Weaning off of Prednisolone experiences?

[GrumptyDumpty]

Hello, first time poster here, but I have lurked and poured over all of your responses for many months now. Thank you all for creating such an awesome community that I hope to be able to contribute to.

I am here for my cat Boogie who was diagnosed with IBD/Triaditis in September. After an intense couple months thinking we were going to lose him, we got things under control with the help of prednisolone (steroid), gabapentin (for pain), cerenia (for nausea) and cyproheptadine (for appetite), ursodiol (for liver/bile duct health). He is still on the pred, gabapentin and ursodiol. All others were slowly weaned off watching for any decreases in appetite. We have been weaning the prednisolone very slowly as well. This has been his taper schedule, as directed by his vet.

10/20/22 - started on 5 mg prednisolone daily
11/20/22 - started on 2.5 mg prednisolone daily
12/20/22 - started on 2.5 mg prednisolone every other day

All of this was well tolerated, but today I'm noticing he's kind of a duller version of himself, not as interested in food (but still eating). He just is starting to remind me of the way he was acting when sicker. I want to act quickly on this so he doesn't progress to a full blown IBD flare-up. I read through old posts and found that others have struggled when reducing to every other day dosing. My vet is going to call me tomorrow AM but I just wanted to see in the meantime what has worked for others. My questions are:

1. When your cat started showing symptoms again, did you immediately restart the steroids back at the prior dose?
2. Did restarting the prior dose help get them back on track, or did they suffer a full blown flare-up of symptoms?
3. Did your vet recommend continuing the taper but adding back in supportive meds (cerenia, odansetron, pepsid, cyproheptadine, etc?)

Any other insights or stories of how your cat was affected and what you did to fix it would be much appreciated. Thanks everyone. Also here is a picture of him below, he is the love of my life!

 

[neely]

Welcome to TCS! I'm glad you decided to join the site after lurking and reading some of the threads on here. Although I have not had any personal experience with IBD I have used prednisolone for our present cat who had several flare ups of Pancreatitis. Since you have been weaning your cat off Pred. I would not recommend restarting it without talking to your vet first. I'm sure other members who have cats with IBD will be able to weigh in with their knowledge and support. artiemom daftcat75 S silent meowlook
Best of luck and please keep us posted on Boogie's progress.

 

[GrumptyDumpty]

Welcome to TCS! I'm glad you decided to join the site after lurking and reading some of the threads on here. Although I have not had any personal experience with IBD I have used prednisolone for our present cat who had several flare ups of Pancreatitis. Since you have been weaning your cat off Pred. I would not recommend restarting it without talking to your vet first. I'm sure other members who have cats with IBD will be able to weigh in with their knowledge and support. artiemom daftcat75 S silent meowlook
Best of luck and please keep us posted on Boogie's progress.

Thanks for responding so quickly and for the warm welcome! I definitely am not going to do anything without my vet's direction. Luckily I have an incredible vet and have spent countless hours on the phone with her trouble-shooting his case. I came here mostly to see what has worked well for others and to compare notes. I'm sorry to hear your kitty had to deal with pancreatitis. Such a painful and awful condition. Were you able to successfully wean your cat off of Pred?

 

[neely]

Were you able to successfully wean your cat off of Pred?

Yes, with the help of our vet who sounds a lot like your vet, i.e. incredible and very knowledgeable.

 

[daftcat75]

I don't make (and wouldn't recommend) any pred dosing changes without the input and blessing of the vet.

I have not been able to wean Betty past 2.5 mg once a day. This was by choice because she has needed a dental since I adopted her in January. We got her weaned twice and her appetite took a hit. It has since recovered. I mean it's not going to be anything like it was at higher doses of pred. And I'm okay with that.

Every cat is different and every IBD cat is different. What Betty has proven to me time and again is that her case is not anything like Krista's case before her.

What has helped Betty:

1. Unless you have confirmed via endoscopy that Boogie has an ulcer, I would toss Pepcid from your medicine cabinet. It's bad news for his digestion and gut flora. So much of IBD comes down to gut flora. Neutralizing stomach acid also eliminates the first line of defense against pathogenic bacteria (the bad guys like salmonella, e. coli, and clostridium.)

