Tapering Prednisone

[mcscaljon]

Hello
I wasn't sure under which topic to post under so apologize in advance.
Our boy Wiggles was on Prednisone 1.25 mg every other day, diabetic and has occasional IBD flare ups.  We got down and stayed at Pred 1.25 mg for a month, was doing really well and I was going to taper to every 3rd day and he had an IBD flare up - vomiting, diarrhea.  Did not get hospitalized and recovered pretty quickly. 
I went back up to Prednisone 1.25 mg alternating every other day 2.5 mg for one month and then taper the 2.5 mg to 1.25 mg every other.  Stayed on this for another 21 days.
I started this week to go every 3rd day .. with 1.25 mg.  My question is .. is this the proper tapering .. I have heard of others going 1.25 mg every other day X2, then skip the third ...

Thanks for your help
Minhchau

[Catherine]

Have you seen here? : http://cimda.co.uk/smf/index.php/topic,16.0.html  It explains the treatment and reducing regimes.

[mcscaljon]

Thank you Catherine

[Jo CIMDA]

Hi Minhchau and welcome

When you get down to very low doses of prednisolone there are many different ways of reducing the dose, and generally none are wrong.

The way you have tapered the pred dose looks good to me. I don't know how much Wiggles weighs but even if he is a light dog 1.25mg EOD is not a dose that will have much significance, but when a dog has been on pred for a long time it is always best to take the final reductions very slowly - so that it is hardly noticeable.

So some of the options could be:

1.25mg  every third day for a month and then you can go to every 4th day, if you wish, and then 5th etc.,

Some people would stop it altogether after a period of every third day dosing.  When you get the dose down to every third day, there is very little therapeutic effect because the duration of biological effect of prednisolone is 12-36 hours.

1.25mg every third day could be reduced to 1mg every third day, then after a month or so reduced to 0.5mg every third day etc...... until you feel it is time to leave it off altogether.

And there could be many other permutations of an end stage prednisolone reducing protocol.   Throughout this time watch him closely for any changes.

Jo

[mcscaljon]

Thanks Jo.  This is very helpful and along the same lines with what I was thinking as my next steps after every 3rd day.  Currently he is on every 3rd day.  It has been one week.  Keeping our fingers crossed.
Throughout this period, would you get lab work, such as CBC to watch the WBC?  For Wiggles, relapse has been one of 2 things - seizure like activity which thankfully we have not had for a while, OR digestive issues (diarrhea/vomiting).  We did one time had IMHA - but again, thankfully his HCT / HGB have been stable.

Thanks again.

[Jo CIMDA]

Hi

You know Wiggles better than anyone and I am sure you will pick up on anything that might be 'just not right'.   There comes a time where you have to eek out visits to the vet and blood tests and eventually you will become comfortable with this and relax a bit more, but it isn't easy. However, I always say trust your instinct and if you are not sure have bloods taken because even if everything is alright it is never a waste of money and it sets the bench mark for future tests and gives peace of mind.

I hope by taking this last stage slowly, and whether you wean him off altogether or leave him on a very low 3rd, 4th or 5th daily maintenance dose of pred it doesn't really matter as long as he maintains homoeostasis and you are comfortable with your decision.

It is very hard to switch off the anxiety you have experienced over the last months, but long term remission can happen and it does to many dogs.  Eventually you learn to lead a more normal life.  I used to get up every morning and look at Ziggy and if he was well I would get on with my day, but that early morning check continued throughout his life.

I am really happy that you have reached this stage of treatment. It is an achievement.

Jo

[sunvizion]

it sounds very complicated, why do you give animals all these specifics?

[Jo CIMDA]

Hi

Treatment of autoimmune disease can be very complicated but if a good drug regimen is followed the results can be very good.

Jo