplementation, but they should always have some "on hand" if anorexia or other signs develop.

Is your dog drinking a lot or does he just have the sleep incontinence? If the urinating problem is not associated with increased thirst or increased urine volume, I'm not sure that lowering the prednisone dosage wil help.

Have you done a complete urinalysis and urine culture to rule out a infection (UTI)?

Pia Pet said...

Thank you for the prompt reply. I will take the dog in this week for his senior bloodwork and an appointment, which will include UA, and if appropriate we'll do a culture too. We just got off a long Easter roadtrip to/from Atlanta, it is possible the "stress" of the trip has sprouted a little UTI as well (he has been drinking more since we returned a few days ago). The travel days I made sure to give him a slightly increased dose (back up to 2.5 mg) to combat the stress. However, my observations regarding the sleep incontinence have always been on days when he gets his prednisone. Otherwise, he has a pretty tight and steel drum bladder and sphincter. Thank you again.

Matthew Goldstein said...

I am a second year vet student, and I would love some help with my own 2.5 year CM papillon mix. He has had diarrhea since the end of April. After an extensive GI workup, he was finally diagnosed with atypical hypoadrenocorticism by ATCH stim about one month ago. Despite glucocorticoid supplementation, the diarrhea has not gone away. He is currently on 1/4 of a 5mg pred BID, and he is only about 10 pounds. Attempting to reduce the dose resulted in a huge increase in frequency and loss of control. After this, we ultrasounded his abdomen and didn't find anything significant except small adrenal glands. I was wondering where you would go from here? Would you recommend changing the glucocorticoid supplementation drug? Would an even higher loading dose and then tapering be potentially effective. Thank you so very much for your thoughts.

Matthew Goldstein

Dr. Mark E. Peterson said...

Atypical Addison's in my mind is a "bad" term - these dogs either have primary or secondary hypoadrenocorticism. It is not that difficult to differential the cause by measuring serum aldosterone and/or plasma ACTH in these cases.

If your dog really has secondary hypoadrenocorticism (or "atypical" disease with normal mineralocorticoid secretion), then the prednisone should control the diarrhea.

So either your dog has primary hypoadrenocorticism and needs Percorten, or the diarrhea is a separate problem (most likely).

Mou said...

We have a 2 year old 60lb standard poodle diagnosed with Addison's 2 months ago. He was started out on 20mg of Prednisone and is now at 10mg once a day and receives Percorten every 30 days. I actually have two questions concerning the prednisone.

When we dropped him down to 5mg a day he actually became more lethargic. Should we have dropped him down slower in dosage to allow him to adjust better?

Ever since starting him in his current regime, he's started building back muscle though very slowly. He also has his energy back. However, his hair loss has continued. His fur is much more corse, wiry, and very thin. Is this a side effect of the prednisone?

Dr. Mark E. Peterson said...

Your dog's prednisone maintenance dose is 2.5-5 mg per day. Chronic administration of 10 mg a day will likely lead to muscle atrophy and other signs of iatrogenic Cushing's disease (pot belly, enlarged liver, hair thinning, insulin resistance, predisposition to other infections). It's possible that the skin changes you describe are related to the drug,

Remember that giving prednisone will make the patient "full better" even if the original problem isn't cured. It sounds like there is something else going on - I can't tell you what it is-- but no dog weighing 60 pounds needs 10 mg a day to control Addison's!

You need to talk to your vet about further investigation into your dog's problems.

K Swartz said...

Hi Dr. Peterson,

I just read an article about Prednisone and Addison's.

My Saint Bernard, George, is 2 years old and weighs 145. Just diagnosed with Addision's this past Thursday. Got 2.6 ml of Percorten and started on 30 mg of Prednisone per day (15 in AM, 15 in PM).

My vet and I are learning more, we'd like to lower the Prednisone to 5 mg per day. He is suffering from cortisol overload...lethargy, frequent urination, hunger, thirst, incontinence last eve. Then sooner the better. Considering that he hasn't been on it for even a week, how do I taper? Or can I just go to 5 mg?

Here is how we've begun lowering it:
Day 1-4: 30 mg
Day 5: 15 mg in AM, none at night (terrible bloody diarreha)
Day 6: only gave him 10 mg this morn

Can I just give him 10 mg today and begin just 5 mg tomorrow? Or is that too much danger without tapering?

Thank you!

Katherine and George

Dr. Mark E. Peterson said...

You should be fine to lower the dose to 5 mg per day now. Remember that a 5-mg dose is the human replacement dose so we are still giving the amount that you or I would need to survive. So even for your large breed dog, that will still be plenty!

K Swartz said...

Hi again Dr. Peterson!

I have lowered George's prednisone dose to 5 mg in the AM. (His other pertinent info is at the bottom of my email.)

Here is how we lowered it:
Day 1-4: 30 mg
Day 5: 15 mg in AM, none at night (terrible bloody diarreha)
Day 6: only gave him 10 mg in AM
Day 7: Only gave him 5 mg in AM
9/12, Today: Only gave him 5 mg in AM

For the last two days he has been pretty lethargic--he seems to rest until 4 pm or so. Then, after dinnertime, he has a burst of energy. Love it, but trying to keep him calm for now.

Could this be because he only gets AM prednisone? If so, should I experiment with 2.5 in morn, 2.5 in eve?

Thanks!

Katherine and George
York, PA

George, Male, Saint Bernard, 2 yrs old, 145 lbs.
Diagnosed with Addison's September 5, 2013 (ultrasound and ACTH test)
Started 30 mg of Prednisone September 5, 2013 (15 mg in AM, 15 mg in PM)
First Percorten given September 8, 2013 (2.6 ml)
Bland diet (had bloody diarreha 3 days ago, September 9th, all day)
Prescribed sucralfate (1 gram) every 8-12 hrs, 1.5-2 hours prior to food
Prescribed Pepcid (30 mg) daily
Prescribed Flagyl (500 mg) 2 tablets twice per day
Tapered to 5 mg of Prednisone September 11, 2013 (5 mg in AM)

Last Blood Work 9/8/13:

K 5.5 high (3.8-5.3)
BUN 43 High (9-33)
NA 136 Low (145-156)
NA/K RATIO 26 (26-36)

Dr. Mark E. Peterson said...

Twice a day prednisone would be better than only once daily.

If you aren't doing so, you might want to lightly salt the food too. That might help increase his sodium a bit (I'm worried that he could be loosing electrolytes in the stool due to the diarrhea).

Lawrence said...

Hello Dr Mark. I have a 13 year old Maltese who has Chronic Bronchitis. We have seen clinical signs of Addisons and now the ACTH test confirms this. He is about 3.5kg. Seems that 1mg is the appropriate dose of Prednisolone?

Dr. Mark E. Peterson said...

For the average-sized Maltese, 1-mg should be enough for Addison's glucocorticoid supplementation.

Amber said...

My 18.8 lb female rat terrier (9 yrs old) was just diagnosed with Addison's last week after nearly a year of on anf off symptoms and incosistent treatment. An ACTH gel test was done last week and she is in fact Addisonian. She was given .5cc of percorten and put on 2.5 mg of pred daily. She has begun to have symptoms of PU/PD and the vet said to stop the pred all together instead of lowering the dose. We did the same thing in July (was given 5 mg of pred every day) and she then began to show addison symptoms in the beginning of September. Am I correct in my understanding that she needs both the percorten and the pred? From other sites I have found, it seems like she should only be getting 1mg of pred a day and the percorten dose is correct. I don't want her to keep yo-yoing between too much meds and no meds and having symptoms, it's not healthy for her or me (or my wallet!)

Dr. Mark E. Peterson said...

Yes, based on your dog's body weight, 1-mg per day would be a good maintenance dose of prednisone.

Lynn Ozonian said...

I have a 7 1/2 year old, 70 lb. Portuguese Water Dog with Addisons diagnosed 2 years ago. Initially with his prednisone and percorten shot he was better. But his hip dysplasia has gotten much worse and also has bouts of pancreatitis and perhaps IBD. In addition, he now has low thyroid. Daily he takes 10 mg of prednisone, 600 mg of gabapentin,12 mg of soloxine, 100 mg of tramadol, and 40 mg of Pepcid. In July, he underwent Stem Cell therapy and he has had some improvement with his pain levels - and his brown hair (which had almost become white) is now growing back brown. From reading your posts, I think I should reduce his Pred to 5 mg per day since he is showing signs of PU/PD. I think based on his improvement that I should also talk to his vet about decreasing his pain meds. I have also read that stem cell therapy might help with Addisons. Do you have any info on this or have any recommendations on his dosage of meds?

Dr. Mark E. Peterson said...

I would definitely recommend lowering the prednisone dosage to 5 mg per day. If the polyuria and polydipsia continue, you might even be able to lower the dosage to 2.5 mg per day.

Denise said...

Hi Dr. Mark. My 4 year old toy poodle, Bailey, was just diagnosed with atypical Addison's this morning. She had been in the hospital overnight. I spoke with my vet this morning and she administered Percorten-V and will be giving her prednisone. My concern is that after reading many articles along with your article and all the blogs, why did she give Bailey Percorten when from my understanding if she has atypical Addison's, she only needs prednisone? The vet even told me this morning that she rechecked her bloodwork and her sodium and potassium were in the normal range. Will this hurt her? Please advise. Thank you.

Dr. Mark E. Peterson said...

There are 2 causes for naturally-occurring hypoadrenocorticism in dogs:

1) primary adrenal insufficiency, in which the adrenal gland itself fails, usually leading to both glucocorticoid and mineralocorticoid deficiency.

2) secondary adrenal insufficiency, due to pituitary disease (loss of pituitary ACTH secretion).