2. Twice daily (1/4 capsule each) saccharomyces boulardii with MOS can help immensely at reducing pathogenic strains while also soothing and healing the gut lining. Going to twice daily s. boulardii (specifically the Jarrow brand which contains MOS) had a noticeable improvement on Betty's appetite.
https://www.amazon.com/dp/B0056GCLVO/?tag=thecatsite

3. I also give Betty an FMT pill from AnimalBiome once a day. It's like probiotics on steroids (forgive the expression.) Rather than being just a few helpful strains, it contains the entire microbiome from carefully screened healthy donor cats.
The Cat Gut Microbiome

4. In the preflight instructions for a dental appointment that got canceled at the last minute, Betty got gabapentin and became a bag of Jello. But when I got the cancelation call from the doc, I plated her breakfast and she tore into it like she hasn't since we were back on the higher doses of pred. It seems in Betty's case, she has some pain, likely dental pain given what we've seen of her teeth. Twice daily gabapentin at 25 mg seems to have her eating well again without sedating her.

Betty takes her own meds by packing any pills into capsules, dipping those capsules in Hills A/D, and dropping them on the carpet for her. Fortunately, Betty is still able to eat Hills A/D. But she also only ever gets it for taking meds (or the very rare case where she goes completely off her regular food.)


I purchase size five capsules for her pred and ondansetron. For her s. boulardii and gabapentin, I use size four capsules (a bit larger but still very much cat-sized.) I also use a capsule filling machine I purchased from Etsy for $30. I wish I could link to it here. But every time I have tried, the redirects don't resolve. Instead, simply search for the MYHERBAR seller. Once a week, I split four gabapentin capsules four ways each (sixteen capsules) and once a month I split about a dozen human-sized Jarrow capsules into 50 cat-sized capsules. Both of these are so much easier with the capsule filling machine. Once a week, I cut her pred and ondansetron and pack pink (for pred plus ondansetron) and orange (for ondansetron only) capsules for the week. I spend about 30 minutes every Sunday morning making up her capsules for the next week. The SB capsules only take an additional 30 minutes.

 

[silent meowlook]

Hi. I didn't have time to read all the replies. I am sorry your cat isn't feeling well.
With a complicated case like this, it is always best to be under the care of a Veterinary Specialist in Internal Medicine. You may already, and if so, that is great.

My cat has suspected GI Lymphoma, after having had IBD for years. She is currently taking:
Prednisolone 5mg eod,
Chlorambucil 2 mg. eod,
Cerenia 6 mg. eod at least one hour prior to Chlorambucil,
Subcutaneous fluids Lactated Ringers 50 to 100 mls. SQ every other day to every day as needed.
Vitamin B12 injection 0.5cc under the skin with fluids once a week.
Famotadine injectable 2 mg. under the skin as needed for acid reflux. (I have not had to use this in months.)
Visbiome probiotic 1 capsule daily (I often don't give this)
Forte-Flora probiotic sprinkled on food to entice to eat.
Ondansetron 4mg under the skin or in the muscle as needed for breakthrough nausea (Haven't used this in a year)
Mirtazapine 3 mg as needed for appetite stimulant (Have not yet used this)
Buprenorphine as needed for pain. (Have not had to use this in over a year)
Methimazole 1.25mg twice daily (for hyperthyroidism)
Albuterol inhaler (for asthma)
She eats the Royal Canin Rabbit limited antigen diet canned only


To answer your questions:

It took me almost 6 months to get Cheetah (my cat) down from Prednisolone 10 mg. a day to 5mg. a day. I would try and she would look worse, so I would up the dose again. Of course I talked to her Veterinarian (who I worked with, so easy access) . I have finally got her down to 5 mg. eod. It took a while to do this and sometimes I have to increase it back to daily.

Cheetah never really suffered a full-blown relapse, but I am able to treat at the first sign of a problem. It is a very individual thing, so what works for one cat may not be the same for another.

There is nothing wrong with a cat being on Prednisolone if that is what it takes for them to feel ok. Cats generally tolerate low doses quite well.

How was your cat diagnosed? Did they do ultrasound? Biopsies?
Is your cat vomiting now?

Talk to your vet and see what they think you should do. You might want to ask about a supplement for the liver such as Same-E.

Your cat, Boogie is adorable. I hope he feels better soon.

I have copied a link below to some information you might find useful.

Triaditis in Cats – A Common Syndrome in Our Feline Friends (criticalcaredvm.com)

spec-fpl-treatment-for-feline-pancreatitis.pdf (idexx.com)

 

[artiemom]

So sorry it has taken me this long to reply. I am sick with the RSV triggering asthma attacks.. If I come across short, abrupt, and not fully answering your questions, I apologize. I am still not physically well.

yes, 2 babies with IBD.. one which morphed into SCL, current guy. My last guy, it appeared the IBD morphed into megacolon. I guess you could say, I have a bit of experience with stuff..

