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Glucocorticoid Use in Practice

featured free internal medicine pharmacology

1. First, memorize these prednisone doses. 

While the need to have things memorized is rare, these pred doses are an absolute exception! Doing so will ensure that you always know what dose of steroids to reach for and that you never find yourself relying on Plumb’s in the face of a crisis.

But really, don’t rely on Plumb’s during a crisis as many of the dexamethasone doses are alarmingly high!


Prednisone Doses

Physiologic: 0.07-0.1mg/kg/day *

Anti-inflammatory: 0.25-0.5mg/kg/day

High Anti-Inflammatory: 1mg/kg/day **

Immunosuppressive: 2mg/kg/day or 40mg/m2 ***

* Dogs treated for Addison’s should not have any steroid side effects! If they do, their dose is too high.

** Use a high anti-inflammatory dose for conditions that are presumed to be autoimmune, however, infectious disease have not been entirely excluded. Pending response to therapy and test results I may later increase to 2mg/kg/day.

*** Max dose should not exceed 40-60mg per dog per day. Studies have shown that dosing steroids on a mg/kg basis in large breed dogs often leads to overdose and undue steroid side effects. Consider dosing steroids using body surface area for all large breed dogs. They need much less than their smaller counterparts!


2. Second, use these relative glucocorticoid strengths to convert your prednisone dose into a different steroid.


3. Calculate your dose

  1. Pick a prednisone dose. Are you aiming for a 5 times physiologic dose in an Addisonian crisis or are you aiming for immunosuppression in a dog newly diagnosed with IMHA?
  2. Calculate your prednisone dose range in milligrams.
  3. Convert prednisone to your intended steroid. Pick a dose based on standard tablet size and whole numbers rounded to the nearest tenth.

Example 1. You are planning to administer an anti-inflammatory dose of prednisone to a 6kg cat with chronic rhinitis. The clinic where you are doing relief only carries methylprednisolone, 4mg tablets. What dose should you prescribe?

0.25mg/kg x 6 kg = 1.5mg and 0.5mg/kg x 6 kg = 3 mg

Total dose of prednisone = 1.5- 3mg

Total dose of methylprednisolone= 1.5/1.25 – 3/ 1.25 = 1.2mg to 2.4mg

Methylprednisolone 4mg tablets: Give ½ tablet once daily for ___ days then taper.


Example 2. You are treating Trudy, a 32kg Lab who was diagnosed with IMHA. She is icteric, transfusion dependent, and anorexic so you want to start her on dexamethasone instead of oral prednisone. What dose should you prescribe?

  • 2mg/kg x 32kg  = 64mg
  • 64mg/10 = 6.4mg
  • 6.4mg/ 4mg/mL = 1.6mL

You reach for dexamethasone to pull up Trudy’s dose and see that the clinic only has dexamethasone SP. What dose should you prescribe?

  • 2mg/kg = 64mg
  • 64mg / 10 = 6.4mg
  • 6.4mg / 3mg/mL = 2.1mL

Trudy does well and it is time to discharge her with oral prednisone. What dose do you choose?

Prednisone 20mg tablets: Give 1 tablet by mouth every 12 hours. 


4. Copy and paste from these steroid side effects to your medical record


You will notice significant steroid effects during the period of steroid taper. First your pet will drink excessive amounts of water and urinate frequently. Even the best and most potty trained pet may have urinary accidents in the house both during the day and at night. Do not restrict water during this time. Dogs will act ravenous and may even get into the trashcan or steal food off the dinner table or counter. Despite the increase in appetite resist the urge to increase the amount that you are feeding them. It is OK to split their normal food into smaller meals throughout the day. You can also curb the appetite with healthy treats such as carrot sticks, bell pepper slices, green beans (canned, frozen, cooked or fresh), apple slices, popped popcorn (without butter, salt or other flavoring). Despite the increased appetite you will likely notice that they lose weight. They are not starving, the weight loss is actually decreased muscle mass and a direct side effect of the steroid. Along with the decreased muscle mass you will notice that they may seem weaker. This could mean not able or willing to jump on and off the furniture or you may notice that they are less “stable” on their feet. Dogs will often pant excessively which might prompt you to believe that they are having trouble breathing. Panting is normal in dogs and you will note that although they are panting that they are not in distress. All of these symptoms will slowly resolve as we continue to taper the steroids. Many dogs go through a period of weight gain immediately after discontinuing the steroids.

Do not stop this medication abruptly. Do not combine with any non-steroidal anti-inflammatory medications.



Side effects are uncommon however please monitor for increased thirst and urination, weight loss despite an excellent appetite, increased breathing rate or difficulty breathing.


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 About the Author: Heather Kvitko-White, DVM, DACVIM (SAIM)

Dr. Heather Kvitko-White is an internal medicine specialist who left private specialty practice to pursue her love of education. With a background in clinical case consulting, she started creating content as the Pragmatic Professor. As a writer and national speaker, she promotes a cost-conscientious and common-sense approach to caring for animals without sacrificing quality. She founded KW Veterinary consulting with the goal of helping to bridge the gaps between academia, industry, and private practice.



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