Cortisone belongs to a group of drugs called glucocorticoids. Glucocorticoids are a group of drugs commonly used in treatment of allergic skin diseases. They may also be known as corticosteroids, steroids, by their trade names (Prednil, Pred-X, Macrolone, Delta Cortef, Depomedrone etc) or by their active ingredient (prednisolone, hydrocortisone, dexamethasone, methylprednisolone, etc). They may be administered as tablets injections or creams and are often used for temporary relief of itching and inflammation. In most cases treatment is rapidly effective but the beneficial effects can be associated with some side effects.
Glucocorticoids are very useful drugs with a bad reputation. Unfortunately the side effects are often over emphasised, and the benefits overlooked.
The body produces cortisone in times of stress. Its role is to gear the body up for short-term survival not long term maintenance. It will increase glucose levels so we can run faster (to escape from a chasing Lion), and decrease inflammation (you don’t need a painful swollen foot whilst running away form the lion, even if that inflammation will help you heal later). In medicine they are most commonly used for their anti-inflammatory properties.
People are much more sensitive to corticosteroids than our pet animals. As such much concern about side effects is derived from owner’s experience in people.
In an ideal world we would never use corticosteroids, or indeed any medication, as we would have no disease. This is not an ideal world and we do have disease. As such the question you should ask with any medication is what is worse, the disease or the medication. If the medication is worse than the disease don’t use it. It is easy to get so distracted by the list of side effects for a medication, that we can forget our pets also die of disease! It is worth remembering that in today’s litigious society, side effects are often listed that have never occurred with that product, but may have occurred in that family of drugs. Also frequency with which they are likely to occur are not listed (is it one in 10 animals who take it, or 1 in 10 million?). It is a little like food warnings ‘may contain traces of nuts’. It is so frequently added it becomes of little use in decision making, as you cannot assess the real risk of that particular food containing nuts.
The risk of side effects from glucocorticoids correlate with the dose and duration of therapy ie. the higher the dose and the longer the therapy the more likely side effects are to occur.
Side effects fall in to two groups: short and long term. Short-term side effects are quite common, generally mild, and will usually resolve when you stop the medication. Long term side effects usually take months or years to develop. Occasionally very high doses of corticosteroids are used, usually in life threatening situations, then the risk of more serious short-term side effects does occur.
To reduce the likelihood of side effects long-acting injectable corticosteroids are usually avoided. A short acting glucocorticoid tablet such as prednisolone is used instead. This allows the dose to be fine tuned to the lowest effective level and therefore reduces the risk of side effects. The dose is generally tapered to the lowest effective alternative day regime. Once the problem starts to recur please contact us to determine how to proceed. The maintenance dose may vary with season and other therapy. Higher doses every second day cause a lower risk of side effects than a lower dose given daily. This is because the body has a chance to go back to normal on the off day. Very occasional use of long-term injectable steroids can be acceptable in pets hard to medicate orally.
If modest doses are used for periods up to three months the risk of significant side effects is minimal whereas if prednisolone is used for longer periods much smaller doses are recommended. If we feel that the maintenance dose of prednisolone needed is too high we will look at ways to reduce it, whilst still controlling the disease it is being used for. The aim is always to find the minimum effective dose, not the minimum dose.
This list is not exhaustive. Many of the side effects listed are not serious, and are listed so that you are not overly concerned if they occur. We have tried to indicate which are more serious, and those that are rare. If you have any concerns please contact us. Just remember we are using this medication for a reason.