I did use prednisone on Artie.. I used it at full dose for several years. His reaction was patchy fur loss.
With Geoffrey, IBD/SCL, He began on Prednisolone, had some rations to it. I asked to change over to Budenisonide. It seems to be better for his system.
The pred reactions were very lethargic, hiding, not himself, poor appetite.
With the budesonide, he is not lethargic, not hiding, it is better for him. I do see patchy fur loss from the steroid.

As far as tapering down.. well, the IMVEt wants me to. I tried 3 times, to no avail Each time I tried, Geoffrey would vomit.. It was as if his IBD was reoccurring. Since vomiting was the only symptom we have for his SCL.. I am refusing to cut back on his dose. He still takes a small dose of it twice a day. It has all been trial and error.

You could try using a probiotic added to his food-- It seems to help with gut issues; especially diarrhea. I have used Proviable Forte (prescription).. and for bad diarrhea, added in S. Boulardi.

For decreased appetite, I used the oral mirtazapine for Geoffrey. It did help his appetite, but reactions were constant pacing, meowing, and the effects lasted days..

With Geoffrey, because of the chemo, I am giving him Mirataz. It is an ointment which I put on his ear flaps; alternating ears each night. With this; again, through trial and error, we have decreased the dose down to 1/2 to just a dab..

I am fortunate that I have a fairly good relationship with my IMVet. He trusted me with Artie's care.. Now, after all the trial and error, he trusts me with Geoffrey's care. It was a lot to go through, but I think we are on a good mix of drugs, and I am refusing to change anything up. Three times trying to eliminate mirataz and the budesonide, and I put my food down. The IM Vet agrees.

The IMVEt expressed decreasing doses of meds very slowly, over a couple of weeks. When I began seeing changes to Geoffrey's behavior-- emotional, physically, mostly vomiting and poor appetite, I went back to the original doses. I immediately saw the markedly improved difference.

From what I understand, every cat and their owners are undergoing different experiences. There are so many things to try, each case if different.. It is a lot of hard work.. time and emotionally all consuming.

I am glad you have a good vet, one you can trust. That is major.

I guess, from your original question--sorry fuzzy brain from ack of sleep, prolonged asthma attack, RSV..
I think you could be seeing some side lethargy as side effects of the prednisolone. I saw that with Geoffrey. I researched, and thought it could be from the pred. I asked for the budesonide, to try out. It seems to agree with Geoffrey so much better.. Something to think about, and discuss with your vet.

I wish you luck with your baby.. and thank your for reading this rambling message. I have not been posting because of brain fog, from lack of sleep, and all the inhalers..
((hugs)))

 

[GrumptyDumpty]

I don't make (and wouldn't recommend) any pred dosing changes without the input and blessing of the vet.

I have not been able to wean Betty past 2.5 mg once a day. This was by choice because she has needed a dental since I adopted her in January. We got her weaned twice and her appetite took a hit. It has since recovered. I mean it's not going to be anything like it was at higher doses of pred. And I'm okay with that.

Every cat is different and every IBD cat is different. What Betty has proven to me time and again is that her case is not anything like Krista's case before her.

What has helped Betty:

1. Unless you have confirmed via endoscopy that Boogie has an ulcer, I would toss Pepcid from your medicine cabinet. It's bad news for his digestion and gut flora. So much of IBD comes down to gut flora. Neutralizing stomach acid also eliminates the first line of defense against pathogenic bacteria (the bad guys like salmonella, e. coli, and clostridium.)

2. Twice daily (1/4 capsule each) saccharomyces boulardii with MOS can help immensely at reducing pathogenic strains while also soothing and healing the gut lining. Going to twice daily s. boulardii (specifically the Jarrow brand which contains MOS) had a noticeable improvement on Betty's appetite.
https://www.amazon.com/dp/B0056GCLVO/?tag=thecatsite

3. I also give Betty an FMT pill from AnimalBiome once a day. It's like probiotics on steroids (forgive the expression.) Rather than being just a few helpful strains, it contains the entire microbiome from carefully screened healthy donor cats.
The Cat Gut Microbiome

4. In the preflight instructions for a dental appointment that got canceled at the last minute, Betty got gabapentin and became a bag of Jello. But when I got the cancelation call from the doc, I plated her breakfast and she tore into it like she hasn't since we were back on the higher doses of pred. It seems in Betty's case, she has some pain, likely dental pain given what we've seen of her teeth. Twice daily gabapentin at 25 mg seems to have her eating well again without sedating her.

Betty takes her own meds by packing any pills into capsules, dipping those capsules in Hills A/D, and dropping them on the carpet for her. Fortunately, Betty is still able to eat Hills A/D. But she also only ever gets it for taking meds (or the very rare case where she goes completely off her regular food.)