Atypical Addison's disease is generally thought by most veterinarians to be an early stage of primary adrenal disease. So your vet is probably thinking that Percorten injections may be a good idea. That may or may not be correct, however, and without either measuring a plasma ACTH level or doing an ACTH stimulation test (and measuring basal and post-aldosterone values), one can't tell the difference between primary, secondary, or atypical Addison's.

I would recommend completing the workup to determine if your dog has secondary hypoadrenocorticism (pituitary ACTH deficiency), in which prednisone alone would be the treatment, or if your dog has primary hypoadrenocorticism with normal serum electrolytes, in which case the eventual need for mineralocorticoid treatment is very high.

GaBasset said...

You are providing a great resource, thanks for taking the time to provide so much valuable information! I have a Basset who was diagnosed in March of 2013. He is currently on 1.25 mg of prednisone daily and getting his Percorten injections every 28 days. I took him in today for his injection and asked about follow up blood work, and I was told that they don't recheck until a year after diagnosis. From what I am reading here I am wondering if I should accept that answer. He seems to be doing well, his appetite is good, he is active and overall seems great. Should I insist on blood work to make sure everything is where it should be? Is there anyway to find a local vet that has experience treating Addison's dogs? Thanks for your help.

Dr. Mark E. Peterson said...

First of all, I'm happy to hear that your dog is doing well on treatment for Addison's disease. We generally monitor serum electrolytes at least monthly for 2-3 months until we are confident that the Percorten dose is right, then recheck every 3-6 months or so.

Your vet may be correct in the end... in your dog, everything may be perfect and no dose adjustments may be necessary. But if you don't monitor, how would you know (unless your dog became very ill)?

If you want another opinion, I'd recommend a veterinarian certified in Internal Medicine (a diplomate) by the American College of Veterinary Internal Medicine (ACVIM). I believe that you can search for a vet internist on the ACVIM website, but you might have the call them to find such a vet in your area.

Sara Redfield said...

Is significant tremoring, particularly when sleeping or relaxing, worrisome for an "atypical" Addisonisn 11-yr old jack russell after one week of being on increased pred dose (2.5 mg daily from 1.25 every other day)? She had vomiting with tremors last weekend. Also, what are symptoms of switch from secondary to primary?

Dr. Mark E. Peterson said...

First of all, the continued tremor is troublesome. Diagnosis of Addison's in an 11-year old dog is unusual - most of these dogs are young adults - not seniors. In addition, atypical Addison's is not a final diagnosis -- it just means that the workup hasn't been finalized, at least in my mind.

There are 2 causes for naturally-occurring hypoadrenocorticism in dogs:

1) primary adrenal insufficiency, in which the adrenal gland itself fails, usually leading to both glucocorticoid and mineralocorticoid deficiency.
2) secondary adrenal insufficiency, due to pituitary disease (loss of pituitary ACTH secretion).

Atypical Addison's disease is generally thought by most veterinarians to be an early stage of primary adrenal disease but that may not be correct.

In addition, iatrogenic Addison's (from treatment with glucocorticoids such as prednisone) could induce a form of secondary hypoadrenocorticism too. This is actually the most common form of the disease. Has you dog been on steroid in the past?

To differentiate between primary and secondary hypoadrenocorticism we need to measure a plasma ACTH level or doing an ACTH stimulation test (and measuring basal and post-aldosterone values).

You need to talk to your veterinarian about the workup and diagnosis, and you may need to get a referral to a specialist for another opinion.

If you are certain we aren't dealing with iatrogenic hypoadrenocorticism, I would recommend completing the workup to determine if your dog has secondary hypoadrenocorticism (pituitary ACTH deficiency), in which prednisone alone would be the treatment, or if your dog has primary hypoadrenocorticism with normal serum electrolytes, in which case the eventual need for mineralocorticoid treatment is very high.

Sara Redfield said...

Yes, she has been on steroids before. She usually would go on steroids twice a year for allergy-related reasons. So, her use of pred throughout her life may have induced her hypoadrenocorticism?

Dr. Mark E. Peterson said...

Glucocorticoid use, depending on the type of steroid dose, length of treatment, route of administration, and the individual, could indeed lead to the suppression of the pituitary-adrenal axis and iatrogenic hypoadrenocorticism.

What were the results of the ACTH stimulation test? Based on the response, we can generally get an idea if we are dealing with iatrogenic vs spontaneous hypoadrenocorticism.

Dr. Mark E. Peterson said...

Glucocorticoid use, depending on the type of steroid dose, length of treatment, route of administration, and the individual, could indeed lead to the suppression of the pituitary-adrenal axis and iatrogenic hypoadrenocorticism.

What were the results of the ACTH stimulation test? Based on the response, we can generally get an idea if we are dealing with iatrogenic vs spontaneous hypoadrenocorticism.

Denise Beutel said...

Hi. My 4 yr old toy poodle has had atypical addison's since October 28, 2013. She weighs 11.8 lbs and is taking 1.25mg of prednisolone per day. No percortin for now because her sodium and potassium levels are in the normal range. We will continue to monitor that because we know that that will probably change. My question is that we receive a 5 mg tablet of prednisolone and have to cut it into quarters, which is extremely tricky. There is probably never a day that she gets an exact dose because they do not cut without some crumbling. First, she is a ravenous eater and finishes her meals way too fast. She is always hungry. Should her prednisolone dosage be lowered to help with the appetite issue? Not to mention that many of your bloggers have their dogs at much lower levels which, I know, would be better for her overall health as she will be on this for the rest of her life. Second, is there any other tablet or form of prednisolone that would be easier for us to administer to her so that she gets the proper amount each day? Thank you.

Dr. Mark E. Peterson said...

Yes, your dog is on much too much prednisone. The daily maintenance dose is only 0.5mg, up to a high of no more than 1.0 mg per day. In contrast, you are giving 1.25 mg/day.

Prednisone tablets are available as 1 mg and 2.5 mg sizes. In addition, both prednisone and prednisolone are available as a syrup/oral liquid or solution; you can get this liquid as as 1 mg/mL concentration. All of these formulations are human-labeled products so your veterinarian may not be familiar with them; your local pharmacy will know about them, however.

Either way, I'd get either the 1-mg tablets and give 1/2 tab a day. Or use the liquid and give 0.5 mg (1/2 ml per day).

Denise Beutel said...

Thank you. This was extremely helpful. Just one more question, my dog has been on this 1.25mg of prednisonole since October 28th, 2013. You suggested I bring the dose down to .5mg per day. Do I need to gradually taper her down to this level and, if so, how do I do this or can she just begin. Thank you.

Dr. Mark E. Peterson said...

You should be able to just decrease the dose immediately to 0.5 mg. If the appetite falls off, however, then go back up to 1.0 mg for a week or so; then try decreasing to 0.5 mg again.

beaglemom said...

Dear Dr. Peterson, My beagle was diagnosed with Addisons in Dec 2012; Over the past year, we have lowered her dose of Pred to .5 mg per day. At this dose, she suffered from PU/PD. I forwarded my vet your blog article on reduced dose pred, and a few weeks ago, he further lowered her daily dose to .25 per day. She acts fine on this amount, but she still seems to drink and urinate just as frequently. I have another beagle about her size and age--her half brother, actually--and the difference is so striking. In December we tested her urine to make sure she had not developed diabetes. My vet seemed convinced that she did not. Her last blood panel showed her K/NA ratio at 3.9. She is also on a weekly dose of Estrogen as she sometimes leaks urine. What else could be causing the PU/PD? Could she be on too much DOCP? (my vet uses her body weight as a guide) I am very worried about her. I live an hour away from Cornell Vet school, and although I fear it would insult my vet-who I generally think it terrific--I'm wondering if I should bring her to an endocrinologist there for a second opinion. Is there something we are missing?

Dr. Mark E. Peterson said...

It does sound like you need any opinion. If your vet can't figure out what's causing the increased urination, then they may welcome some help. I'd go to Cornell to get another opinion.

Sabina said...

Thank you very much for this website and your help. My 9.5 year old Westie, Mika, was diagnosed with Addison's in September 2013. She was put on 1.25 mg predinosone (she was 11lbs) and Percorten 2.2 mg/kg IM. After reading your comments, I lowered the dosage of prednisone first to 1 mg and then to 0.6-0.75 mg (she is now 14 lbs). Her second injection was after 45 days, we were checking her electrolytes every week. For the last three months her injection are every 25 days. Her next shot is not due for another 2 days, but she vomited twice after dinner on 5th and 3rd night before the next shot. Please advise if I should check her electrolytes a.s.a.p. or should I wait for the next appointment. Mika was diagnosed with Lyme disease in the summer of 2011 (asymptomatic) and with hypothyroidism in the summer of 2013. She is taking Synthroid 0.1mg twice daily and 5mg pepcid once daily together with her prednisone. Please help. Thank you very much.

Dr. Mark E. Peterson said...

Yes, if your dog is ill, the serum electrolytes should be checked to make sure that the Percoten-V dose doesn't need to be adjusted.

Agilitymom said...

I have an 8 yr old Standard Poodle who was recently diagnosed with Addison's. He is on Prednisone 5 mg daily and DOCP injections every 26 days. He has had three injections, so far. He is doing great, back to showing in agility and obedience. His weight is back up. Energy is great. He does eat and drink more than he used to but is not incontinent or anything. He does seem to be losing hair, though. The problem is his ALT and AST are continuing to climb. Both are over 400 now. The Alk Phos is normal, however. Abdominal ultrasound is normal. They are wanting to do liver biopsies. I have read that liver elevation can be caused by to much Prednisone or that switching to another type of corticosteroid may be helpful. Do you think this could cause the liver enzyme elevation or what is your thoughts? Thank you.

Dr. Mark E. Peterson said...

