Prednisolone / Prednisone
Dosage & Administration Guidelines
| Species | Route | Dose | Frequency | Duration & Clinical Notes |
|---|---|---|---|---|
| Dog | PO | 0.5-1 mg/kg (anti-inflammatory); 2-4 mg/kg (immunosuppressive) | q12h to q24h (anti-inflammatory); q12h (immunosuppressive) | Duration: Varies; taper for long-term therapy Notes: Use lowest effective dose. For immunosuppression, may be given daily initially, then taper to alternate-day therapy. |
| Cat | PO | 1-2 mg/kg (anti-inflammatory); 4-6 mg/kg (immunosuppressive) | q24h (anti-inflammatory); q12h (immunosuppressive) | Duration: Varies; taper for long-term therapy Notes: Cats may require higher doses due to lower sensitivity. Use with caution in diabetic cats. |
| Horse | PO | 0.5-1 mg/kg (anti-inflammatory); 1-2 mg/kg (immunosuppressive) | q24h | Duration: Varies; taper for long-term therapy Notes: Oral absorption is variable; consider parenteral administration for acute conditions. |
| Horse | IV | 0.5-1 mg/kg (anti-inflammatory) | q24h | Duration: Short-term (1-3 days) Notes: For acute inflammatory conditions. |
| Cattle | IM | 0.5-1 mg/kg (anti-inflammatory) | q24h | Duration: Short-term (1-3 days) Notes: Used as adjunctive therapy for ketosis and inflammatory conditions. |
| Cattle | PO | 0.5-1 mg/kg (anti-inflammatory) | q24h | Duration: Short-term Notes: Oral administration may be less reliable in ruminants. |
| Small Ruminants | IM | 0.5-1 mg/kg (anti-inflammatory) | q24h | Duration: Short-term Notes: Use with caution; may cause immunosuppression. |
| Rabbit | PO | 0.5-2 mg/kg (anti-inflammatory) | q12-24h | Duration: Short-term Notes: Use with caution; rabbits are sensitive to corticosteroids. |
| Bird | PO | 0.5-2 mg/kg (anti-inflammatory) | q12-24h | Duration: Short-term Notes: Limited data; use with caution. |
Clinical Indications & Species Uses
- Anti-inflammatory and immunosuppressive therapy for a wide range of conditions
- Replacement therapy for adrenal insufficiency
- Palliative treatment for certain neoplasms
- Inflammatory and allergic conditions (e.g., dermatitis, pruritus, allergic reactions)
- Immune-mediated diseases (e.g., immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, systemic lupus erythematosus, pemphigus complex)
- Neoplasia (as part of chemotherapy protocols, e.g., lymphoma, mast cell tumors)
- Orthopedic conditions (e.g., osteoarthritis, intervertebral disc disease)
- Respiratory diseases (e.g., feline asthma, chronic bronchitis)
- Gastrointestinal diseases (e.g., inflammatory bowel disease)
- Neurological conditions (e.g., spinal cord compression, meningitis)
- Endocrine disorders (e.g., hypercalcemia of malignancy, adrenal insufficiency as replacement therapy)
- Inflammatory and allergic conditions (e.g., dermatitis, pruritus, allergic reactions)
- Feline asthma and chronic bronchitis
- Immune-mediated diseases (e.g., immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, inflammatory bowel disease)
- Neoplasia (as part of chemotherapy protocols, e.g., lymphoma)
- Eosinophilic granuloma complex
- Hypercalcemia of malignancy
- Adrenal insufficiency (replacement therapy)
- Inflammatory conditions (e.g., arthritis, bursitis, myositis)
- Allergic reactions (e.g., insect hypersensitivity, urticaria)
- Immune-mediated diseases (e.g., immune-mediated hemolytic anemia, purpura hemorrhagica)
- Recurrent airway obstruction (heaves) - as adjunctive therapy
- Neoplasia (e.g., lymphoma, mast cell tumors)
- Ketosis (as adjunctive therapy to glucose and supportive care)
- Inflammatory conditions (e.g., arthritis, pneumonia, mastitis)
- Allergic reactions (e.g., anaphylaxis, insect bites)
- Immune-mediated diseases (rarely used)
- Inflammatory conditions (e.g., arthritis, pneumonia)
