Proper way to wean off prednisolone 5mg

Can anyone please give me any suggestions or opinions on properly weaning my 6 lb cat off of Prednisolone? He is currently on a dose of 5 mg a day tablet and he's been on it for roughly 3 weeks .

Christian

camry75 said:

Can anyone please give me any suggestions or opinions on properly weaning my 6 lb cat off of Prednisolone? He is currently on a dose of 5 mg a day tablet and he's been on it for roughly 3 weeks .

Christian

Click to expand...

It's difficult if not impossible to answer that question properly (if we even can) without knowing why he is on it in the first place (diagnosis?) and why you want to wean him off it.  And what does your vet say about weaning him?

He was prescribed it by the vet because he thinks he might have IBD . He prescribed a mg tablet of Prednisolone and also gave me a prescription for Flagyl . I want to wean him off because I want to treat him using a holistic approach . I have not talked to my vet yet about weaning him off, so I'm just asking for opinions

One of my cats is on Prednisolone for IBD as well, and it has helped him tremendously.  I understand the concerns over using Pred long-term, though.  

I would talk with your vet about titrating your cat off the Pred safely.  Your vet is really the person who can give you the best advice regarding this situation as I am not a vet and would never want to give you advice that could potentially harm your baby. 

OK thanks for the reply. How should I tell my vet I want to wean him off it? Will he understand because right now the dose of 5 mg isn't doing anything ?

Christian

camry75 said:

He was prescribed it by the vet because he thinks he might have IBD . He prescribed a mg tablet of Prednisolone and also gave me a prescription for Flagyl . I want to wean him off because I want to treat him using a holistic approach . I have not talked to my vet yet about weaning him off, so I'm just asking for opinions

Click to expand...

Wow IBD is a very complicated disease, my cat ultimately died of complications from it. 

- How old is your cat?

- What are your cats symptoms?

- When did the symptoms start?

Most cats with IBD go through a progression of symptoms and treatment (there are many threads here about IBD) and one usually doesn't go to prednisolone until the disease is worse, and not being controlled by other treatments like diet, and milder drugs.  And when pred works it works quickly.  Usually a cat goes on Pred when there is in addition to either diarrhea or vomiting, weight loss that can't be controlled by other means.  When Pred works, even if GI symptoms aren't fully controlled, there is weight gain and that shows that the pred is working.

Has your cat been loosing weight in addition to GI symptoms?

- How old is your cat?


5 years only 6 lbs


- What are your cats symptoms?


Diarrhea (not leaking, he makes it to the litterbox fine, have seen a little bit of blood, and maybe just 2 times of vomiting )


- When did the symptoms start?


We started to treat him roughly 3 weeks ago, but they could have been going on longer because he was adopted from a rescue.



Most cats with IBD go through a progression of symptoms and treatment (there are many threads here about IBD) and one usually doesn't go to prednisolone until the disease is worse, and not being controlled by other treatments like diet, and milder drugs.  And when pred works it works quickly.  Usually a cat goes on Pred when there is in addition to either diarrhea or vomiting, weight loss that can't be controlled by other means.  When Pred works, even if GI symptoms aren't fully controlled, there is weight gain and that shows that the pred is working.



Has your cat been loosing weight in addition to GI symptoms?


He has actually gained 1 pound in roughly 3 weeks, but that may be due to a change in diet.  Before he was on dry chicken Purina Cat Chow (not sure how long) to now, and since we've got him no more dry, to just canned Nature's Variety Instinct Rabbit (1/2 in morning, 1/2 at night). 


The vet did an ultrasound and diagnosed IBD, affecting his small intestines.  He also did blood work and didn’t see anything serious.  He said his organs a very small, but look normal.  He wanted his condition improved by diet to put him on a novel protein (no poultry) and also prescribed Prednisolone 5 mg tablet (I originally thought more than this, whew!!) once a day and liquid Flagyl twice a day and to let him know if there has been any improvement.   He also recommended their Science Hill food, which I declined.

I just feel he prescribed Prednisolone too quickly. Do you feel this way?

You've raised an interesting and quite complex question. I can't answer it at this very second but I will respond at my first opportunity a bit later today. Where are you located? Currently it's 11:30Am my time.

Also, you say he gained a pound. But you can't tell if there was weight loss prior due to his history correct? Did the shelter weigh him? This could be important info if they did several weighs.

Correct he has gained 1 pound from  5 - 6 lbs in this last 3 weeks.  Don't know if it is the Prednisolone 5 mg or just diet change or even both.   He's got a pretty good appetite but not sure how it was before now. I got more information and looks like he had been steadily around 4-5 lbs before I got him.

I am in Michigan so it's the same time as you in the EST.

camry75 said:

I just feel he prescribed Prednisolone too quickly. Do you feel this way?

Click to expand...

In answer to your question; possibly, but as i said its complex.  Read on and then let me know what you think.

Ok so let's see where i can go with this.  First an ultrasound will not produce a definitive diagnosis of IBD, although it can go a long way along with symptoms to making a reasonable diagnosis.  What it can't distinguish between is IBD and SCL (small cell lymphoma). The only way to get a definitive diagnosis is either by a full thickness intestinal biopsy or endoscopy depending on where the ultrasound shows the most thickening.  Even then it isn't always 100%. Mind you, most people when they go the biopsy route are looking at a progression of the disease, due to uncontrolled weight loss, that might mean IBD or could mean it has morphed into the above mentioned more serious small cell lymphoma. Only biopsy (or less reliably endoscopy) can distinguish between IBD and SCL.

