Zycortal Symposium Proceedings

How are glucocorticoids being supplemented when using Zycortal (DOCP) for mineralocorticoid supplementation? Prednisolone appeared to be the most commonly used drug for glucocorticoid supplementation. Cortisone was mentioned as an alternative, as it allowed smaller doses to be given accurately. However this drug is expensive and requires an import license, meaning it is rarely used. An alternative for patients requiring a particularly small dose is a paediatric preparation (prednisolone 10 mg/ml; Focus Pharmaceuticals Ltd.) of prednisolone which is available in a liquid form. This drug can be used under the cascade when tablet sizes of prednisolone become limiting. The most commonly used starting dose of prednisolone was 0.2 mg/kg, however dose increases seem to be very rarely required long term and most patients seem to require a dose reduction. It was discussed that the dose of prednisolone is extremely variable, even within breeds. Therefore it is important to consider each patient individually when adjusting prednisolone doses. It was noted that dogs diagnosed at a young age require higher doses of prednisolone, which are then later reduced. The need for an increased dose of prednisolone was also discussed at length and opinions on this subject were extremely variable. It was agreed that the glucocorticoid requirements were increased during times of metabolic stress. However there was a difference in opinion regarding when a dose increase should be considered. Some specialists recommended a dose increase at any time of potential emotional or metabolic stress, including: kennelling, a trip to the vets, firework season, concurrent illness or surgery. Alternatively, other specialists recommended a dose increase only for metabolic stress such as illness or elective surgery. It was recommended that should a patient seem lethargic or dull following a trip to the practice, it should pre-emptively have a dose increase of prednisolone prior to any subsequent consultations. There was also variability in the amount that the prednisolone dose was increased by. It was noted that in human medicine, the dose can be increased by up to twenty times. In canine patients the dose generally seemed to be increased by two to five times. The dose increase used is subjective, with extremely sick patients having a more marked dose increase compared to patients who are anticipated to experience emotional stress.

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