Should My Itchy Dog Get Prednisolone?

Updated November 28, 2020

If you have an itchy dog, then you know how hard it can be. What would you say then if you were told that one of the most effective treatments is sometimes not offered to you? Or that other times it should never have been used.

Prednisolone is a problematic drug, and I understand why vets avoid it, but sometimes it’s just what’s needed. Amber, who’s pictured above is a perfect example.

Amber’s Story

Atopic dog pattern

Like many Labradors, Amber suffers from the common skin allergy of dogs we call atopic dermatitis. You can read about it here but her symptoms were a classic example:

  • Repeated ear infections
  • Dermatitis and licking in the paws
  • Scratching at the body and face

When I first met her, she was a distressing case. At no time during her first exam did she stop either scratching her muzzle and ears, or biting her feet. It was incredibly difficult to concentrate and come up with any plan.

Fortunately I had already read her previous history. It was a litany of frequent visits to the vet. For example, at one point it said “owner has a constant battle with the ears”. To the owner’s credit, she kept it up when many others would have given up or run out of money.

Once you stop fighting, the ears suffer permanent damage and you’re heading for ’end stage’ ears, constant pain and total ear canal ablation.

Amber’s Treatment

Amber’s problem was continuous, and she needed a continuous solution. At the first visit, I treated her secondary ear and skin infections, with a promise of a longer term approach once they were fixed.

Apart from a vomiting episode that we put down to the antibiotics, everything went like a dream.

At the second visit, she was improving well. We discussed the treatment options, and the owner elected to use prednisolone. At the third visit, she was back to playing at home, and only scratching two or three times a day.

I saw her the other day for a routine check. It’s now 12 months and she’s never needed to see a vet for her skin since.

When To Use Prednisolone

Prednisolone is certainly not a wonder drug. I’ve deliberately chosen a perfect example to show you what it can do, but Amber’s not typical.

Prednisolone has significant side effects that you can read about here. For probably two thirds of dogs that we try it on, we can never get the dose low enough to make these acceptably mild.

For other dogs, the prednisolone never works well enough. It’s important to point out that Amber’s owner also started five important dose-sparing strategies at the same time:

  • Medicated shampoo
  • Skin support diet
  • Top shelf parasite control
  • Ear flushing
  • Topical cortisone on flare ups

Without these the required dose would have been too high. But even with them it stays too high for most dogs.

Dog Skin Allergy Drug Choices

medication choice factors

Prednisolone is one of at least four long-term, systemic medications for atopic dermatitis. How do you choose? Have a look at my dodgy diagram.

For Amber, prednisolone nicely ticks all three requirements off. However, most other drugs can be placed somewhere in the triangle. Where they go depends on the drug, the patient and the vet.

There is usually a trade-off between price, safety and efficacy. I’ll make some general comments about each of the four. You can read more by following the links.

Cytopoint is clearly the safest option, and probably the most effective. However, as a monthly injection, it’s also the most expensive.

Apoquel is usually cheaper but also expensive. We see side effects in a few dogs, and it doesn’t always work quite as well. However it’s still an excellent drug.

Atopica is not a common choice any more as it’s about the same cost, but seems to have more side effects. However, it still has a place on occasions.

Prednisolone is very cheap, but has lower efficacy and very low safety.

How Long Can A Dog Stay On Prednisone?

Whether a dog can stay on prednisolone depends on the response over time. All dogs need close monitoring, and six-monthly blood testing is ideal.

Reasons for stopping prednisolone include worsening side effects, worsening skin disease (especially in young adults) or failure of the owner to attend follow up appointments.

For the lucky few like Amber, there’s no reason to think that she won’t be on it for life. Prednisolone is badly flawed, but dogs like her show why it should always be among our options.

In the end it’s all about quality of life.

Have something to add? Comments are welcome below and will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These articles are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story!

Andrew

10 Replies to “Should My Itchy Dog Get Prednisolone?”

  1. How much is it for prednisone tablets as my staffie dog blade keeps on scratching himself and the vets wants far too money for the tablets now he’s starting to cut himself with scratching can u help with this plz

    1. Hi Amanda. Prednisolone is one of the cheapest drugs prescribed by veterinarians and a prescription might only cost $20 or $30. However the problem is that because of the dangers involved in its use, you will also need regular check ups.

  2. Hi Andrew,

    I read your article with interest as my 16 year old puppy suffers from itchy skin and has been prescribed Prednisolone which works well with no side effects. He used to have periodic episodes in winter but this summer seems to suffer more often. I was under the impression this was something that was used until the itching stopped, but it’s only a short time before he is back to nibbling at his skin again.

    Am I better off leaving him on the lowest dose continually rather than stopping only needing to restart another course a couple of weeks later?

    Thanks, Dianne

    1. Hi Diane. That’s a good question. The answer depends on how much you need to give to get him back under control. Often it is better to keep a dog on a low steady every other day dose if it stops flare ups, as these need higher doses to control.

  3. Hi Andrew,
    My dog is currently on Prednisolone for Atopic Dermatitis. It had been working really well until we reduced the dose to every 2nd day as per vet’s dosage instructions. Now our dog is back to continual linking and scratching.
    Wondering what options we now have to help him.
    I have been reading about Cytopoint, but have read some reviews that it can cause aggression in some dogs. Can you please advise?
    Many thanks

    1. Hi Amanda. It’s not a great idea to use prednisolone on an every day basis, but I do know some dogs who seem to be just fine if that’s the best you can do. After all, comfort is the most important thing. As for Cytopoint, it’s a monoclonal antibody, so some of the suggested links with illnesses don’t really make a lot of sense.

  4. Hi Andrew,

    Are you saying that certain dogs can handle Prednisolone safely for the rest of their lives? I’ve found that my dog is really responsive to low dose Pred for itchy skin, but have always considered it only for short term usage. Cheers

    1. Hi Ben. Yes that is true – tolerance to prednisolone varies a lot between dogs but some (including the one linked from this article) can handle it extremely well. I estimate around 30% of dogs can be free of visible effects with lifelong use at the lowest effective dose.

      1. Thanks Andrew. My dog was in a short course of oral pred for another issue but found he had immediate relief from his chronic itchy muzzle.
        To see him at ease is a relief for both him and me. Have been leaning towards trialling Cytopoint, but nice to know that Prednisolone may be another option and he seems initially to handle it quite well.

  5. Thank you for such a balanced article. I have had to resort to prednisalone for my two dogs and have worried so much about it and have had negative comments from so many. I ffeel a little easier now. Thank you.

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