Veterinary Medicine - November 2008 - (Page PD12)

Table 1a. Canine pharmacologic dosage ranges Prednisone or prenisolone Physiologic requirements: Antipruritic eﬀect: Anti-inﬂammatory eﬀect: Immunosuppressive eﬀect: 0.05 to 0.25 mg/kg/day 0.5 mg/kg/day 1.0 to 1.5 mg/kg/day 2.0 to 6.0 mg/kg/day Table 1b. Anti-inﬂammatory dosages for common systemic glucocorticoids Drug Dosage Oral preparations (short duration) Prednisone, prednisolone 0.5 to 1.0 mg/kg every 12 to 24 hours Methylprednisolone 0.22-0.44 mg/kg every 12 to 24 hours Trimeprazine with prednisolone One tablet contains the equivalent of 5 mg of trimeprazine and 2 mg of prednisolone; dosage chart is on the product bottle. Oral preparations (intermediate duration) Dexamethasone Triamcinolone 0.07 to 0.15 mg/kg every 12 to 24 hours 0.5 to 1.0 mg/kg every 12 to 24 hours Injectable preparations (short duration) Prednisone, prednisolone Dexamethasone 0.5 to 1.0 mg/kg every 12 to 24 hours intravenously, intramuscularly, or subcutaneously in some formulations. 0.07 to 0.15 mg/kg every 12 to 24 hours intravenously, intramuscularly, or subcutaneously in some formulations. Injectable preparations (longer lasting) Triamcinolone acetonide Methylprednisolone acetate 0.1 to 0.2 mg/kg intramuscularly or subcutaneously a single dose of 10 to 20 mg/cat intramuscularly Methylprednisolone is an often-overlooked alternative to prednisone. Methylprednisolone is methylated at the C6 position, improving its anti-inﬂammatory action with less tendency to induce sodium and water retention. By achieving equal anti-inﬂammatory eﬀect with lower doses, methylprednisolone may be an option to minimize annoying side eﬀects. stress have been shown to increase cortisol production to 10 times their physiologic levels. While canine dosage guidelines exist in the literature, treatment of each patient should be customized to achieve the lowest effective dosage and for the shortest period of time necessary to control the clinical signs. Glucocorticoids are mainly used short-term while addressing causes of pruritus and treating complicating factors. Many clinicians ﬁnd one of the following protocols or a variation helpful when managing their allergic patients’ inﬂammation and pruritus with glucocorticoids. They use these protocols while also addressing complicating factors and underlying or coexisting etiologies (e.g., ﬂeas and secondary infections): Acute canine protocol. Treat the inﬂammation and pruritus with two to ﬁve days of glucocorticoid therapy consisting of either a short-acting oral glucocorticoid or single injection of a short-acting glucocorticoid. I commonly use subcutaneous dexamethasone sodium phosphate (SP) at 0.5 to 1.0 mg per 10 lbs body weight. The dose is similar to the dose used for high-dose dexamethasone suppression tests. It may be administered subcutaneously or intravenously and is usually very well tolerated with minimal subsequent polyuria and polydipsia. The beneﬁcial effects last two to ﬁve days, which is slightly longer than the other short-acting glucocorticoids. Acute feline protocol. For short-duration oral therapy, prednisolone, methylprednisolone, or dexamethasone is more commonly utilized because cats inadequately convert prednisone to prednisolone. Cats may be difﬁcult to administer oral medication to and they 12 PRACTICAL DERMATOLOGY FOR THE BUSY PRACTITIONER

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Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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