Medications
Introduction to Steroids
By Debbie Roes

A number of medications can be used to help manage Feline Inflammatory Bowel Disease (IBD). Corticosteroids,
or steroids for short, are typically the key drugs prescribed by veterinarians for this condition. This article covers
some basic information about corticosteroids, the various types of steroids, why one type may be used over
another, potential side effects, and other important things to know.

What are Corticosteroids and Why Use Them?
Corticosteroids are a class of hormones that are produced in the adrenal glands. They are involved in a wide
range of bodily functions, including the stress response, immune system response, control of inflammation,
nutrient metabolism, and the maintenance of blood electrolyte levels.

Corticosteroid medications mimic the effects of the hormones that naturally produced by the adrenal glands.  
When prescribed in doses that exceed the levels that are normally present in the body, corticosteroids suppress
inflammation. This can reduce the signs and symptoms of various types of inflammatory conditions, including
inflammatory bowel disease. Thus, corticosteroids are valuable class of medications in the management of
Feline IBD.

If your cat had an ultrasound done that highlighted suspected IBD (IBD can only be definitively diagnosed
through an intestinal biopsy), you were likely told that intestinal thickening was observed. This is a hallmark of
the disease and steroids may be used to decrease this inflammation on either a short or long-term basis.  
While some cats’ symptoms can be managed successfully through dietary changes, most will need to remain on
these drugs over the long-term to help control inflammation and related symptoms. However, in many cases, the
dosage can be reduced over time as the cat’s condition improves.

Types of Steroids
There are several different types of steroids that can be used to help manage Feline IBD. These medications are
available in multiple formats, including pills, chewable tablets, compounded liquids, transdermal gels, and
injections. The forms available will vary depending upon the type of steroid prescribed. The following are the
steroids generally prescribed for Feline IBD.

Prednisolone and Prednisone
Prednisolone and prednisone are the most commonly used steroids for Feline IBD. It is important to understand
the difference between these two steroids, as people often get them confused and they are not the same. The
primary distinction is that prednisone needs to be converted by the liver (into prednisolone) before it can be
utilized by the body.

Studies have shown that oral prednisolone has a better bioavailability for the feline patient than oral prednisone,
as evidenced by a higher concentration of prednisolone in blood samples when equal amounts of both drugs
were given to the same animals. It’s not entirely certain whether this finding resulted from increased
gastrointestinal absorption or decreased hepatic (liver) conversion from prednisone to prednisolone, but the
bottom line is that prednisolone has been shown to be the superior choice for cats.

Dosages of prednisolone typically start out at a higher level and are gradually tapered down as the cat’s
condition stabilizes. While dosing is very individual, it’s common for a 10 pound cat to receive 5 mg. of
prednisolone twice per day for the first two weeks and 5 mg. once a day for another two weeks. Then the
dosage is often decreased to 5 mg. every other day for four weeks or as needed for maintenance therapy.  
Higher doses are sometimes used for severe or resistant IBD cases.

The most common mistakes made during treatment are starting off with too low a dose of prednisolone or not
giving the drug for a long enough period of time. The inflammation in a cat’s intestinal tract did not develop
overnight, so it will also take time to reduce that inflammation. Of course, steroid treatments are often more
effective when combined with other adjunct therapies, including food changes, B-12 injections, probiotics,
digestive enzymes and oftentimes anti-nausea medication.

Budesonide (Entocort)

Budesonide, or Entocort, is another steroid that is used to manage Feline IBD. This drug was developed to treat
Crohn’s disease, a form of inflammatory bowel disease, in humans.  While prednisone and prednisolone are
systemic steroids, budesonide is targeted directly at the gastrointestinal tract.  

Budesonide is taken orally and moved along the gastrointestinal tract along with the rest of the intestinal
contents. Along the way, the inflamed intestinal lining is bathed with corticosteroid treatment, similar to when you
rub a cortisone cream on your irritated skin. The budesonide gets absorbed by the cat’s intestines but is then
removed almost immediately by the liver in what is termed a “first-pass effect.” In this way, the body at large only
sees minimum steroid activity and fewer systemic side effects, such as diabetes, are seen.

While budesonide is sometimes the initial steroid given to cats with IBD, cats may also be switched to this drug
from prednisolone if that steroid hasn’t been as effective as desired or if difficult to manage side effects have
occurred.  Veterinarians have used both drugs successfully in their Feline IBD patients, so they are both viable
options to be considered for your cat.  

One negative aspect of budesonide is that it tends to be more expensive than either prednisone or prednisolone.
However, budesonide can be obtained via a reputable online pharmacy at a lower cost (you will need a
prescription). All online pharmacies are not created equally, though, so be careful to use a legitimate one. If
you’re unsure, we recommend checking with your veterinarian or the FDA website:
www.fda.gov/ForConsumers/ConsumerUpdates/ucm048396.htm

Dosage recommendations for budesonide vary, but the standard is generally 1 mg. per day for cats, regardless
of their weight. However, doses may range from .5 mg to 3 mg. per day depending upon the prescribing
veterinarian and the cat. If one is switching from prednisolone to budesonide, it is often recommended to
continue the prednisolone on a weaning schedule while beginning budesonide. This is done in order to avoid
withdrawal symptoms when going from a drug with a high systemic effect to one with low systemic availability.  
As with all medication changes, this is something which should be discussed and coordinated with your
veterinarian.

Depo-Medrol / Medrol (Methylprednisolone)
Depo-Medrol is a long-acting steroid shot that is generally administered in a veterinarian’s office.  It lasts
between one to six weeks, with an average effectiveness of three to five weeks. It is an option that can be used
in lieu of steroid pills and liquids for hard to medicate cats.