The liver changes we see with glucocorticoids lead to enlargement of the liver and increased brightness of the liver on ultrasound evaluation.

The glucocorticoids also induce an isoenzyme of alkaline phosphatase that can lead to marked elevations on that enzyme. The ALT and AST can also be high in these dogs. Classically, the serum alkaline phosphatase will always be higher than the ALT or AST.

In your dog, it's certainly possible that the prednisone dose is too high. If you giving more than 0.1 mg/kg/day, I'd certainly drop it down to that level. Switching to prednisolone or methylprednisolone (Medrol) would be a good idea so the liver doesn't have to metabolize the prednisone.

Overall, if this doesn't work, I agree that a further workup (eg, bile acids, liver biopsy) would be indicated.

Pia Pet said...

Hello, I posted a comment almost a year ago about my 13 yr old neutered male Vizsla who is Addisonian. His Addison's appears to be well-managed (Percorten, and hydrocortisone tab as needed). My present question is, is it possible that an Addisonian male could also be showing signs of acromegaly? For some time, I have noticed some body changes that are making me wonder. This is just not senior fat. His rib cage seems enlarged, his tail is very thickened and it looks more like the tail of a Lab (not a vizsla), he has noticeable skin folds on the back of his neck (where he routinely gets his Percorten injection) and his upper teeth are more widely-spaced and more "bucked" out than his younger years with gumline receded (alternatively, this could be more an issue of dental health). I understand that the condition is connected to somatotropin hormone levels and is more prevalent in unspayed females. Is a general vet practice equipped to run a specific blood chemistry that would measure my dogs growth hormone levels and it is a reliable diagnosis? When I showed some of the symptoms to my former regular vet (the very thickened tail and overall beefed up look to the dog's rib cage area) he dismissed it as the dog being older, carrying more fat. There are internal medicine specialists in the DC area, but none like yourself with an endocrine specialization. Can long-term Percorten administration (since 2006) bring any of these changes on? The dog weighs 58 pounds, which has been his weight for many years. Thank you for any guidance.

Dr. Mark E. Peterson said...

Acromegaly would be very unlikely. We can't easily measure growth hormone (GH) levels, but we can measure insulin-like growth hormone (IGF-1), which is an indirect measure of GH secretion. So you could do that as a screen to rule out acromegaly.

However, have you check thyroid function? Hypothyroidism might explain some of your dog's signs.

Percoten shouldn't cause the signs you describe.

Pia Pet said...

thank you for your reply. As for your question about having tested the dog's thyroid function the answer is "yes". On a typical senior blood panel that was run a few years ago that measured free circulating T4 he came up as below normal. Then the vet had me run a more extensive thyroid screening that went to U Michigan (if I remember correctly). Those results came back showing normal levels. Based on those results the vet said "your dog's low reading on the free T4 is therefore secondary to his Addison's disease and he is really not hypothyroid, and we will not continue to re-assess if he is hypothyroid because of the results of the extensive screening which gives a more complete picture of thyroid function". If these are the conditions, should I have his thyroid function re-tested or is that unnecessary? or possibly, would the dog benefit from a small dose of levothyroxine? Thank you!

Dr. Mark E. Peterson said...

I'd redo the complete thyroid panel (eg, T4, FT4, TSH, and thyroglobluin autoantibodies) and run an IGF-1 level. Talk to your vet about your concerns.

Agility Dogs said...

I have a 41 lb english setter that was diagnosed with atypical addisons. He's on 2.5mg of predisone a day. He is an agility dog that competes on the weekends. We have done follow up blood work since starting his meds and the numbers are perfect. Please note we caught his addisons early and he never had a crisis. My question is about giving extra on the weekends. I ran him one weekend and was fine Saturday but was very stressed on Sunday. We then tried giving extra 1.25 doses three times on Saturday into Sunday. What I didn't count on was the high stress on Saturday, he was better on Sunday with dealing with stress. Would it be safe to start giving him extra amounts on Friday to carry him into the weekend? And how much extra, 1.25 mg 1x or 2x before Saturday. I am trying to level him out over the two days. I currently have to deal with different behaviors each time he runs because his levels seem to go up and down. I know it's all trial and error at this point but if you have any suggestions that would be great. My vet is not even sure at this point. He was diagnosed in February so we are still early on in the process of figuring out what works best.

Dr. Mark E. Peterson said...

I think your approach is reasonable. You might want to switch to prednisolone which doesn't have to be converted in the liver (prednisone is converted to prednisolone). That would help, since prednisolone has an effect within an hour or so; if he's having a bad day, giving an extra quarter tab during these times of extra stress would also be fine.

Mary Pittas said...

Just over 2 years ago my dog Niki had stem cell treatment for her hip dysplasia, instead of using her own stem cells her vet used donor cells. A couple of months later she became very ill, lost her appetite, lost copious amounts of fur and her pain was so bad she could barely walk. After blood tests at a new vet she was diagnosed with Addison’s disease. She was put on 2.5mg of prednisolone and 1.8 ml of Percorten-V. A few weeks into treatment she began to drink ridiculous amounts of water and had PU/PD. Over time her vet reduced her Prednisolone to 1.25mg per day and extended the interval time of her Percorten-V injections, now only 1.6 ml every 7 weeks. Her PU/PD continues for the first 5 weeks after her injection then the final 2 weeks her PU/PD ceases.
Niki weighs approximately 28 kgs and is a 10 year old Border Collie X Kelpie. We have tried switching to her to Cortate but she lost her appetite and her pain levels increased so she’s back on Prednisolone. We do not have methylprednisolone (Medrol) available in Australia.
Is there anything else I can try to ease her PU/PD? Appreciate any advice you can offer. Thank you, Mary Pittas

Dr. Mark E. Peterson said...

Have you considered splitting her dose of Percoten and giving it every 3.5 weeks? That may help lower the serum concentrations of the Percorten, which seem to be contributing to the signs.

Other than lowering the pred dose or going every other day, I don't have any great suggestions about other glucocorticoids.

You could try desmopressin and see if that helps -- that is a drug meant for diabetes insipidus, but it sometimes helps with undefined PU/PD.

Cindi Bowman said...

I read with interest about the dog that received a stem cell transplant from another dog. Do dogs have concerns with graft vs host disease as with humans?

Dr. Mark E. Peterson said...

Yes, dogs do indeed have the same concerns with graft vs host disease as in humans.

Leslie B said...

Hi Dr. Peterson,
Thank you so much for sharing your experience and information!

My 6 yr. old, 50 lb. female lab was diagnosed with atypical Addison's on March 25 via the ACTH stimulation test (pre ATCH cortisone = 0.5, post = 0.6). 2 weeks ago potassium was mid normal and sodium high normal range. Original symptoms were lethargy and her hair grew long, curly and unruly, she did not have a crisis, eating problems or diarrhea.

We are in the process of lowering the pred, it's currently on 1.75 mg/day. She is acting much better and is bright eyed.

My question is this: She pants a lot for no reason and sometimes her breathing is extremely fast. This is especially noticeable when she is sleeping in the evening. Is this related to the pred or should I be asking my vet to look into something else?

Thanks again!

Dr. Mark E. Peterson said...

Yes, the panting could indeed be associated with the prednisone/prednisolone. That said, the dose you are giving now is pretty low. I'd discuss the situation with your vet - you might want to at least get a chest x-ray to make sure it's nothing serious.

Leslie B said...

Thanks so much for the speedy response. I have an appt for a consult with an IMS in about a week and will talk to her about this as well as my vet.

Tracey Inman said...

My fifteen pound, 4.5 year old male Miniature Poodle was diagnosed with Addison’s Disease on March 7th. He received 0.65ml of DOCP at the clinic, and began taking 2.5mg of Prednisone once a day. On April 17th he began taking 0.5ml of Prednisone, as he was urinating excessively (and specifically in the house, on furniture etc). I have alternated doses for him since he began the lower dose of liquid Prednisone so that we do not trigger another crisis, i.e. on April 17th he received 0.5ml, on April 18th 2.5mg, on April 19th and 20th 0.5ml, and so forth.

He has shown no reaction to the DOCP injections (he had his 2nd one on 3/31 and will go for a 3rd one on 4/25), and in fact has had positive results. He is more lively, and can now walk more than ½ a mile, play with my other dog, jump on the couch, etc. The problem is, he also now urinates on the couch, and in other undesirable areas in the house. I understand that too much Prednisone will cause an increase in urination. The problem is, I don’t know how much is too much and how little is too little? I don’t think that my regular Vet has treated many dogs with Addison’s Disease and is therefore prescribing dosage based on practicality and not individuality. From the information I have researched online, it does appear that he is receiving too much Prednisone and needs to be weaned down to an acceptable dose of Prednisone for his weight. Do you think that his current dosage in conjunction with 0.65ml of Percorten-V every 25 to 28 days is too much? I would be grateful for any input that you share. Thank you.

Dr. Mark E. Peterson said...

Based on your dog's body weight (15 pounds or 6.8 kg)), the calculated dose, at 0.1 mg/kg/day, would be 0.7 mg. I have no idea how much pred 0.5-ml contains but you can easily determine that by looking at the bottle.

Some dogs just cannot receive any pred or they will drink too much so this will be trial and error to determine the ideal dose for your dog.

Tracey Inman said...

Dr. Peterson, thank you for your reply. The bottle says (15mg/5ml) per oz. His dose is 0.5ml once daily. I was told that the liquid dose is equivalent to 1.5mg of the pill form.

Dr. Mark E. Peterson said...

So cut the dose in half and evaluate the response.