I purchase size five capsules for her pred and ondansetron. For her s. boulardii and gabapentin, I use size four capsules (a bit larger but still very much cat-sized.) I also use a capsule filling machine I purchased from Etsy for $30. I wish I could link to it here. But every time I have tried, the redirects don't resolve. Instead, simply search for the MYHERBAR seller. Once a week, I split four gabapentin capsules four ways each (sixteen capsules) and once a month I split about a dozen human-sized Jarrow capsules into 50 cat-sized capsules. Both of these are so much easier with the capsule filling machine. Once a week, I cut her pred and ondansetron and pack pink (for pred plus ondansetron) and orange (for ondansetron only) capsules for the week. I spend about 30 minutes every Sunday morning making up her capsules for the next week. The SB capsules only take an additional 30 minutes.

You are AMAZING. You've given me many things to look into, especially the supplements. And the tip for getting them to take pills with A/D and a carpet is life changing. I'm going to share that video with every cat mom I know. Thanks so so much for this detailed and informative reply.

 

[GrumptyDumpty]

Hi. I didn't have time to read all the replies. I am sorry your cat isn't feeling well.
With a complicated case like this, it is always best to be under the care of a Veterinary Specialist in Internal Medicine. You may already, and if so, that is great.

My cat has suspected GI Lymphoma, after having had IBD for years. She is currently taking:
Prednisolone 5mg eod,
Chlorambucil 2 mg. eod,
Cerenia 6 mg. eod at least one hour prior to Chlorambucil,
Subcutaneous fluids Lactated Ringers 50 to 100 mls. SQ every other day to every day as needed.
Vitamin B12 injection 0.5cc under the skin with fluids once a week.
Famotadine injectable 2 mg. under the skin as needed for acid reflux. (I have not had to use this in months.)
Visbiome probiotic 1 capsule daily (I often don't give this)
Forte-Flora probiotic sprinkled on food to entice to eat.
Ondansetron 4mg under the skin or in the muscle as needed for breakthrough nausea (Haven't used this in a year)
Mirtazapine 3 mg as needed for appetite stimulant (Have not yet used this)
Buprenorphine as needed for pain. (Have not had to use this in over a year)
Methimazole 1.25mg twice daily (for hyperthyroidism)
Albuterol inhaler (for asthma)
She eats the Royal Canin Rabbit limited antigen diet canned only


To answer your questions:

It took me almost 6 months to get Cheetah (my cat) down from Prednisolone 10 mg. a day to 5mg. a day. I would try and she would look worse, so I would up the dose again. Of course I talked to her Veterinarian (who I worked with, so easy access) . I have finally got her down to 5 mg. eod. It took a while to do this and sometimes I have to increase it back to daily.

Cheetah never really suffered a full-blown relapse, but I am able to treat at the first sign of a problem. It is a very individual thing, so what works for one cat may not be the same for another.

There is nothing wrong with a cat being on Prednisolone if that is what it takes for them to feel ok. Cats generally tolerate low doses quite well.

How was your cat diagnosed? Did they do ultrasound? Biopsies?
Is your cat vomiting now?

Talk to your vet and see what they think you should do. You might want to ask about a supplement for the liver such as Same-E.

Your cat, Boogie is adorable. I hope he feels better soon.

I have copied a link below to some information you might find useful.

Triaditis in Cats – A Common Syndrome in Our Feline Friends (criticalcaredvm.com)

spec-fpl-treatment-for-feline-pancreatitis.pdf (idexx.com)

Thank you for this awesome reply. Boogie was diagnosed via ultrasound back in September. After a month of hell and trying to get his medications right, he's been doing really well ever since. I think that's why I freaked out when he started showing symptoms after the steroid wean. You've given me some good ideas when reviewing your regimen and am very grateful that you shared all this info with me.

 

[GrumptyDumpty]

So sorry it has taken me this long to reply. I am sick with the RSV triggering asthma attacks.. If I come across short, abrupt, and not fully answering your questions, I apologize. I am still not physically well.

yes, 2 babies with IBD.. one which morphed into SCL, current guy. My last guy, it appeared the IBD morphed into megacolon. I guess you could say, I have a bit of experience with stuff..

I did use prednisone on Artie.. I used it at full dose for several years. His reaction was patchy fur loss.
With Geoffrey, IBD/SCL, He began on Prednisolone, had some rations to it. I asked to change over to Budenisonide. It seems to be better for his system.
The pred reactions were very lethargic, hiding, not himself, poor appetite.
With the budesonide, he is not lethargic, not hiding, it is better for him. I do see patchy fur loss from the steroid.

