Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.
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Prednisone for Dog Cancer

Cortisone drugs have a bad rap.

Pharmaceuticals like prednisone, prednisolone, dexamethasone, budesonide, and triamcinolone are drugs in the cortisone family. And over the years these medications have achieved much attention as bad chemicals.

This is very likely due to what could be described as overuse.  These drugs of have historically been prescribed for a wide variety of medical conditions in medicine.  Since these meds provide symptomatic relief for many problems, a large number of people–as well as pets–have received them.  And the truth is that we have likely used them excessively in our patients in the past.

As time went on, the medical community began to realize that cortisone drugs have side effects that warrant other meds being tried first.  In other words, using higher doses of cortisone drugs when milder treatments could have been effective has been shown to be the wrong strategy.  We have witnessed this phenomenon in allergies and arthritis in particular.

However, when one is coping with a cancer diagnosis, the realization must be made that cancer is extremely aggressive.  In spite of all of our medical advances, it still resists treatment.  Thus, in order to get an edge on cancer to promote longevity and life quality, we need to use a broad range of tools to attack this disease.

Cortisone drugs have their place in cancer medicine.  The side effects that are seen with cortisone use are rarely life threatening, while systemic cancer is always life threatening.  Therefore if the drug can increase a patient’s lifespan and the disease will proceed relentlessly without it, it is sensible wisdom to at least consider its use.

Here are guidelines for the use of the most common drug in this class, prednisone, taken from Plumb’s Veterinary Handbook, the gold standard of veterinary drug texts:

1.  Glucocorticoids can mask disease! Try not to use them until you have a diagnosis.

2.  Make a specific diagnosis!

3.  Determine course from outset

4.  Determine endpoint before you starting treating

5.  Use the least potent form for the minimal time

6.  Know where glucocorticoids inappropriate. (Behrend 2007)

Prednisone and prednisolone are central players in cancer chemotherapy protocols, most commonly for lymphosarcoma.  And the good news is that they really make a difference in both life quality and life span.  Oncologists are achieving median survival times of 10-14 months using these chemo protocols.  This is most definitely worth considering.

The bottom line is that in some cases we have swung too far in being anti-drug.  We need a balanced approach to cancer treatment.

We should always consider diet, apoptogens, anti-metastatics, pain control as needed, and efforts to convert our patients to a cancer-fighting brain state.  We must consider surgery, radiation, and chemotherapy (all of these are discussed in the Guide).

Don’t forget, when using cortisone drugs, decrease the dose of Apocaps to ¼-1/2 the labeled dose if your dog is receiving cortisone drugs, give with a full meal, and use this combination under veterinary supervision only.

Best,

Dr. D

About the Author: Demian Dressler, DVM


Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://DogCancerBlog.com.

  • Mark

    Good stuff. I try to take the more holistic approach with myself and my Great Dane that has lymphoma. And while she was on a high dose of prednisone at first, it is tapering down, and the side effects weren’t that bad. Obviously all drugs have the negative side, but like said you have to weigh the situation and see if the benefits outweigh the negatives along with other options.

    Considering it can be quite effective, makes every sense to use it.

    • Demian Dressler

      Thanks very much for your comments Mark
      Best,
      Dr D

  • Mark

    Actually, the same thought process was done with the chemo option we chose Doxorubicin. Has some nasty side effects, but with its ability to add some time to her diagnosis, it’s the route we chose for a few reasons.

  • Barb

    Hello, This is very good advice. I’m editor of the Sussex Spaniel Club of America’s newsletter, The Scentinel, and would like to reprint this article for our members. We have about 140 members. I believe they would find the information useful and interesting. Thank you. Barb Jones

    • Demian Dressler

      Dear Barb,
      no problem, just cite source and feel free to distribute.
      Best,
      Dr D

  • Bob Laws

    My Labrador was diagnosed with Lymphoma in early August. We quickly started reading up in this type of cancer in an effort to get as informed as possible. Chemotherapy was financially impossible. I was given some Prednisone by one veterinarian who suggested either of two similar approaches. I needed clarification on how much Prednisone whould really help, as we got some relief, but it kind of came and went. I called your clinic in Kihei and found out you don’t take phone calls or e-mail, and I didn’t need anyone to tell me that you’re super busy, as I can only imagine with all you do for pets and their owners. I had already bought the DC Survival Guide. But I needed to know if I could up the dosage when the L-Glands under my dog’s jaw began to swell more than before, and he was jjust dragging around the house. I left a simple message with your assistant with no promise that you would call back. You didn’t call back. But what would help people would be a way to get simple information quickly. I put the dog down within the 2 months estimated life time expected, still not knowing. I got the book though..so what. Your time is valuable and that’s the way it is. But do you want to help people or not?

