Chronic Steroid Use
Glucorticoids (or steroids) is the class of drug with the most applications for disease treatment. This group is second only to antibiotics when it comes to the number of lives saved. Common drugs in this group are Prednisone (or Predniolone), Dexamethasone, Trimacinolone (Vetalog), and methylprednisolone (Medrol). These medications are a synthetic version of the natural hormone cortisol that is produced in the adrenal cortex. These medications produce much a stronger anti-inflammatory responses and last much longer in the body than natural cortisol. With these medications doctors are able to control not only the strength but the duration of the effects of these medications.
Side effects of these medications can be classified into two distinct groups, with he first being short term side effects. Pets on glucorticoids are likely to experience side effects such as increased hunger, increased thirst (and consequently increased urination), panting, and loss of energy. Steroids also suppress the ability of the pets immune system so if there is any underlying infection occurring the use of steroids can bring the infection raging to the forefront. Another complication is in pre diabetic pets. The use of steroids in these animals is often enough to "tip them over the edge" into a diabetic state. It is important to note that in these cases the steroids do not cause diabetes unless the tendency is already present, and often times the diabetes will resolve once the steroids are stopped. In sensitive patients upset stomachs can occur. These situations should be viewed as serious and your veterinarian should be contacted.
The goal with any steroid use is to use the lowest dose possible to get the desired effects and often if any of the above side effects become issues the dose can be lowered. This adjustment will usually solve the problems if not many times a different steroid can be tried.
Long-term steroid use is considered to be a time period more than 4 months on steroids. There are many conditions that require a longer period of time on the medications but a new set of side effects are added to the ones previously listed. The first side effect of long term usage is urinary tract infections. These occur in about 30% of long term steroid patients. These UTIs will not present the same as they do in-patients not on steroids due to the suppression of the inflammation. Often puddles of urine in the home are the only symptom pets might show. For these reasons it is important to screen urine for signs of infection. Another problem can be the development of thin skin, blackheads, and a decreased ability to heal wounds and grow hair. Hard plaques of diseased skin can also occur forming almost like a shell, caused by calcium being deposited in the skin. Opportunistic infections can also occur due to the immune suppression that come with steroid use. It is also important to know that while excessive thirst and urination can be a side effect of steroids pets should be screened for diabetes if weight loss accompanies these symptoms. Dogs on high doses of glucocorticoids for long periods of time may develop Cushings Syndrome this is largely described as the symptoms listed above. If this happens it maybe important to add in other medications to try to decrease the amount of steroids needed to control the disease being treated.
Basically it is important to understand that all steroids are not bad nor is all steroid usage bad. They have many life saving qualities but must be respected and not overused. It is very important to stick to prescribed doses to prevent further complications with these medications. It is also important to respect these medications and to perform routine exams and blood testing to make sure no other problems arise.