The reason an IBD cat is loosing weight is not lack of food, its that the intestines have lost their ability to absorb nutrients and unchecked it will eventually take the cat's life, or if it changes into SCL same prognosis but faster (unless treated).  But here is the kicker:  If you wanted to do a biopsy, and i say if because there are valid reasons to avoid it (ask me later if you need to know) you must do the biopsy when the cat is not on Prednisolone.  The pred puts the disease into remission and the biopsy will reveal nothing.  Very few people want to take the cat off pred, do the biopsy and then re-start the pred.

The order of things is important.  IBD can often be controlled for many years with a milder approach.  Novel protein diets, probiotics, B-12, Tylosin (a GI helpful antibiotic) and sometimes Metronizadole, in combination can keep the cat from loosing weight.  You may or may not fully control the diarrhea, but the most important thing is to maintain the weight.  What usually happens with serious cases is that

1) after years of trying the above, the above starts to fail and the cat starts to loose weight.  The cat is now at risk of dying (at some point) of the disease, and unchecked it can turn into SCL (small cell lymphoma) which is b.a.d.  This is when most people decide to biopsy or not to biopsy, but regardless if the weight is being lost, then Prednisolone is basically your cat's only friend at this point and stands between your cat and death.

2) Some people decide (and money counts here) to do the biopsy at this point when there is weight loss and bad ultrasounds. If the diagnosis was SCL then there are more options (basically a stronger drug called Leukeran).

3) But regardless, if there is weight loss from IBD then Pred is your cat's best hope and you can often get remission for a good length of time. 

Note that Pred is not an Anabolic steroid (associated with lots of side effects in people) its a Corticosteroid which is much different and well tolerated.  The downside to using Pred in cats with severe IBD (weight loss that can't be otherwise reversed) is much less than in dogs and humans, and basically includes a higher risk of diabetes and a somewhat suppressed immune system which in theory can lead to problems later.  The bigger problem is the problem now not the hypothetical problem later because the downside to not using Pred in this scenario is your cat's going to die, and sooner, not later.  How much weight can a six pound cat loose and still live?  Not much, and when a 6 pound cat is down to 4 pounds, all sorts of end of life things can start happening.

But back to the order of things.  It takes three weights to know if a cat is losing weight in a dangerous way. 1st: baseline. 2nd: establishes loss 3d: shows a trend, and its the trend that is very worrisome, not a single incident of weight loss.

So if my cat got a diagnosis of IBD due to diarrhea and an ultrasound without weight loss, i'd be trying ALL the things prior to Pred to gain remission.  Then and only when all those other things started to fail (and sometimes they never do) would i do the biopsy/pred or pred only route and then i would hope that we would get a lot of time.  My cat got 15 months on pred after years of it being controlled other ways.  He died at 15.

So if you haven't established weight loss as a trend, then i think it may have been premature to start the pred if you haven't tried the other things first, but i am not there, i am not your vet, and i dont have the cat in front of me.  Your question, has he gained weight due to the food or the pred is a good question, if you started them at roughly the same time its hard to tell. I would be banging down the door of the shelter to see if they have weights on your cat.

Mind you, there are OTC novel protein diets and prescription novel protein diets, and when DNA testing has been done on both, only the scrip food comes up as true novel protein as the companies producing the OTC foods use the same vats as their other foods, so that could be a problem. Remember, IBD is basically a very bad food (protein) allergy.  The Hill's food that you might have been offered was probably Z/D which is not a novel protein diet but a hydrolyzed protein diet that tricks the cat into not even seeing it as a protein.  The downside is that it can cause even worse diarrhea in cats (as it did briefly in mine).

I know this was a lot.  I hope it helps.  Please ask any follow up questions.

StephenQ:  Thank you so much.. I learned so much from your response to this question from Camry75. I am not going to hijack this thread but, thank you. I understand so much more. It has sunk in so much better than what the Vets's were telling me.

Artiemom said:

 
StephenQ:  Thank you so much.. I learned so much from your response to this question from Camry75. I am not going to hijack this thread but, thank you. I understand so much more. It has sunk in so much better than what the Vets's were telling me.

Click to expand...

Happy to help :-)

Thank you so much for the info StephenQ!
Very very helpful in understanding my situation.

Have to keep his weight up and I started a log last Saturday.

I'm going to contact the vet and see what he wants to do based on how he's doing.

camry75 said:

Thank you so much for the info StephenQ!
Very very helpful in understanding my situation.

Have to keep his weight up and I started a log last Saturday.

I'm going to contact the vet and see what he wants to do based on how he's doing.

Click to expand...

OK keep us updated.  The short version of the above is, if you can't keep his weight on without the Pred, then he needs the Pred.  If you can keep the weight on by doing everything else, then by all means, consider doing all the other things first.

If you decide with your vet to take him off the pred as an experiment it will be important to track his weight often and regularly, at least 2x a week.  If the pred is responsible for the weight gain, you will see a reversal quickly.  I highly recommend you buy a baby scale and keep a weight log.  How ever often you weigh him 9and daily is probably too much) do it on the same days each week so you not only get the trend, but you can more easily translate the trend into ounces +/- per week.  Here is an example scale:

So we dropped his Pred to 2.5 mg/day per the vet yesterday, we're going to monitor his hunger and his weight and see what happens here

camry75 said:

So we dropped his Pred to 2.5 mg/day per the vet yesterday, we're going to monitor his hunger and his weight and see what happens here

Click to expand...

Ok please keep us updated.