Ja Casano said...

good evening dr. mark peterson!
im a vet student and my dog is currently suffering fr enlarged testes, not yet clear if it is cancer but his vet started with 5mg/day dose for him and weighs about 13kgs. im just so worried right now his already 17yrs old and its been two days when he started the prednisone. i just need more opinion please. thank you so much!

Dr. Mark E. Peterson said...

In this post, I'm certainly not talking about the use of glucocorticoids for testicular swelling! This is not my area of expertise, but I cannot think of any reason why prednisone would help. If the steroids don't help within a few days, I would consider castration and biopsy.

Candice said...

Thank you so much for this blog, it is wonderful. My border collie tested positive for primary Addison's but remains (going on 3 years now) in atypical Addison's. He is 42 lbs and I was giving him 1.0 mg predinsone/QD. He didn't show outward signs of PU but lost his coat! He looked terrible. I feed a high quality food, he is a competitive obedience dog. I couldn't think of another reason for his coat to look so horrible. I decreased his predinsone and he is now stable on 0.2mg/QD. Very occasionally I have to give a little extra- twice in the last 3 months. My question is how much is too little?! I don't want to stress his adrenals. I also supplement with standard process canine adrenal support. Thanks!

Dr. Mark E. Peterson said...

If you don't give enough prednisone, your dog will develop a decreased appetite, vomiting, or diarrhea. So if that doesn't happen and your dog is acting normally, the dose should be adequate.

Candice said...

Wow, thank you!

Jeanine Wilder said...

My 4-year-old pound puppy (Manchester Terrier mix?) was diagnosed with Addison's last week--ack! He was hospitalized for a couple of days to stabilize after his crisis (Na 124 and K >10.0) and received his first Percoten shot on June 24. The vet sent us home with 10-mg prednisone tablets and instructions to administer ½ twice a day.

Our first followup visit was today (July 1) and I told the vet that Jack seemed to show signs of too much prednisone: PU/PD, ravenous hunger, rapid breathing or panting, dry nose, lethargy, increased sensitivity to heat, etc. The vet insists that he wants to stay with this high dose for several weeks--in spite of any side effects--and only then consider lowering it.

Jack weighs 15 lbs, which would translate to something like .7-1.4 mg of prednisone per day according to your recommendations--is that right? I'd love to go ahead and reduce his dose on my own, but I'm wondering if there's anything to the notion of "loading" an Addison's dog in the beginning before scaling back. And if not, how would you suggest that I begin to sensibly lower the prednisone to an ideal level, please?

Thank you SO much for this invaluable resource, Dr. Peterson--you're a marvel!

Dr. Mark E. Peterson said...

Almost all vets seem to think that they have to use glucocorticoid loading, but it doesn't make any sense physiologically. Prednisone has a short half life and it's not really stored in the body, so how can you "load" it anyway? Why make an Addison's dog Cushingoid before we drop back the dose to normal? It is simply wrong, at least in my opinion. Now if you look at any medicine textbook, it might say to do what you vet is doing, but I'm just seen too many dogs like yours!

In general, you can immediately cut the dose down by half. If that's too much, the appetite will decrease below normal (remember that right now it may be artificially increased due to the excess steroids).

If everything is okay, then you can continue to drop by 30-50% every 3 days or so. If the appetite isn't right or vomiting occurs, give a bit more. In general, we can drop relatively fast because the high doses haven't been given that long.

Stevie Romero said...

Dr. P.

Great information.

I am treating an addisonian min pin who has developed pu/pd. Gradually stopped pred...no help. U/A normal. Blood normal. Dog feels great. Talked to Novartis......very vague answers...I slightly reduced the Percoten and am inclined to reduce further. How likely is the percorten to cause pu/pd?

thank you.

Dr. Mark E. Peterson said...

Percorten has no glucocorticoid activity and should not cause PU/PD. Have your vet do a complete urinalysis and culture if not already done recently.

Rita Sexton said...

My dog is a min poodle, she has a herniated disc and she is on 1/4 5mg prednisone once daily we are about to wein her off this medication
.. she is getting very dry skin and her ears are getting dry skin around the outside..can i do anything about that?

Dr. Mark E. Peterson said...

Low dose pred shouldn't be causing those clinical signs. Talk to your vet about what you can do -- maybe medicated shampoos or conditioner would help.

Allen Plourde said...

We have a 70 pound lab/hound mix recently diagnosed with Addison's. Electrolytes have been normal and he is maintaining well on 2.5mg prednisone QD for almost a month now. Endogenous ACTH test results were low/negligible. Going forward, what type of monitoring other than signs and symptoms would you suggest? Our vet is suggesting quarterly UTI assessment. We were under the impression that we are replacing physiological glucocorticoid- would there be substantial enough immunosuppression at these low levels to merit such testing? Secondly, wouldn't periodic electrolyte testing be prudent to monitor for disease progression and need to mineralocorticoid therapy?

Dr. Mark E. Peterson said...

First of all, Addison's disease mean complete adrenocortical insufficiency so that doesn't fit your dog's diagnosis. If cortisol secretion is subnormal with low pituitary ACTH secretion, then the diagnosis would be secondary hypoadrenocorticism.

In that case, glucocorticoid therapy alone is sufficient. There is no real reason to closely monitor serum electrolytes unless you don't believe the plasma ACTH result. Was that sample taken before any treatment was given? If taken after steroid treatment, then the result would be invalid.

I would not routinely monitor for UTIs in your dog unless there has been a history of past infections. The low dose of pred shouldn't be an issue for UTI development.

Steve Talenti said...

Hi Dr. Peterson,

Very informative Blog. Thanks so much for sharing your knowledge.

My question is regarding my dog who has been diagnosed by a dermatologist as having Endocrine Alopecia. He is a 16 year old Chow/Husky X. Hair loss began 2 years ago. He is also Hypothyroid but this is controlled with thryoid replacement. T4's have been normal for 4-5 years now.

We tried monthly injections of Medroxyprogesterone. We were supposed to give it for 4 months but stopped after 2 months because he became reclusive. The same thing happened when we tried Melatonin the year previous. ACTH test was performed and was normal.

I am wondering if you are aware of Dr. Al Plechner's work and his Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS) and your thoughts?

I had his blood work done and my dog's Total Estrogen is high 25.17 pg/ml, Cortisol Low .57 ug/dl, IgA, IgG, IgM are all low. Blood was drawn at 2:20 p.m.

Suggested treatment is 3 injections of 70 mg DepoMedrol IM at 10 day intervals. Then recheck labs, if IgA is above 58 start 4 mg Medrol daily.

I am concerned about giving him Medrol and the potential side effects but if he is cortisol deficient or if he has defective cortisol then I presume replacing that with Medrol, similarly as I am doing for his thryroid would be warranted.

What are your thoughts on this protocol and potential harmful effects it could have on my dog?

If I were to try this for 4-5 months and then weaned him off of it could it cause his existing cortisol production to permanently shut down?

Thanks in advance,
Steve

Dr. Mark E. Peterson said...

It's likely your dog has Alopecia X. We do not know the exact cause for that disorder but it's believed to be a primary disease of the hair follicle. It's not an immune disorder or an endocrine disorder, although some dogs (for unknown reasons) will regrow hair after growth hormone injections. It's clear that they do not have growth hormone deficiency.

I don't want to say anything bad about another veterinarian. But giving large doses of glucocorticoids -- enough to induce iatrogenic Cushing's disease -- makes no sense and is just plain wrong in my opinion.

You can't diagnose cortisol deficiency on baseline test - you need to do an ACTH stimulation test to document that. Estrogen is a very difficult assay to do in dogs and most results I see are suspect and likely falsely high.

Is your dog sick? If he feels fine and just has hair loss, I'd leave him alone and not induce any more problems.

Steve Talenti said...

Thanks for your reply Dr Peterson.

He is not symptomatic aside from some muscle atrophy, some arthritic changes in his hips and spine and borborygmus. Also, his hair loss and his skin is hyper-pigmented where the the hair is missing.

His appetite has always been very good and he drinks normally. His USG is normal. If he eats more than his regular amount per meal he may vomit.

Lastly, he walks around constantly. He has always been a very "busy" dog but now it seems like he is anxious or possibly uncomfortable and he pants a lot.

We did an ACTH stimulation test at the dermatologist in April, Sample 1: 3.1 ug/dl, Sample 2: 11.4 ug/dl, which I was told was normal.

We do CBC and chemistry every 6 months and everything is always in normal range.

He takes 5 grains (300 mg) of desiccated Thyroid (Thyroid by ERFA) twice daily. He has been on this for 4-5 years. His Free T4 (equilibrium dialysis) and his Total T4 are always in the middle of the reference range.

I have two final questions.

Do you ever measure Immunoglobulins in dogs and if they are low is there anything that can be done about it?

If you feel it would be warranted I would like to have a consultation with you and my Vet. I read on your site that you offer this, I am in Canada and my Vet is extremely cooperative. I really want to do whatever I can to make sure that I am not neglecting something for my dog. I know he is old but I want to keep him as comfortable and healthy as possible. Should I contact your office to arrange a consultation?

Thanks so much,
Steve

Dr. Mark E. Peterson said...

No reason to consult with me. I don't think your dog has adrenal disease. I am not an immunologist. In my practice, I don't ever measure immunoglobulins. I would have your vet talked to an immunologist or someone who specialized in immune-mediated disease.

Eric Zor said...

I have a 90 pound hound mix who got diagnosed with addisons in may. shes been on 5 mg of prednisone since the beginning and gets dismutase every day also. shes been gaining weight and getting bald spots so my vet said to lower the pred to 2.5 mg a day, the first 2 days were great she had so much energy but the 3rd day she started having diarrhea and seems tired. does she just need some time to get use to the new dose or should i bring her back up to 5 mg. If i bring her back up what could i do for the hair loss. Thank you so much for all your help.