As far as tapering down.. well, the IMVEt wants me to. I tried 3 times, to no avail Each time I tried, Geoffrey would vomit.. It was as if his IBD was reoccurring. Since vomiting was the only symptom we have for his SCL.. I am refusing to cut back on his dose. He still takes a small dose of it twice a day. It has all been trial and error.

You could try using a probiotic added to his food-- It seems to help with gut issues; especially diarrhea. I have used Proviable Forte (prescription).. and for bad diarrhea, added in S. Boulardi.

For decreased appetite, I used the oral mirtazapine for Geoffrey. It did help his appetite, but reactions were constant pacing, meowing, and the effects lasted days..

With Geoffrey, because of the chemo, I am giving him Mirataz. It is an ointment which I put on his ear flaps; alternating ears each night. With this; again, through trial and error, we have decreased the dose down to 1/2 to just a dab..

I am fortunate that I have a fairly good relationship with my IMVet. He trusted me with Artie's care.. Now, after all the trial and error, he trusts me with Geoffrey's care. It was a lot to go through, but I think we are on a good mix of drugs, and I am refusing to change anything up. Three times trying to eliminate mirataz and the budesonide, and I put my food down. The IM Vet agrees.

The IMVEt expressed decreasing doses of meds very slowly, over a couple of weeks. When I began seeing changes to Geoffrey's behavior-- emotional, physically, mostly vomiting and poor appetite, I went back to the original doses. I immediately saw the markedly improved difference.

From what I understand, every cat and their owners are undergoing different experiences. There are so many things to try, each case if different.. It is a lot of hard work.. time and emotionally all consuming.

I am glad you have a good vet, one you can trust. That is major.

I guess, from your original question--sorry fuzzy brain from ack of sleep, prolonged asthma attack, RSV..
I think you could be seeing some side lethargy as side effects of the prednisolone. I saw that with Geoffrey. I researched, and thought it could be from the pred. I asked for the budesonide, to try out. It seems to agree with Geoffrey so much better.. Something to think about, and discuss with your vet.

I wish you luck with your baby.. and thank your for reading this rambling message. I have not been posting because of brain fog, from lack of sleep, and all the inhalers..
((hugs)))

I'm so happy to hear about your experience with budesonide! The plan is to switch him over eventually...but first he needs I131 radioactive iodine treatment (that is a whole other story!) and we were afraid to rock the boat too much before he had to be in the care of an animal hospital since the nurses need to have minimal contact with him during his stay. After he recovers though, the plan will be to switch him to budesonide. I heard that can be a rocky transition from pred so I'm happy to hear Geoffrey does well on it. Thank you for your detailed response and I hope you are feeling much better yourself!

 

[GrumptyDumpty]

BOOGIE UPDATE: He is doing SO much better than when I first posted. I spoke to the vet the next day and she advised me to start him back up on the 2.5 mg daily pred. He bounced back in less than 24 hours with no major flare up, and is now eating like a little piggy. I just gave him 2 doses of Cerenia (4 mg daily) to help him through, and he is off of that now. The plan will be to keep him on 2.5 mg Pred and try budesonide after he recovers from his scheduled I131 radioactive iodine procedure for his hyperthyroidism. That is a whole other issue! On top of all this triaditis business, he is allergic to methimazole and started rejecting Y/D when he was sick! Now there is a worldwide shortage of Y/D so while his kidneys are still good I want to get him treated with I131. Scary to have to leave him isolated after I've been watching him like a hawk for the past 4 months, but I think it will be worth it in the end for his health and quality of life.

Thank you all for your concern and replies, you gave me lots of food for thought and things to try with my little man. I am so grateful!

 

[neely]

while his kidneys are still good I want to get him treated with I131. Scary to have to leave him isolated after I've been watching him like a hawk for the past 4 months, but I think it will be worth it in the end for his health and quality of life.

Thanks for the update especially the good news about Boogie bouncing back and eating like a champ. Regarding the I-131 radioactive iodine treatment we went through that a year ago at this time. Yes, it's frightening to think of leaving him for up to five days at a veterinary specialty hospital but they will monitor him closely and call with updates. Plus you can check in frequently. The way I got through it was to tell myself a year from now I'll look back and the time will seem to fly by - a year later that's exactly what happened. While he's still a good candidate for the procedure it's wise to go through all the preliminary testing and schedule it now. When the time comes if you have any questions or concerns please feel free to ask us.

 

[GrumptyDumpty]

The way I got through it was to tell myself a year from now I'll look back and the time will seem to fly by - a year later that's exactly what happened.

I needed to hear this! Thank you