    • Demian Dressler

      Dear Bob,
      I am sorry to hear about your dog, and I know that dealing with canine lymphoma is very painful.
      Now, as to individual consultation: writing a book and a blog does not mean that I can be a veterinarian for everyone across the country at all times. I answer most questions to the best of my ability here on the blog, free of charge, as a public service. However, I do not supplant your veterinarian in giving specific and unique directions to cases where I cannot see the patient, have done not done a physical exam, have no access to lab work, etc. As a matter of fact, giving specific medical advice under these conditions regarding drug dosing for a given animal without having the veterinarian in charge of case management involved, and supervising the instructions, is not only bad medicine, it is borderline unethical professionally (at best). Finally, I have my own practice and a full caseload of patients, and there are only 24 hours in a day. So yes, I do want to help people, and I will do so to the best of my ability and within what I choose as feasible for me personally, and what is acceptable professionally and medically. Your veterinarian is the person who is responsible for drug dosing protocol and I am sure would have answered this question for you, and is the person who medically is managing your pet’s day to day needs.
      Thank you for your understanding
      Dr D

  • Ellie

    Why do you say to cut the dose of Apocaps if the dog is receiving prednisone ?

    The directions that come with the Apocaps say not to use them at all if the dog is getting prednisone. If I had known that before I bought them, I wouldn’t have wasted $65.

    • Demian Dressler

      Dear Ellie,
      general information can be found on the Apocaps website:

      The apoptogens in Apocaps possess some anti inflammatory effects. As a general precaution, the statement to avoid the use of Apocaps with prednisolone is made on the bottle. Under veterinary supervision, we commonly use Apocaps along with pred medications but at reduced doses. The reason is there can be some overlapping side effects (rare digestive upset) when full strength Apocaps are used with full strength cortisone drugs. Thus under veterinary supervision at reduced doses and while the patient is monitored, this use is acceptable. Our highest priority is pet safety, and we are deliberately very precautious with safety recommendations, just as you would find with an over the counter medication such as aspirin, on the package insert.
      As to your concern, if you are not fully satisfied you may return the product for a full refund.
      I hope this clarifies your question and helps.
      Best,
      D

  • jenny

    My yorkshire terrier responded very well to prednisone for the last five weeks of her life; she ate well, had more energy, and didn’t have any major side effects. There is no cure for widespread cancer so whatever works to make your animal comfortable seems the best course of action.

  • Santhosh

    Dr. Dressler, I just bought The Dog Cancer Survival Guide and its very helpful to understand the options I have and the dietary changes needed. My 10 yr old lab, was recently diagnosed with low grade sarcoma after conducting a couple of biopsies. There is a growth on his palate and his new vet, who is a surgeon, just began with chemotherapy using Vincristine sulphate (Biocristin-AQ is the name of the specific drug). I tried looking for a veterinary Oncologist in India (I live in a city called Bangalore) but couldn’t find one. I would be grateful if you can recommend one/contact me so that I can explain further.

    • Dr. Demian Dressler

      Dear Santhost,
      I am sorry but I do not have a recommendation for oncologists in India.
      D

  • Gillian Dey

    my 14 year old has been diagnosed with MAST cell, she is on Prednil, is this of the family of Prednisolone? i dont like the side effects of bloating, hunger, thirst and weakness in the back legs. I am at odds as to whether continue with the drug when the Vet says she only has a couple of months to live, the cancer already progressed to the liver.

    • Dr. Demian Dressler

      Dear Gillian,
      there are other options- other pharmaceuticals (Kinavet, masitinib, and more), diet, apoptogens, and others. Are all of the tools at your disposal being used (always consult with your veterinarian)?
      Best
      Dr D

  • byron

    My dog has prostate cancer he is being taken care of by a hollistic vet he was on 15 mg prednisone and he is now down to .25 mg he was diagnosed in feb 2011 and has never been healthier, he is an american eskimo dog 11 years old an athlete all his life running in agility competions, i am hopping to get him off the prednisone by next year. Changing they way he eats and what he eats has been the best thing I have ever done most dog foods are killing our dogs.