Dr. Mark E. Peterson said...

For a 90-pound dog, 2.5 mg of prednisone may not be enough. It certainly would not be expected to cause hair loss at that dose, unless you are also giving large doses of Florinef.

Have you excluded hypothyroidism? Talk to your vet.

c1e2a240-5b2d-11e4-abb8-ff2e78999c64 said...

Hi Dr Peterson:
You have treated two of our dogs Skat and Atticus both with adrenal tumors. Now our dog scout has been diagnosed with Addison's. She stopped eating for a week before her electrolytes showed her addison's. Her potassium/sodium was at 20. Our vet in upstate NY has prescribed 3 -.1mg tablets of florinef twice a day with prednisone only if there is an emergency. Her ratio was today showing 28 after a day and a half of the florinef. i notice here that you recommend Prednisone. Should she be on anything besides or along with florinef?

Dr. Mark E. Peterson said...

Some dogs will do fine on Florinef alone, since this drug does have some glucocorticoid activity. However, since dogs with Addison's disease do not make any cortisol, I like to supplement with a very low dose of prednisone. If the dogs develop side effects such as excessive thirst, then we can stop it or give it only when needed. Good luck!

Karin said...

We've had a tough time trying to diagnose and treat a dog that started to "fail" ten months ago. After much frightening trial and error, our current theory is that the dog developed hypothyroidsim, and the thyroid meds cause him to flush cortisol too quickly, causing Addisonian symptoms. He has small adrenal glands and tests just barely in the normal range on the ACTH test. Our theory is he crashed on the thyroid meds (he tests as needing thyroid, zero on test) because the Addisons symptoms get so much worse when he's on thyroxine (cortisol tests at zero). After an "Addisonian Crisis" (while being boarded at the vets), he responded well to injected prednisone, leaving us with a diagnosis of hypothyroidism (1 mg thyroxine daily) and atypical Addisons (10 mg prednisone daily). The dog was 129 pounds before the crisis (not overweight, large breed dog), 122 pounds after the nearly fatal crisis. Since our theory is the thyroxine causes increased metabolism and subsequent cortisol loss, and our goal is to balance these two meds, is a higher dose of prednisone indicated? We worry that we won't be able to establish a safe balance between the two meds. We would be grateful for any suggestions.

Dr. Mark E. Peterson said...

It should not be a problem to give both thyroxine and prednisone. Right now, you are giving huge doses of both supplements, which could suggest that something else is going on. If the thyroid tests were zero at the time of severe illness or at time of being on the prednisone, the results mean next to nothing (with the exception of finding a low T4 WITH A HIGH TSH level).

Talk to your vet. You may need a referral to a specialist.

c1e2a240-5b2d-11e4-abb8-ff2e78999c64 said...

thanks for your answer Dr Peterson... what signs would present if Scout needed Prednisone to supplement the Florinef ? also as a dog with addison's do you think its safe to put frontline on Scout ? we have encountered some ticks here late in the season .
this is a follow up to above question..that i will quote here just in case
"You have treated two of our dogs Skat and Atticus both with adrenal tumors. Now our dog scout has been diagnosed with Addison's. She stopped eating for a week before her electrolytes showed her addison's. Her potassium/sodium was at 20. Our vet in upstate NY has prescribed 3 -.1mg tablets of florinef twice a day with prednisone only if there is an emergency. Her ratio was today showing 28 after a day and a half of the florinef. i notice here that you recommend Prednisone. Should she be on anything besides or along with florinef?"

Dr. Mark E. Peterson said...

Dogs with Addison's do not secrete any cortisol, a glucocorticoid hormone that is essential to life. Prednisone is a synthetic form of cortisol. I believe that it just makes sense to replace the hormones that are deficient, and that's why I always give both mineralocorticoids (florinef or Percorten) and glucocorticoid (prednisone or cortisone acetate) to dogs with documented Addison's disease.

c1e2a240-5b2d-11e4-abb8-ff2e78999c64 said...

Hi dr Peterson
It's now been three weeks since Scouts last blood test. She is due in on Monday nov 24. She is as I stated above about 65 lbs. she is addisonian. She is taking three .1 mg twice a day of florinef. She has been doin great actually until last night. She threw up in the middle of the night. Ate breakfast and lunch. But threw up dinner about an hour later. She had taken her nighttime pills just before dinner. the last few days she has had a little less energy but has been eating well. she has been back on her rymadyl and doing just great until the last day or so. We have been given by the local vet a few 10 mg prednisone pills for emergency situations. Do you think it could be she needs the prednisone? thanks
john denicola
Sent from my iPhone

Dr. Mark E. Peterson said...

I would give 5 mg of pred to start to see if that helps. Call your vet and schedule an earlier appointment!

c1e2a240-5b2d-11e4-abb8-ff2e78999c64 said...

Thanks we did give her 5mg of prednisone last night and she seems better. More energy and ate breakfast and so far has not thrown up. She got up this morning and trotted down the stairs and ran outside.. we are seeing the Vet monday morning. I will ask him if we should give her prednisone daily. Thanks so much for answering on this blog site. It is much appreciated. We are great admirers of your approach and expertise. Kind of crazy that our last three dogs have had adrenal problems.thanks again

Nancy Moorman said...

Dr. Peterson - I only want to thank you for all of the time you have taken to answer questions regarding Addison's disease. I have just taken our son's Dalmatian/ Pointer mix who was diagnosed with Addisons in the Spring. In just these few months, we are now on our 3rd vet., but I am VERY thankful for all of your information regarding Prednisone. Thank you SO much!! Lowering his dosage has taken away all symptons. Much appreciative, Nancy

Dr. Mark E. Peterson said...

Thank you - I'm glad that I have helped you and your dog!

craig sharpe said...

Merry Christmas Dr Peterson, My 8 1/2 year old black lab was diagnosed with Addisons Nov 24th. She seems to have responded well to the treatment of percoten and prednisone. Through the last month she has become dehydrated 4 times and her platelet count is dropping which was low when diagnosed. My vet increased her prednisone from 2.5 to 10mg per day. This doesn't seem to be a common problem in addisons dogs from what I have read and am concerned. Any insight you could give me would be greatly appreciated

Dr. Mark E. Peterson said...

Sounds like something other than Addison's. With treatment, those dogs do not get dehydrated and low platelets have nothing to do with Addison's. Talk to you vet and maybe get a referral to an internal medicine specialist.

Dr. Mark E. Peterson said...

Sounds like something other than Addison's. With treatment, those dogs do not get dehydrated and low platelets have nothing to do with Addison's. Talk to you vet and maybe get a referral to an internal medicine specialist.

Elizabeth Parrillo said...

Hi Dr Peterson.

I have a 17 lb dog that has been well-treated for Addison's for nearly 8 years. I administer her shot. She is on .42 ml/28 days and 1 mg poured daily. My question is: can I give her shot 8 days early at regular dose and then begin every 28 days from that point? I am going away and am leaving 8 days prior to get shot date. I could have her pet sitter take her to a vet for the shot but I am hesitant. I just had her semi-annual lytes done. She is perfect :-)

Dr. Mark E. Peterson said...

Giving the Percorten shot a week early should not cause any problems.

6b35ee70-9f34-11e4-92fe-078f4db6d898 said...

Hi Dr. Peterson,
I had a question about my 12 year old chocolate lab. He was diagnosed with addisons 8 years ago. Mostly everything has been fine. He get percorten every 28 days at 1.5ml. He usually does not take pred unless at times of stress and it's usually only 2.5 mg once a day. My dog weighs 85 lbs. for the last week he has been lethargic, walking very slow and gingerly, staring off into space, very mushy overall. He is eating fine and drinking. I gave home 5 mg of pred to see if he would snap out of it then 10 mg the next day he still is acting the same. I was wondering if I should wait to see if the pred will take affect soon and he will snap out of it. Or if I should temporarily increase the dose. While on 10 mg he did not show any signs of overdose excessive urination and thirst. Usually 10 mg would make him go constantly. Any advice would be a great help. Thank you in advance

Dr. Mark E. Peterson said...

Sounds like some other problem, unrelated to Addison's is developing. Talk to your veterinarian. Simply giving too much prednisone is not the answer!

Trish said...

Dr Peterson - I have a 14 year-old lab who was diagnosed with atypical Addison's at the age of two. He did not tolerate prednisone (frightful incontinence) and so has been on 0.5 mg of dexamethasone/day ever since. His veterinarian at the time (now retired) suggested we consider every-other-day therapy, but he seemd to be stable, so we lef him alone. Recently, though, he has developed a number of symptoms that make ne wonder if we should reevaluate either his dose of dex or the frequency it is given. He is drinking even more than usual, is perpetually hungry, very dry coat, pacing, panting and whining. I was reminded of our old vet's question re dosing by a chance conversation with a people endocrinologist when we were discussing our pets and he mentioned incidentally that dex is much longer acting than prednisone. Would there be any value in doing an ACTH test at this point? Is there any way to assess whether the dex dose may be more than he needs in his old age? Thank you very much.

Dr. Mark E. Peterson said...

Dexamethasone is a very long acting, potent glucocorticoid and is never used for long term replacement therapy. Doing an ACTH stimulation test now is unlikely to be helpful. I'd consider switching to a shorter-acting preparation and see if the signs resolve. At 14, this could also be due to a multitude of other problems. Talk to your vet about a checkup.

Dr. Mark E. Peterson said...