Depo-Medrol is usually more of a short-term steroid solution than the others discussed in this article.
For reasons that are still unclear, this medication often stops working after several months. Additionally, there
can be an increased risk of side effects such as diabetes when it is used long-term. Most veterinarians today
prefer to use oral forms of short-acting steroids (prednisolone or budesonide) so they can easily change the
dosage as needed to moderate drug effectiveness and adverse reactions.

Atopica (Cyclosporine)
Cyclosporine is an immunosuppressant that works by blocking white blood cells from organizing and responding
to infection or invasion. Atopica is an oral form of cyclosporine that has been modified for better absorption in the
intestinal tract. It is typically used to control feline allergic dermatitis and other immune-system based skin
conditions in cats. However, it has also been used successfully in the management of Feline IBD. And like
budesonide, it is less likely to cause systemic side effects.

The usual dosage of Atopica for cats varies from 2.27 to 5.45 mg. per pound per day. The medication is typically
given once per day for 4-6 weeks and then may be tapered to every other day or twice weekly as needed to
maintain the therapeutic effect. Atopica is best given on an empty stomach (either one hour before or two hours
after a meal) to help facilitate absorption. Generic cyclosporine should be avoided, as its bioavailability has not
been tested in dogs or cats.

While Atopica can be effective in treating Feline IBD, there are several cautions for pet owners to be aware of.
This medication may increase the risk of infections, including toxoplasmosis, so it is recommended that cats on
this drug be kept indoors and not be fed a raw diet. Atopica should not be used in cats with liver disease, as it is
removed from the body by the liver and places additional stress on that organ. It is also best avoided in cats with
a history of cancer. As stated in the product insert from the manufacturer, prolonged use of Atopica may increase
susceptibility to the development of tumors, including lymphoma, due to the suppression of the immune system.   

Side Effects of Steroids
You may have taken steroids yourself for a medical condition or know someone else who has. If so, you may be
worried about the potential side effects of these drugs, including weight gain, water retention, and mood
changes. While side effects can occur in cats that are given steroids, especially for long periods of time, the
incidence of these problems is lower than what is seen in either humans or dogs. That said there are issues that
may arise in some cats.

Both short-term and long-term side effects can occur with steroid usage. Some of the possible short-term side
effects include:
•  Increased hunger
•  Increased thirst and urination
•  Loss of energy
•  Behavior changes
•  Development or worsening of infections (especially of the skin)
•  Vomiting or nausea (less common)
•  Occasionally personality changes (steroids can change behavior, but this is a relatively rare side effect).

The increased hunger that may be seen in cats taking steroids is often welcomed by their owners, as cats with
IBD often eat less than they used to. This is especially helpful when working to change to a novel protein diet or
to higher quality food sources (e.g. from dry food to canned, or to a raw food diet or home-cooked diet).
However, this side effect is not seen in all cats and may also be temporary. In addition, some cats may have a
reduced appetite when taking steroids, but this is less commonly seen.

The other short-term side effects are things to watch out for and to share with your veterinarian if noticed. If the
side effects are unmanageable, the steroid dosage may need to be adjusted or an alternate steroid or another
drug may need to be used.

When steroids are used for more than three or four months, particularly at higher doses, additional side effects
may be encountered. The most commonly seen long-term side effects include:
•  Urinary tract infections  (UTI – occurs in up to 30% of patients)
•  Development of thin skin, blackheads, hard plaque spots on the skin (calcinosis cutis), or a poor or thin coat
•  Poor wound healing ability
•  Obesity (due to increased hunger)
•  Muscle weakness
•  Susceptibility to infections
•  Changes in liver function
•  Predisposition to diabetes and Cushing’s disease
To reduce the risk of any of the above side effects, it’s best to avoid using steroids on a daily basis. Steroids are
present in the body about thirty-six hours after administration, so if the steroid is given daily, some of the
previous day’s dose is still present. Most steroid protocols require daily use only during the initial treatment
phase and then the dosage is often dropped down to every other day.

Other Important Things to Know
Since the cat’s adrenal glands function primarily in the morning hours, it’s best to give steroid medications in the
evening, as the dose will begin to wear off as the adrenal glands are ready to kick in. The preferred way to give
steroids on a long-term basis is to administer them every other evening. It’s important not to abruptly discontinue
steroid usage, as this can cause serious or life-threatening consequences. The dose must be tapered under the
supervision of your veterinarian.

References:
1.   Inflammatory Bowel Disease in Cats – VCA Animal Hospitals
2.   
Feline Inflammatory Bowel Disease – Max’s House
3.   
Steroid Treatment – Long-Term Effects in Cats – VCA Animal Hospitals
4.   
Prednisone and Other Corticosteroids – The Mayo Clinic
5.   
Prednisolone for Veterinary Use – Wedgewood Pharmacy
6.   
Prednisolone and Prednisone for Dogs and Cats – Wedgewood Pharmacy
7.   
Budesonide (Entocort EC, Entocord) – The Pet Pharmacy
8.   
Wedgewood Pharmacy (general reference for medication formats)
9.   
Corticosteroids – Peteducation.com
10.
A Guide to Depo Medrol for Dogs and Cats - The Anti-Inflammatory – Pet Care Rx
11.
Bioavailability and Activity of Prednisone and Prednisolone in the Feline Patient – Veterinary Dermatology
12.
Cyclosporine – The Pet Pharmacy
13.
Atopica for Cats – Official Product Site (Novartis)
14.
Atopica Use in Cats - eHow
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