Withdrawing prednisone and worried having side effects

[summersoonsurely]

Elderly dog with low grade lymphoma is being weaned of prednisolone.

Max dose was 0.3mg/kg for 10 weeks.
Halved dose for the last 5 days.

Today suddenly very lethargic.

Anyone any experience please? Really unsure whether it's a withdrawal from a lose dose or something else I should see vet about.

I’m a human doctor, not a vet but - if dogs are the same as humans (which they might not be) - that sounds like quite a fast reduction in dose. When you take steroids as a medication, the body switches off its own steroid production and it can take some time to get it started again.

I would definitely speak to a vet today if your pup is lethargic. Hope s/he is ok.

Thank you @MissLucyEyelesbarrow for responding. I thought so too (nurse here) and I did question it. It's a very low mg/kg dose apparently so she said this regime would be fine.

Such a worry.

I don’t know much about dosing I wish I could help. My dog is 6.3kg and on 2mg a day and I think he needs an increase. The lethargy without steroids is really noticeable, it’s partially why we started him. As a human when I take them they give me an unreal burst of energy at the start but I have only ever weaned off slowly, so I didn’t notice a dramatic shift the other way. I think lethargy and lymphoma go hand in hand. ❤️ love to you and your lovely dog x

Again, caveating that I know zero about dog physiology, and it may not be the same as humans.

However, in humans, there would be a couple of considerations in this scenario:

Firstly, you can often safely reduce a steroid dose fairly quickly until you get to the equivalent of the level that the body produces by itself, when not on medication (roughly equivalent to 0.1 mg per kg per day of prednisolone - no idea what it would be in dogs). Once you hit this level, you should reduce more cautiously, to give the natural steroid production time to switch back on.

Secondly, as I'm sure you know, a steroid dose needs increasing if a human is unwell, e.g. if there is an infection. If your dog were a human, I would wonder whether the lethargy was due to an infection and probably increase the steroid dose back up as a precaution.

Obviously you should not change the dose without consulting the vet and - for all I know - dog physiology is totally different. But it might be worth raising these points with the vet.

No dog or medical knowledge at all, but I took Pred myself for a long time. I know when I was ramping it down I was told if I got symptoms of withdrawal I should increase back to the previous dose and spend longer on each 'level', and consider taking half and 1/4 pills to add more levels to the process, if that makes sense. I was also told the side affects would probably come at the low doses when the drop was a bigger %. So 40mg to 35 probably fine, but 10 to 5, more likely to have an issue and might need to do 12.5 for a week.

Thank you all for answering

I debated all morning whether to take her to an OOH vet but pups slowly picked up over the day and decided a quiet day resting was better than being poked and prodded by a vet who we hadn't met before. Roast beef, veggies and gravy has been demolished so all seems ok atm. 💙

I'll be seeing our usual vet in the morning though.