Dexamethasone is a very long acting, potent glucocorticoid and is never used for long term replacement therapy. Doing an ACTH stimulation test now is unlikely to be helpful. I'd consider switching to a shorter-acting preparation and see if the signs resolve. At 14, this could also be due to a multitude of other problems. Talk to your vet about a checkup.

rucyrius said...

hi Dr Peterson
i have mentioned Scout to you in earlier posts. She is Addisonian and was doing very well on fludrocortisone. Now she had been diagnosed with a splenic tumor .. it is unknown whether it is malignent or benign and from the one xray it looks like it has not spread to other places.. we are debating whether to let her live her life out this way(she has already had two bleeds and recovery in this last week) or have a splendectomy .. when she recovers she is good and eats and drinks.. she is 12... do you think the addisons is a reason not to try an operation? she will surely die of a bleed out if we do nothing but of course she may not survive the operation..we are having a hard time deciding... Atticus ,scouts old partner that you saw also died from bleeding adrenal (medulla) what are the odds? thanks John DeNicola

Dr. Mark E. Peterson said...

In my opinion, Addison's disease has a good prognosis and is not a reason in itself not to treat a concurrent condition. That said, I'm not here to judge if you should or should not do surgery for the splenic tumor. You will have to have a discussion with your veterinarian about that decision. Good luck..

rucyrius said...

Thanks so much for your answer

John and Debra DeNicola

Matt M said...

Hi Dr.Peterson,
We are 2 weeks since our 25kg dog was converted from Florinef to DOCP and started at 0.1mg/kg/day of prednisone (2.5mg/day).

She is having excessive hunger, and some weight gain already (more so than when she was on Florinef/pred) Also, continues to have some PU/PD.

Is lowering the prednisone dose a option in this case (even though at low end of the usual maintenance dose?)

Thanks

Dr. Mark E. Peterson said...

Why did you convert? Because of the PU/PD? You can certainly try lowering the pred dose further or even stopping it completely for awhile to see if that helps. If it doesn't, then I'd worry about another reason for the PU/PD. Percorten has no glucocorticoid activity and would not cause that problem.

Susan Liszewski DVM said...

I posted before but it never came up. Trying again. I have a Golden Doodle that is an Atypical Addisons patient. The owners travel with him and he is happy doesn't seem stressed etc. When they travel cross country with him he always has bouts of diarrhea and everything else seems fine. He is on maintence pred only. My question is even though he is not stressed in how we percieve it could this be a stress issue requiring us to increase his prednisolone dose while traveling AND if so do they need to keep it up for the whole trip? Just looking for the best way to manage. I think he is on a daily dose of 5 mg maintence still with a lot of side effects but managable, so if we increase how much to go up? Thanks for any insight.

Laura Bartolomeo said...

I have a 50# (formerly 65#) Lab mix who was just diagnosed with Addison's. She had her first shot of Percoten-V three days ago and has been on 5mg of Prednisone for 4 days. Her appetite and water intake increased the first couple of days but then today she looked nauseous after I gave her the Prednisone and now at midday has thrown up twice... Throwing up, weight loss, loss of appetite/dehydration was what eventually got us to the Addison's diagnosis. I was hoping things were getting better. Is there a better time of day to dose, with food/without food that might be causing the problem?

Dr. Mark E. Peterson said...

This should not happen - call your vet in the morning.

rucyrius said...

Hi Dr. Peterson:
As mentioned before in this blog.Scout has Addison's disease ,which was diagnosed rather late in life as she in now almost 13 years old.She was diagnosed about 6 months ago..since that time she has a spendectomy,which she has recovered well from.. My question to you is we now have deer ticks in our area of Delaware county ,NY....which is a recent development. Our dogs spend a lot of time in the meadows and woods. Scout has been treated with advantix and we are considering a sclaibor collar which worked well last year, but now she is Addison's and without a spleen..What is your opinion on treating Scout with advantix and possibly putting the scalibor collar on only when she is out side? thanks
John and Debra DeNicola

Dr. Mark E. Peterson said...

I asked one of my "expert" veterinary friends (Dr. Randy Lynn, Merck Animal Health) for help here. See his response below:

There is no real reason to be afraid of any of the flea and tick products that are registered for use on dogs in the USA. Since this dog has no spleen they need to be very careful and limit exposure to fleas which carry hemobartenella and ticks which carry all sorts of nasty bugs. No spleen will leave him way exposed.

They mention scalibor. That's made be Merck and contains deltamethrin a synthetic pyrethroid. It should be put on and left on. It takes a while to get the collar to release the ingredients. They will not get good coverage if they take it off all the time. The activity against fleas is not very good. It has good repellency against ticks.

I would advise using a combination of scalibor and bravecto. The bravecto is extremely safe and lasts for 12 weeks. It is excreted unchanged in the bile. It is gangbusters against fleas and ticks. It has no repellency. The repellency will come from the scalibor collar. We have specific studies showing they are safe to use together.

Mary Pittas said...

My 10 year old Corgi X Finnish Spitz was a rescue dog and previous owners were abusive. They broke her front right leg and didn’t get treatment. Over the years the arthritis in her front right leg got worse and she has been on Previcox 227MG, half a tablet daily since January 2013.
In November 2012 she had blood tests prior to commencing Previcox, her ALP was 666. In May 2013 after being on Previcox for 4 months she was retested and her ALP dropped to 394.
In May 2014 she again had blood tests and her ALP increased to 609. 3 days ago she had blood tests and her ALP has sky rocketed to 1942. Her ALT is slightly elevated at 138. Her vet wants to perform an ultrasound on her liver.
She is not showing any symptoms, her weight is stable and her fur is healthy. Her appetite has not changed. Would appreciate any advice and information.
Thank you, Mary Pittas

Dr. Mark E. Peterson said...

Previcox is an antiinflammatory agent - not a glucocorticoid like prednisone. I'd get the ultrasound done to rule out serious underlying disease.

Natasha Molla said...

Hi, could you explain the "ratio" I hear people refer too? I assume the NA/K values? What do I want and when do I want it?
Thanks, Natasha

Dr. Mark E. Peterson said...

I would not look at ratios -- best to look at absolute sodium and potassium values instead.

Natasha Molla said...

Ok, thanks on the ratio comment. So, my dog will be going in for a lytes test tomorrow, she is ~63 lb, 3 yo lab. DX date 8/27/15. She was originally given 2.5 ml of perc (hope I got the units correct) and is currently on 2.5 mg daily pred. Her 14 day numbers were: NA 145 (scale 138-160) and K 3.6 (scale 3.7 to 5.8), hem 2+

I believe her Perc and Pred dosages can be reduced. Thoughts?

Dr. Mark E. Peterson said...

The pred has nothing to do with the serum electrolytes. The Percorten probably can be reduced. Talk to your vet.

Natasha Molla said...

I see so the Perc is what you modify based on the electrolytes results. Do you reduce pred based on side effects exhibiting then? By the way, her lab work on 8/26/15 was NA 144, K 5.1, no hem, same scales as above. The decision was to keep her on the 2.5 ml of perc based on how fast her K escalated the last 2 weeks. I have heard of side effects from the perc injections so I am waiting a week before reducing her pred.
She isn't sleeping at night (sleeps mostly during the day while no one is at home) and she is up every couple hours at night, I was hoping that reducing one of these medicines might stop this behavior.
Thank you for your responses, hope I am not being a pest!

Dr. Mark E. Peterson said...

I agree - I'd try to reduce the dose of both drugs.

Rhonda B said...

My dog had Cushing's for about 2 yrs and now has been pushed into Addison's. She received Percorten but didn't feel much better. She is about 34 pounds and is on 5 mg pred QOD. The vet wanted to do QD but I am leery of prednisone so she said we could do QOD. Now after reading this site, I am thinking she is still on too high a dose. Should we go to 3mg a day or 1.5 twice a day? SHe has PU/PD but she also has diabetes insipidus. Her appetite has improved but not by much-she eats maybe 1/2 can of food at meals but most times won't eat anything but hot dogs-I know, it's awful but I figure better than nothing. She will eat 2.5 hot dogs and she nibbles on my other dog's dry KD food.
The vet's goal is after one month to get her to twice a week dosing w/ prednisone. ??But again after reading this site, that seems almost worthless....

Dr. Mark E. Peterson said...

The calculated prednisone dose for glucocorticoid maintenance is 0.15-0.3 mg per day. Some dogs will need more and others less.

Your dog appears to be complicated in that we almost never see secondary DI in dogs with Cushing's (this would be caused by a huge pituitary tumor in most cases). Talk to your vet and consider a referral to a specialist to figure this out.

Clare B said...

Hi Dr Mark

I have a Boxer 6 years old (25kg) who has had A Typical Addisons for the last 5 years, until now successfully managed with 6.25mg Prednisolone daily. (after lots of trials over the years we have found this to be her minimum dosage, any lower and she becomes unwell). She has recently suffered muscle loss around head and body, after a referral visit - we have been informed that lack of reflexes and muscle loss may be attributed to excess steroid. She was switched to hydrocortisone, due to having less side effects and hopefully to clear up muscle issues. But dosage was insufficient and she was sent into an addition crisis. So now back on Pred for time being. Thyroid tests have come back low but not abnormal. And other tests have confirmed she is not changing to Typical Addisons. It has now been suggested to try Cortisone Acetate as this may be gentler on her. I have some questions re this;
1) How best is it to switch over from Pred to Cortisone Acetate?
2) What is the potency of the Glucocorticoid in Cortisone Acetate compared to Pred?
3) Is a change in her medication likely to resolve muscle/nerve issues - or should this be investigated further outside of her addisons

Any advise would be greatly appreciated

Dr. Mark E. Peterson said...

We sometimes switch from prednisone because of side effects such as PUPD, which can sometimes occur at very low levels. In your dog, the pred dose that I would have given is 2.5-5.0 mg tops - so your dose of 6.25 mg is too high and that is why you are seeing the signs. I'd recommend that you start from scratch and figure out what's really wrong with your dog -- those with atypical Addison's should not require larger glucocorticoid doses. And they should never develop adrenal crisis. Really sounds like some underlying problem is being covered up.