- Allergic reactions (e.g., insect bites, anaphylaxis)
- Ketosis (in sheep and goats, similar to cattle)
- Inflammatory conditions (e.g., dermatitis, arthritis)
- Allergic reactions
- Immune-mediated diseases (rarely used; caution due to immunosuppression)
- Inflammatory conditions (e.g., arthritis, dermatitis)
- Allergic reactions
- Immune-mediated diseases (rarely used; caution due to immunosuppression)
- Reptiles: Inflammatory conditions, allergic reactions (limited data)
- Small mammals (e.g., ferrets, guinea pigs): Inflammatory and immune-mediated conditions (limited data)
Pharmacology & Mechanism of Action
Drug Class: Corticosteroid | Pharmacological Group: Glucocorticoid
Mechanism of Action: Prednisolone and prednisone are synthetic glucocorticoids with potent anti-inflammatory and immunosuppressive properties. Prednisone is a prodrug that is rapidly converted to prednisolone in the liver. Prednisolone binds to the glucocorticoid receptor in the cytoplasm, leading to translocation into the nucleus and modulation of gene transcription. This results in increased synthesis of lipocortin (which inhibits phospholipase A2 and reduces prostaglandin and leukotriene production), decreased pro-inflammatory cytokine production (e.g., IL-1, IL-6, TNF-alpha), and reduced expression of adhesion molecules. These effects collectively suppress inflammation, immune responses, and allergic reactions.
Pharmacodynamics: At therapeutic doses, prednisolone/prednisone produce anti-inflammatory effects by inhibiting vasodilation, reducing capillary permeability, decreasing leukocyte migration and phagocytosis, and stabilizing lysosomal membranes. They also suppress the hypothalamic-pituitary-adrenal (HPA) axis, leading to decreased endogenous cortisol production. At higher doses, they have immunosuppressive effects, including inhibition of T-cell activation and antibody production. They also affect carbohydrate, protein, and fat metabolism, promoting gluconeogenesis, protein catabolism, and redistribution of body fat. Mineralocorticoid activity is minimal compared to endogenous cortisol, but high doses may cause sodium and water retention.
β‘ Pharmacokinetics Summary
Available Formulations & Strengths
Contraindications & Clinical Warnings
- Systemic fungal infections
- Known hypersensitivity to corticosteroids
- Viral infections (especially systemic without appropriate antiviral therapy)
- Corneal ulcers (topical use)
- Gastrointestinal ulceration (relative contraindication)
- Pregnancy (especially first trimester; use only if benefits outweigh risks)
- Concurrent use of live vaccines (immunosuppression may impair immune response)
- Use with caution in animals with diabetes mellitus, as corticosteroids may increase blood glucose.
- Use with caution in animals with renal disease, cardiac disease, hypertension, or congestive heart failure due to potential fluid retention.
- Use with caution in animals with hepatic disease, as metabolism may be impaired.
- Use with caution in animals with osteoporosis or fractures, as corticosteroids may impair bone healing.
- Use with caution in animals with a history of gastrointestinal ulcers.
- Long-term use may cause iatrogenic hyperadrenocorticism (Cushing's syndrome).
- Abrupt withdrawal after prolonged therapy may cause adrenal insufficiency; taper dose gradually.
- In food animals, observe withdrawal times.
- In horses, use with caution in animals with laminitis or at risk for laminitis.
- In cats, use with caution in diabetic cats; may cause insulin resistance.
- In rabbits and rodents, corticosteroids are generally contraindicated due to high risk of immunosuppression and gastrointestinal disturbances.