  • Joe

    Dear Dr. Dressler. I’d like to ask you about my dog. She’s almost 13 (next March)and has a HUGE lump on her side which was diagnosed (via aspirate not biopsy) as being soft tissue sarcoma. The vet that I went to suggested not to operate as she didn’t want to put her “over the edge” and she said the lump was so big it probably wouldn’t grow more as big tumors reach a point where they don’t grow anymore. Well, needless to say the lump has kept growing and it’s now the size of a cantaloupe. I took her to a surgery clinic and they said it would be a very invasive procedure that would cost in the range of $3000(this after an MRI that would be in the neighborhood of $900-1000 so close to $4000 total) and they probably wouldn’t get all of the tumor so it would probably grow back anyways.
    She’s on 20mg Prednisone (every other day after the 5 day twice a day and then 5 day once a day.)which makes her EXTREMELY thirsty and she;s already taking Proin 25 for incontinence which is nullified by the amount of water she’s drinking, so often times especially after taking the Prednisone, there is big puddle of urine behind her after prolonged sleep. Her appetite is so-so compared to 4 months ago for example when she didn’t have the tumor, but she enjoys her chicken (cooked in pressure cooker) or roast (slow cooked)and she’ll eat some dry grain free kibble as well plus a senior vitamin.
    For some reason, she’s less reluctant to eat the cheaper grain rich kibble that my other dog eats!
    So at this point, since there appears to be nothing else we can do since the very expensive surgery which I can’t afford may be too much for her and without guarantees, I’m considering going all natural with Essiac, CoQ10, Milk Thistle, Curcumin, enzymes and ImmunoPro (or other immune system boosters) MINUS the Prednisone which seems to be making her more uncomfortable than helping due to the extreme thirst and urine leakage.
    Do you think that at this point it’s more counterproductive to use Prednisone since it’s an immuno-suppressant? Besides her finicky eating with the dry food only she seems to be alright enjoying playing fetch, our walks and car rides and being feisty towards our other dogs like she’s always been!
    I know you can only give suggestions and opinions and not medical advice but I’d like to know what you think about me not giving her Prednisone anymore since I’d be giving her immune boosters. Forgive my long post.
    Thank you very much. Looking very much forward to your reply.

    • Dr. Demian Dressler

      Dear Joe
      pred has limited usefulness for these so I would discuss with your vet tapering off it. See if there is a vet that will do the surgery without the MRI (if safe enough). Consider apoptogens and neoplasene and high dose IV vit C as some more robust options to consider with your vet.
      If you have not read the Guide, i believe this would be worth the investment.
      Also:
      http://dogcancerblog.com/the-cost-of-my-dogs-life-part-1/
      I hope this helps
      D

  • lynn

    Hi, I understand that you may not time or first-hand examination to help me, but perhaps some of your other readers may or you can point me to other resources. My Golden was diagnosed with a mass cell tumor from a needle biopsy yesterday. This came on suddenly. She has had soft cell “fatty binine tumors for years.” This one had also seemed fatty until this week, when it swelled to, well, it looks like she has an oozing, bloody tennis ball lodged into her stomach. We noticed it Wednesday night. She had been perky and happy the day before! She is almost 15 and vet doesn’t recommend surgery given her age. Also discovered she has a thyroid problem. We are giving her benedryl, antibiotic (yesterday only), topical powder to dry her oozing tumor and special betadine cleanser to lightly clean her wound once a day. We are to start prednisone on Sunday (had to wait three days because she’s been on Dermax for arthritis). I bought your book last night and am half way through it. I’m learning a lot from it. But I’m a little frustrated that it doesn’t seem to address situations with older dogs that aren’t candidates for surgery, chemo or radiation. I’m going to gradually start the diet if she makes it long enough, but I would like to see you address more about treating dogs that are already at the end of their average lifespan. More hospice type care. My dog went from seemingly fine to two days later having a oozing surface tumor, not eating, needing help to stand, and intermittent light whining, which breaks my heart. She vomited last night after taking antibiotic which we cut out for the time being. I can’t stand to see her in pain, yet I don’t want to give up so quickly. I just found out she had cancer! But she can’t get up by herself and I’m not able to lift her alone. She’s 92 pounds even after being on a very limited organic commercial food diet the past two years (hence the thyroid problem) Vet says to try to hang on so she can start the prednisone on Sunday. She has pain med in interim, but she still whines especially when I leave her side. Is there anything else natural she can take to help with pain?

    Everything I find on mass cells just assumes tumor will be removed or inoperable ones will treated with chemo and radiation. If my dog was a couple of years younger vet says would definitely remove it, but not the wisest option now. With dogs this old the time that might buy isn’t to me worth the loss in quality of life. I would so appreciate it if you can point me and others like me to some resource.dealing with older dogs with Mast Cell tumors that aren’t candidates for surgery or chemo. Something beyond just diet and good interactions, something that helps with pain and is not prohibitively expensive.