5 mg of pred is roughly equalvalent to 25 mg of cortisone, but cortisone has much more mineralocorticoid activity (your dog's mineralocorticoid activity is thought to be normal). If you give high doses of cortisone, it won't help the muscle wasting at all.

Clare B said...

Thank you for such a quick reply DrPeterson, greatly appreciated.

Her adrenal crisis started within a few days after the switch was made from the 6.25mg Pred to 6.25mg Hydrocortisone, this is the first one she has had for years. I read that the Hydrocortisone contained much less potency of the glucocorticoid and I wondered if this initial dose of Hydrocortisone would have been too much of a reduction for her (if I am correct) and may have caused this.

The past three months she has had three fainting episodes, some chronic pancreatitis, very lethargic, some hair loss, lack of interest and the muscle wasting - which initiated a specialist referral visit.

She has had joint taps which show no inflammation. A neurological check which showed no reflexes in back legs and a long trunk. An ultrasound which showed no issues with pancreas etc. For the fainting we had heart scanned and holter monitor which also ok. Hence, the now focus on the steroid use.

Athough her thyroid level was low but within normal range, would a trial dose of thyroxine be appropriate based on her clinical signs to see if this made any improvements? (I will need to double check the exact T4 results for this)

Do you think we should try getting her down to 5mg a day initially before attempting a switch in medication?

Thanks so much

Dr. Mark E. Peterson said...

Well, I'd expect your dog to be unwell after going to cortisone at the same mg dosage as the pred. An equivalent dose would be about 30 mg.

The problems you describe all appear not to be related to Addison's disease. You can try decreasing the pred dose or doing the switch to a higher dose of the cortisone. Even giving a lower dose on the good days may help.

In most of these dogs, it is VERY difficult to regain lost muscle mass unless the steroids can be stopped completely. That's not likely in your dog.

Shannon said...

Hi Dr. Peterson! I haven't read through the hundreds of comments on this thread, but most of the questions, along with your answers, have helped tremendously. My 85# lab/shepherd was diagnosed in September 2015, and has been getting Percorten shot every 26-28 days. She was prescribed 20mg Prednisone initially by my regular vet, but I was worried this was too much, so he settled at 10mg/day.

I'm seeing all the signs you've pointed out about too much Prednisone, but my vet refuses to vary or even try to lower any doses (Percorten included). What do you suggest would be the most polite way to speak to him about this so that he doesn't feel like I'm relying on "Dr. Google," instead of him? I know my dog better than he does, and I really appreciate his patience and care for my dog otherwise. I don't know why he won't even entertain the idea, or at least read some studies on lowering. I'm frustrated.

Also, do you know any colleagues in/around Pensacola, FL?

Dr. Mark E. Peterson said...

If your dog is drinking too much, then I would definitely recommend that you lower the dose as I've suggested. You certainly can show your vet this message. In almost all dogs, 10 mg is too much (twice the regular human dose).

Karin said...

We wound up lowering, over time and incrementally, our 130 pound dog's dose to 2.5 mg a day to eliminate symptoms of pred, and that is proving adequate to keep him healthy. We did need to advocate with our vet, and be rigorous in observing how the med changes effected the dog as we worked to find the right dose. Good luck!

lourens annandale said...

Greeting My dogs weight is 40 kg and is currently on 5mg prednisolone and .4 mg Florinef. Would it do damage to split the dose to half the dose in the morning and half in the afternoon. I tried it today and my dog seems to have more energy, or must the dose be given at one time, and if so does it make any difference if it is in the morning or afternoon.
Kind regards.

Dr. Mark E. Peterson said...

Splitting the dose is never wrong and sometimes can help. Sounds like it may work better for your dog.

lourens annandale said...

I Thank you so much for your advice/input it its much appreciated
Regards

Morgan said...

Hi Dr Peterson, I have a 6 month old purebred Lab who was diagnosed with Addison's after a crisis at 12 weeks old. He was the smallest in the litter, and in hindsight we realize he was most likely born with it as the breeders did have to pay extra attention to him to make sure he got enough food among his other litter mates, and when we took him home at 8 weeks old slowly it became apparent that he was a sleepy kind of dog and increasingly became less interested in his food. And then he had the crisis where he almost didn't make it.

We are now in some unfamiliar territory as the Vets have never seen a puppy with Addison's, and with his increasing weight it is difficult to know if we are giving him the right dose of Prednisone. And also being a puppy, it would be normal for him to sleep a lot but sometimes we are unsure whether this is just him being a puppy or whether his meds are too low.

He is now about 19kg and is having 28 daily percorten shots (which we have just swapped to doing subcutaneous injections as the intramuscular ones have become traumatic for him and he is very afraid) and we have just upped him to 4mg prednisone every morning.

My questions are, have you had experience with Addison puppies? Does he perhaps need extra Pred while he is growing or does his body just require the same amount as an adult dog? And if he experiences a stressful day, do we double the dose for just that day, or do we continue to double it for a few days following? (We have received mixed advice on that).

He does seem to drink a lot of water, but then I still find on days he drinks a lot he may also seem quite sleepy/docile. On top of that we are in an Australian Summer and the days are getting hotter, so we don't know whether he is just tired and thirsty because it is hot!

Thanks

Dr. Mark E. Peterson said...

No one will have much experience with young Addison's pups. Too much prednisone will blunt body growth so you are just going to play it by ear and do the best you can. To my knowledge, there isn't any evidence that the dose would need be increased just because of the young age.

Morgan said...

Ok thanks for your reply. And do you usually recommend giving double doses of pred on the days following a stressful episode, or just on the actual day?

Dr. Mark E. Peterson said...

Depends on the levels of stress etc. Usually, however, just for the one day.

Unknown said...

My dog Brandy has been diagnosed with addisons for a year and half and gets a DOCP every 25 to 28 days. I give her prednisone before stressful situations or when I believe she has been stressed out. The prednisone dosages are very infrequent. Today I took her to the vet and they cleaned out a ruptured anal gland at the time of her monthly DOCP injection. The vet prescribed antibiotics and a anti inflammatory/pain reliever. How much prednisone should she be receiving while she is recovering? She has never had an issue with her anal glands before and i was also wondering if this could be a side affect of the addisons. Brandy is a 9 year old 60LB AMSTAFF. Thank you

Dr. Mark E. Peterson said...

As long as Brandy is eating and acting ok, I would not change the prednisone dosage.

c1e2a240-5b2d-11e4-abb8-ff2e78999c64 said...

Hi DR. Peterson:
Scout is a 13 1/2 year old mix about 56 pounds. She has been diagnosed with Addison’s and i have spoken to you about her here before. She had a splenic tumor removed last year and has been doing fine for the past year with addison's . she is on 6- .5 mg of fludrocortisone a day with prednisone when needed(She also takes2x 50 mg rimadyl . Three days ago she had a terrible bout of diarrhea she also threw up twice.. i had to take her out every two hours. we took her to a vet and was given an anti nausea shot and antibiotics and about 1 mg prednisone a day along with her fludrocortisone.. she is over the stomach problem but doesn't seem right. and doesn't seem to want to eat like usual..we are awaiting blood test we took when she was at the vet..i wonder does fludrocortisone stop working after a year ...or maybe not work as effectively? should we look into switching to another pill or shot?
Thanks
John DeNicola

Dr. Mark E. Peterson said...

Yes John, I'd consider switching to the Percorten-V injections. In general, they work better than the Florinef, especially in dogs that develop a resistance to the oral medication.

Morgan said...

Hi Dr Peterson, I have another question about my puppy with Addison's. He is 6 and a half months old, and we wanted to know your opinion on having him de-sexed. We definitely do not plan on breeding with him, but are concerned about messing with his hormones even more by removing his testicles. And also the concern of putting his body through a stressful period with the surgery. What do you recommend? Thanks in advance

Dr. Mark E. Peterson said...

Good question. I would at least wait until he was 1-2 years of age. Don't do it yet for sure.

Morgan said...

Great thank-you again. Do you generally recommend de-sexing dogs? We aren't really sure of the pros and cons, and now that we have the Addison's to consider as well.
Sorry if this is a little off topic, your knowledge has just been so valuable for us!

Dr. Mark E. Peterson said...

No, I believe that castration or spaying prevents many problems as the dogs age, so I'm not at all against it.

lourens annandale said...

Greetings Dr Peterson, My vet wants to put my Belgian Shepard who weighs 38 kg, who has been on 5mg prednisolone for 2 months now, since diagnosis of Addison’s, on alternate day 5 mg prednisolone. The vet agrees the dose is a bit high as my dog wants to eat all the time and urinates a lot and has sores, due to very thin skin. The only worry the vet has is not to lower the dose out of fear of any relapses. That is why he tells me the need to maintain the 5mg but give it on alternative days.
Would it be ok to divide that dose rather, to 2.5mg every day instead 5 mg every other day? Any advice would be greatly appreciated.

Kind regards


Dr. Mark E. Peterson said...

Yes, giving a lower dose every day is more physiologic and better.

Mikki Kiger said...

Hi Dr. Peterson,

I have a 3 year old, 28lbs Corgi who was just diagnosed with Atypical Addison's through a basal cortisol test (1.8), normal electrolytes panel and an ultrasound that was intended to check for IBS or Lymphoma, but the technician said he clearly could see that her adrenal glands were undersized and suspected Addison's. We haven't done the Stim test because her vet felt confident that it is Addison's and she is on a 2.5mg prednisone daily until her next check at 3 months. She was on 5mg/day for 3 days, and has been on the 2.5mg/day for 3 days. I have noticed that she is sleeping a lot more, and when it was reduced she is still napping quite a bit but seems to have more energy over the last couple of days. Is this normal when dogs first go on the Pred?

