Hello and introducing myself

[Karen Churchill]

Blood test today showed platelets have gone up another hundred to 337. So tapering of Prednisolone has started. 25% decrease to 15mg twice a day. Blood test again in 2 weeks. This still seems to be an immune suppressing dose as she is 12.9kg. Vet said we may be able to taper more in 2 weeks if bloods still stable.  Do I need to worry about very fast breathing When she is resting or is this just another side effect of the steroids?

[Jo CIMDA]

Hi


"Do I need to worry about very fast breathing When she is resting or is this just another side effect of the steroids? "

Yes, you should be worried.  Knowing that Pippa has been on exceptionally high doses of steroids for over a month and is still on a higher than needed immunosuppressive dose then, if Pippa were my dog,  I would want the dose of prednsiolone reduced further now.   Fast breathing isn't a good sign especially as Pippa's platelets are increasing fast.

If you keep her on this dose for another two weeks, that means she has been on very high doses (higher than need be) for 6 weeks and it is possible that the prolonged high doses of preds could cause serious problems, such a blood clots. 


Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.

40 mg/24hrs of prednsiolone for a 13kg dog  is just over 3mg/kg/24hours.  Pippa has had this dose for over one month.
30mg/24hrs is 2.3mg/kg/24hrs.  Pippa is still having over the recommended maximum starting dose.  See the guidelines above.

Side effects should be taken into account every day of treatment and if the clinical signs become intolerable or dangerous then the dose of pred should be reduced significantly enough to reduce the adverse effects. 

Personally, and in response to the fast breathing,  I would want the preds reduced to below an immunosuppressive dose.  The steroids have done their job and there is no benefit to be gained by keeping her on very high doses - only harm.

If you are anxious about having this discussion with your vet (and I understand why) then you can ask him for a referral to a specialist veterinary practice or vet school. 

At this stage, the side effects of the drugs are as important, if not more so, than controlling the disease.

Jo

[Jo CIMDA]

This is the best reducing protocol that I have come across and it can be confidently used as a guide.

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.
Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.