Understanding how to taper off steroids in dogs is important because steroids, unlike several other types of drugs, need to be gradually weaned off to prevent life-threatening consequences. Tapering off is important regardless of how small the dosage of steroids your dog was prescribed. Steroids should never be stopped abruptly unless indicated by your vet because of very serious side effects. If your dog is currently on steroids and you want to stop them, it's fundamental to consult with your veterinarian for exact guidelines on how to taper off steroids in dogs considering that the process of tapering off is often based on individual factors.
How Steroids Work in Dogs (and Humans)
Your dog's body depends on different types of naturally produced steroids which circulate throughout the body for the purpose of maintaining essential functions such as keeping the electrolytes in balance, maintaining fluid balance and blood pressure.
When a dog is put on steroids, (we are talking about glucocorticoids here, not the type of steroids athletes take to improve performance), this natural production of steroids shuts down. In medical terms, this is referred to as hypothalmus/pituitary/adrenal suppression (HPA suppression).
Depending on the dose of steroids the dog is prescribed, it generally takes about 10 to 14 days for this suppression to take place. Once this HPA suppression takes place, stopping a course of steroids cold turkey can lead to potentially life threatening problems.
After being suppressed for some time, it would be very shocking for the dormant adrenal glands to find themselves suddenly out of the blue to start producing natural steroids in large amounts again. The risks of stopping steroids cold turkey range from withdrawal symptoms to the onset of a potentially life-threatening condition known as Addisonian crisis (which is triggered by a sudden underproduction of adrenal hormones).
Tapering slowly a dog off steroids therefore allows the HPA axis sufficient time to gradually return to its normal functioning without the issue of underproduction of hormones.
There are different types of steroids for dogs prescribed to dogs nowadays. Most steroids end with “-one” --you'll therefore have prednisone, prednisolone, methylprednisolone, dexamethasone, triamcinolone, hydrocortisone and betamethasone.
Steroids may be prescribed at various doses depending on the underlying condition being treated. Dosages may start at physiological doses which are low and just meant to replace natural steroids that are missing. Next, are anti-inflammatory doses which are used to treat inflammatory disorders and then, there are high dosages which are immune-modulating and often given for auto-immune diseases (such as when the body is attacking its own skin (lupus or pemphigus) or attacking the blood (hemolytic anemia).
" Weaning animals off long-term steroids rather than stopping "cold turkey" will give the adrenal gland time to regain activity and prevent hypoadrenocorticism."~Dr. Alan Chicoine
Why Dogs are Taken Off
There may be several reasons why dogs are taken off steroids. One main reason may be that the vet has established that the dog no longer needs to stay on the medication either because the underlying condition has resolved or the medication is not working as hoped. In such as case, as mentioned, the medication should not be stopped at once, but must be gradually reduced over time.
Another reason why dogs may be weaned off steroids is because of side effects. Dogs on steroids such as prednisone may exhibit some decrease in muscle tone in the head (pred head), elevated liver enzymes on blood work, and increased drinking and increased urination, explains veterinarian Dr. Whitehead. These symptoms (although quite common) are often unacceptable to the owner. Long-term use may lead to weight gain, poor skin and coat, elevated liver enzymes, pancreatitis, gastrointestinal ulcers, onset of diabetes, muscle wasting and suppression of the adrenal gland.
Serious side effects at times may warrant a quicker weaning schedule or even removing the dog from steroids cold turkey. One main reason may be the presence of a bleeding ulcer. Affected dogs may start vomiting blood and having dark stools which are due to digested blood.
Steroids work by reducing inflammation in the body, and while this is a good thing, it's unfortunate that this also entails reducing the production of the protective layer of mucus that lines the stomach. Steroids may therefore cause the mucus lining the stomach to get thinner with time and more prone to acid damage, leading to the formation of an ulcer. While there's certainly a risk associated with stopping steroids, there's more of a risk of a life-threatening perforated ulcer, points out veterinarian Dr. Salkin.
Many dogs are weaned off steroids prior to surgery. This because steroids can cause problems with healing; however, in dogs who depend on steroids such as dogs with Addison's,' use of steroids should not be stopped. Consult with your vet for guidance.
"Carafate (sucralfate) is a gastroprotectant that we sometimes use in dogs that are on steroids and have a poor appetite. It helps heal and prevent forming of stomach ulcers." Dr. Kara, veterinarian
Signs to Watch For
While most vets typically wean dogs off of steroids, it may happen that dog owners may decide to stop these medications cold turkey without realizing that doing so may cause damage to their dogs. Whether the stopping cold turkey is accidental or intentional, an Addisonian crisis or other symptoms associated with withdrawal are always a possibility.
Not all dogs will develop such complications though. There is likely some sort of variability between individual dogs. Some individual dogs may be more prone to developing signs of suppression of their HPA axis more than others. This can be attributed to individual variances in the steroid receptors of tissues.
Symptoms to watch for are typically nausea, vomiting, diarrhea, lethargy, that may progress to tremors, seizures and even acute collapse. These symptoms take generally place within the first 10 days after stopping the steroids cold turkey. Should these symptoms occur consult with your vet.
The good news is that there is treatment for Addison's and ironically part of it involves using steroids again which brings us back to question "then, why not slowly discontinue steroids and avoid these risks altogether?"
How to Taper Off Steroids in Dogs
How to taper off steroids in dogs will depend on several factors such as how long the dog has been on the drug, the dosage and the condition being treated. The tapering time should be slow and gradual and may typically take a few weeks. Generally, the longer the dog was on the drug, the longer it should take to be tapered off.
Dogs on this drug on a very short-term basis (like just 5 days) may not necessarily require tapering, but it's best to consult with the prescribing vet for guidance, suggests veterinarian Dr. Britni Miller.
When it comes to tapering off steroids in dogs, vets may decide to take different approaches. One approach is to reduce the daily dosage by telling the owner to give half of the daily dosage for several days, and then half of that once again and so forth. Another approach is to give a normal dose but every other day, then every three days and so forth. Dog owners should not improvise tapering without the guidance of a vet due to individual factors and associated risks. Every vet may also have different weaning protocols.
When vets prescribe short-term dosages usually the instructions on tapering off are clearly displayed on the bottle. While the dog is being tapered off, it's important to closely monitor the dog for any concerning symptoms as those described above.