Dr. Mark E. Peterson said...

Well, you can't diagnose Addison's with an ultrasound so I am not clear on why you think your dog has the disease. In a normal dog, giving daily prednisone would lead to atrophy and test positive for atypical Addisoni's.

I'd stop the pred for 2-4 weeks and do an ACTH stimulation test. If your vet won't do it, find another one who will.

Susan Z said...

Dr. Mark
Thank you for this wonderful resource! I have a 6 yo westie diagnosed with addisons in October. She is on perc injection every 25 days and have been giving prednisolone every other day 0.3 ml (3mg/ml). She weighs 18.5 lbs. Lytes are normal and seems to be doing well other than weight gain and now her hair is thinning on back legs and face. It seems her dose is within your therapeutic range... Should I try to give to her daily instead and lower the dose?

Dr. Mark E. Peterson said...

The pred should be fine at that dose. It doesn't generally cause loss of hair on the face. The hind legs can be affected but it's generally on the trunk. Talk to your vet about other causes of hair loss.

You could try to stop the pred and only give when needed but I don't think that is the problem,

Susan Z said...

Is it best to give daily versus every other day? Would it be ok to switch to daily and cut her down to .5mg daily and maybe even taper to less than that?

Dr. Mark E. Peterson said...

In dogs with Addison's, it's best to give a small dose every day. If you give it every other day, they have NO cortisol or glucocorticoid coverage on the off day.

Kelly P said...

Dr. Peterson, my 7 y/o 22 lb westie was diagnosed in Sept. She was initially put on fludrocortisone and was doing great until a few weeks ago, when, over a period of a couple days I noticed she was having weakness, trouble with the stairs, low energy. I took her in to have her electrolytes checked and they were off. Rather than adjust her dose the vet decided to switch her to percorten 25mg and 2.5 mg of prednisolone per day. I gave her this dose of pred for 2 days and she became extremely bloated, very slow moving and even weaker in her hind end. She also had increased drinking, eating and peeing. I did some research and concluded she was getting too much prednisone, so I decreased it to 1.25mg per day.This was 9 days ago. She has improved somewhat, no longer drinking and peeing too much, has started barking again, and is not as "depressed", but she still wants to eat all the time, and is still weak, slow moving, low energy, struggling with just a couple steps. She did have her electrolytes checked 12 days after injection her K 3.4, Na 158, BUN 23. They will most likely reduce her DOCP dose next time. Are her symptoms caused from her pred dose still being too high? Should I stop it for a day and see if she improves? She goes back to vet in a week. Thanks You

Dr. Mark E. Peterson said...

I'd give it more time and see what happens after the next (lowered) Percorten dose.

Jonathon Redding said...

Dr.
My Basset, 44lb, has AD (peimary) and getting the Percorten-V 1.5mls shot. I'm still new to all this, it's been less than 6 weeks since diagnosed.
Question: for about the last two weeks I have accidentally been giving him a low dose of 0.5mg of prednisone. He is eating anything and everything and seems to be doing well. Do I need to increase his dose or stay where we are at? Is their any blood test that can be used to help determine the correct dose? How much glucoconticoid does a healthy dog produce naturally?

Dr. Mark E. Peterson said...

If your dog is doing well, it's always better to give less than more prednisolone. I'd not increase the dose unless the appetite falls or vomiting occurs. No more than 2.5 mg per day!

Myers Family said...

Dr. Peterson- I have a 7 year old 60 lb female Wheaton Terrier who was diagnosed with Addison's disease when she was 5 years old. She was just diagnosed with an infection which had spread through her body and has been on the hospital for 4 days now. They can't find the source of the infection. She is improving with antibiotics and they told me today that she most likely had a bladder infection but the symptoms were masked until it was too late because he is on 5mg of prednisone a day. I was also told that dogs are more susceptible to bladder infections when they are on prednisone and she recommended that I reduce to 2.5 mg a day. What are your thoughts on that? Are dogs more susceptible to infections when they are on prednisone? Thanks for your help!!

Dr. Mark E. Peterson said...

Well, we can't say for sure that the prednisone caused the problems but 2.5 mg per day should be adqeuate for you dog. In high doses, pred can certainly suppress the immune system.

jazzyb said...

Hi Dr Peterson, my dog is a 7 year old male Cavalier who weighs 7.12 kg. He had been having some mild diarrhea for 2 days and vomited at 3 in the morning. The next morning I awoke to him unresponsive, unable to move with very cold and pale gums. I rushed him to the emergency vet and it turns out he was in late stage hypovolemic shock from an Addison's crisis. Luckily the vet diagnosed him right away with Addison's. He was given 2 bolus 150 mL each of Lactated Ringers, Dextrose, and Dexamethasone. They did the ACTH test and it was positive. She gave him a Percorten injection (I don't see what dosage on the forms) and started him on Prednisolone. The instructions say to give him the Prednisolone at 7.5 mg for 3 days, 5 mg for 3 days, and then 2.5 mg daily. From reading this blog and your comments that seems really high. So far I have had him home 1 day. What are your thoughts on his initial doses of Prednisolone? His stool is still liquidy and looks black but he is doing much better. My second question is about the fact that I am terrified of him having another crisis. He was very close to dying and if I had woken up later he probably would not have made it. I have an appointment with my primary vet on Sat and I am going to ask about supplies that I can have on hand if he has another crisis. The cost of the emergency vet was $3000 and I just don't think I can not afford that again if my regular vet is not open. I am going to ask about getting Ringers Lactate that I could at least give sub Q if not through an IV if he is dehydrated, and see if I can have the dextrose and Dexamethosone in case of a crash. I did buy some Karo syrup for his gums if he crashes. I do have a health care background so am comfortable giving the meds and monitoring if the vet approves it. Sorry for the long post but could you please let me know your thoughts on his initial Prednisolone dose and thoughts about me having a crisis crash kit if this occurs again at night or when my vet is not open? Thanks so much.

Dr. Mark E. Peterson said...

The initial high pred dose is fine because you are going to taper it down. If you give the monthly percorten shots and daily prednisone, another crisis is not expected.

Kelly P said...

jazzyb, I know your dog's crisis was very scary, but he is going to be fine now that you have him on the right meds. I just wanted to suggest you check out the facebook page Addison's Dogs-Canine Addison's Disease. There are some awesome people on there that are very knowledgeable about the disease. You will feel much better about things after reading the posts and asking any questions you may have. Not that Dr. Peterson's advise isn't spot on. I have read this entire blog and it helped me tremendously.

Scarlett Zloch said...

Hi Dr Peterson, I have a 4 year old 15kg poodle/lab cross who was diagnosed with atypical addisons in January. She has been suffering with a lot of symptoms like periods of lethargy, hind leg collapse etc for over two years as well as what looks like very brief (few seconds usually but very occasionally up to a minute) periods of confusion/inability to recognise me that the neurologist originally diagnosed as absence seizures but which didn't respond to various different medications. Around the same time this started happening she got badly attacked by a dog and turned her from a calm happy dog to an extremely anxious dog which has complicated trying to work out what was physical and what was behavioural. Just before Christmas after symptoms worsened and her anxiety was so bad she was barely functioning my vet ran tests and found she had very low cortisol levels and tested her for atypical addisons. This came back negative but after talking to Bellas neurologist they decided to try her on 15mg of prednilosone anyway (as they felt it was the only thing left to try that hadn't been tested for/ruled put over the last few years). Most of her symptoms disappeared within a few days leading to her diagnosis including a dramatic reduction in her anxiety which at the time I put down to her symptoms going away. After reading up on addisons it seems that seizures and anxiety aren't a part of addisons. Is this true? Her anxiety and lethargy have recently come back quite badly despite still being on 10mg prednilosone per day so I was wondering if i should be looking for her to be tested for other things? She is struggling with suffering extreme tHirst and hunger which I think is caused by the steroids but my vet says she'll need to be on this dose for life and that I should increase it to 15mg when she seems anxious so I'm a quite confused about everything. I'm very worried about the long term implications of this dose and unsure whether something else is going on as well. Do you think this is right or should i be looking to do something else. Thank you

Dr. Mark E. Peterson said...

I can't tell you what is wrong, but it's not all due to Addison's disease. 10 mg of prednisone is twice the human daily maintenance dose, and this is 4-8 times what your dog should need. You need to start over with a complete workup, probably with a new specialist (especially if they insist of blaming it all on Addisons').

Morgan said...

Hi Dr Peterson,
I have the puppy with Addison's, he is now 11 months. We recently dropped his dose from 3.5 to 2.5 after we trialled if for a couple of days he was much more energetic. That was for about 3 weeks (last weighed at 23kg) and in this last week he has started to look flat again. This also coincided with his percorten injection that we gave at 27 days (instead of the his 25 days).

Our vet has said that because he has put on some weight and weighs 25kg that we have definitely had it too low these past weeks and her opinion is the normal dose should be 0.2-0.4mg per kg (We decided on his dose following your advice of 0.1-0.2 and our observations of his clinical signs). Now we have given him 5mg for 3 days and he is really tired looking, walking slow, and although he is still eating all his food but isnt excited about it. He appears to be drinking more water but it's a bit too soon to tell. He's definitely not jumping about like the happy puppy he was a few weeks ago.

Is it possible that he would show cushing's symptoms after just one or two days of the higher pred dose? Or is that too fast? I am of the belief he is particularly sensitive to changes in dose and wanted to just up him 0.5mg at a time but we followed the vets advise. I am hoping this is just related to pred dose and not something else I should be concerned about. Thanks, Morgan

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