    • Dr. Demian Dressler

      Dear Lynn
      I am sorry you and your loved dog are going through this.
      have you read the Guide? There is whole slew of information that could benefit your dog. If no surgery, you might discuss with your vet: combination apoptogens, oral and injectable neoplasene under veterinary supervision, matrix 3 cisplatin impregnated beads from Wedgewood pharmacy, antihistamines, antacids, dog cancer diet, beta glucans or modified citrus pectin, injectible corticosteroids, Kinavet or Palladia, among others.
      I hope this points you in a good direction
      Dr D

  • Iva Morgan-Sloan

    Last July my precious cocker was diagnosed with Lymphoma at 5 years old.
    I decided homeopathy would be worth a try, together with a total change in
    food. I contacted a homeopathic vet. We worked together with homeopathic
    medicine. He also recommended all food be raw organic food including meat.
    I varied the food and fortunately Teddi loved it as “soup”. He remained his
    happy cheerful self and while the cancer did not shrink, the nodes did not
    enlarge either. Over time his back legs area lost their muscle, this did not
    interfere with his running around the garden etc.,. Fast forward to last month
    (January 2012) when I decided if I could find a way to shrink all the nodes and
    then return to homeopathic treatment that could be the answer. So I started
    Teddi on prednisone. Within two days he became very ill. His breathing became
    very difficult, he would no longer eat. His whole body became “skin and bone”
    and within a short time there was no choice but to have him put to sleep.
    I know there is no cure for this type of cancer but I do feel the homeopathic
    treatment did slow it’s progression considerably and was a very gentle treatment which certainly extended Teddi’s life and enabled him to enjoy every
    moment. It goes without saying that switching medicines was a dreadful mistake.

  • Yamuna

    My 10-year-old male (not neutered) Lab has recently been diagnosed with prostate tumor (through x-ray and ultrasound) and vets here in India (Bangalore City) have indicated tumor removal surgery ASAP. It started off with urinary tract infection about 14/15 days ago with symptoms of incontinence, strong urine odor, and difficulty defecating in the last 7 days. He is on antibiotics since then (Ceftriaxone and Fortified Procaine Penicillin for 10 days and Taxim tablets twice daily thereafter). But it is very active, healthy, no fever or lethargy at all except for the increased urination. There is no loss of appetite or any other signs of external weakness.

    I would appreciate if you can suggest the best course of treatment and prognosis for my angel.

  • Lora

    My 80 lb mixed great dane/black lab has bone cancer. She can’t put any weight on her left back leg. It’s to the point where we have to carry her up the stairs. We were told she has 2-3 months to live. She is currently taking 10 mg of predisone, 100 mg of Tramadol, 1,500 mg of Pau D’ Arco, and 1,200 mg of Graviola. My question is would it be ok to give her more predisone? Her leg is quite swollen. I am so afraid of overdoing her. What is the max mg of predisone I can give her daily for the inflammation? And also I was wondering if she is getting enough Tramadol for pain and the max for that daily?

  • Jane

    My 3 year old Papillon was diagnosed with lymphoma 6 months ago. He is a big baby he is afraid of his own shadow — so we decided against chemo. The vet put him on predisone 2.5 mg 2 times a day. He is hungry all the time and has gained some weight. I think these are the side effects of the predisone. Recently his lympho nodes on his neck are swollen more then usual. He seems to have some trouble breathing — he snorts alot. He has always been a lazy dog but he seems to be a little more uncomfortable. I don’t know what to do. Is there a test I can do to see if the cancer has spread? I was told when he loses his appietite I will know he is sick but does the predisone mask that. I don’t want him to suffer. What do I do? Please help me I just lost my cat last week and I am not ready to suffer another loss.

    • Dr. Susan Ettinger

      Jane,
      Sorry about your cat and now your dog. If the lymph nodes are more swollen, it is likely that the pred is no longer working, so you need to get to your vet. Remember we never stop pred without a slow taper. Pred typically only keeps the lymphoma under control for about 2-3 months. I am sorry about everything you have been through, but I recommend you recheck your dog with your vet asap.
      All my best, Dr Sue

  • Frankie Keane

    Hi
    My Dog Jonni was diagnosed with lymphoma 3 weeks ago. We have her on prednisone and I started her on a suppliments program called k9critical care…
    I just bought graviola extract…I don’t want to just start giving her new stuff, but after all I’ve read, it seems very aggressive towards cancer and I guess I want to explore all possibilities.
    Thoughts as to how much? Interactions?
    Thanks for your advice,

    Frankie