Adverse Effects & Reactions
Common:
- Increased thirst and urination (polyuria/polydipsia)
- Increased appetite (polyphagia)
- Panting (especially in dogs)
- Weight gain
- Lethargy
- Gastrointestinal upset (vomiting, diarrhea)
- Suppression of the immune system (increased susceptibility to infections)
Serious / Severe:
- Gastrointestinal ulceration and perforation
- Pancreatitis
- Diabetes mellitus or worsening of existing diabetes
- Iatrogenic hyperadrenocorticism (Cushing's syndrome) with long-term use
- Adrenal insufficiency upon withdrawal
- Hepatopathy (elevated liver enzymes, vacuolar hepatopathy)
- Ligament and tendon rupture (especially in horses)
- Laminitis (in horses)
- Suppression of growth in young animals
- Behavioral changes (agitation, aggression)
Rare:
- Anaphylactic reactions
- Cutaneous calcinosis
- Osteoporosis
- Myopathy
- Thromboembolism
- Cataracts (with prolonged use)
- Exophthalmos (in dogs)
Key Drug Interactions
| Interacting Drug / Class | Clinical Effect & Mechanism | Severity |
|---|---|---|
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Increased risk of gastrointestinal ulceration and perforation. | High |
| Insulin or oral hypoglycemic agents | Corticosteroids may increase blood glucose, reducing the effectiveness of antidiabetic agents; dosage adjustment may be needed. | Moderate |
| Phenobarbital or other hepatic enzyme inducers | May increase the metabolism of prednisolone, reducing its efficacy. | Moderate |
| Ketoconazole or other azole antifungals | May increase plasma concentrations of prednisolone, increasing the risk of adverse effects. | Moderate |
| Cyclosporine | May increase the risk of immunosuppression and infection. | Moderate |
| Diuretics (e.g., furosemide) | May increase the risk of hypokalemia. | Moderate |
| Vaccines (live) | Immunosuppression may impair the immune response to vaccines, increasing the risk of vaccine-induced disease. | High |
| Mitotane (o,p'-DDD) | May alter the metabolism of corticosteroids; dosage adjustment may be needed. | Moderate |
Overdose & Toxicity Management
Signs of Toxicity:
- Severe polyuria and polydipsia
- Gastrointestinal ulceration and bleeding
- Hyperglycemia and glycosuria
- Electrolyte imbalances (hypokalemia, hypernatremia)
- Hypertension
- Cushing's syndrome with chronic overdose
- Immunosuppression leading to infections
- Behavioral changes (agitation, depression)
Emergency Treatment Protocol: Treatment of overdose is primarily supportive. There is no specific antidote. For acute overdose, induce vomiting if within 1-2 hours and the animal is conscious (in dogs and cats). Administer activated charcoal to reduce absorption. Monitor vital signs, blood glucose, electrolytes, and fluid balance. Provide symptomatic treatment for gastrointestinal ulceration (e.g., gastroprotectants like omeprazole or sucralfate). In cases of severe hyperglycemia, insulin may be required. For chronic overdose, taper the drug gradually to avoid adrenal insufficiency. Supportive care may include fluid therapy, electrolyte replacement, and management of infections. In severe cases, hospitalization may be necessary.
Food Animal Withdrawal Times
Prednisolone/prednisone are not approved for use in food animals in many countries. However, when used extra-label, withdrawal times must be determined based on the specific formulation and route. In the US, the FDA has established tolerances for residues of prednisolone in cattle, but withdrawal times are not specified. It is recommended to consult with a veterinary pharmacologist and follow local regulations. Generally, a withdrawal period of at least 7 days for meat and 3 days for milk is suggested, but this may vary. For poultry and eggs, no official withdrawal times are established; use is discouraged.
Storage, Handling & Regulatory Information
Storage Temperature: Store at controlled room temperature (20-25Β°C or 68-77Β°F). Protect from light and moisture.
Light Sensitivity: Light-sensitive β protect from direct exposure.
Handling & Special Conditions: Keep in a tightly closed container. Injectable solutions should be stored according to manufacturer's instructions; some may require refrigeration. Do not freeze.
Dispensing Status: Prescription Required (Rx Only)
Approval Status: Approved for use in dogs and cats (oral and injectable formulations). Not approved for food animals; extra-label use is common but regulated.
Extra-Label (Off-Label) Use: In the US, prednisolone and prednisone are approved for use in dogs and cats. Extra-label use in other species is permitted under the Animal Medicinal Drug Use Clarification Act (AMDUCA) provided there is a valid veterinarian-client-patient relationship, and withdrawal times are extended. In food animals, extra-label use is prohibited if an approved drug is available that is effective and meets label conditions. Use in food animals requires careful consideration of withdrawal times and potential residues.
Clinical Pearls & Practice Notes
References & Literature
- π Plumb's Veterinary Drug Handbook
- π Papich Veterinary Pharmacology and Therapeutics
- π Compendium of Veterinary Products (CVP)