Odie - switch from Dexamethasone to Budesonide

Hi all,

I'm looking for anyone's experience with switching from Dexamethasone to Budesonide for a cat with IBD and pancreatitis.

Odie's health issues started back in December 2008. He's been difficult to stabilize, but after many different medications and types of food, we've managed to stabilize. For the last 6 months, we were stable at:

Morning:
0.37mg Dexamethasone
2.5mg Pepcid AC
2mg Chlorambucil (Leukeran) every second day

Evening:
0.37mg Dexamethasone
2.5mg Pepcid AC

As for last week, he's been diagnosed with diabetes. So now we've added 2 units of Lantus twice a day.
His internal medicine vet thinks it's being induced by the Dexamethasone, so we need to try and switch him off of that. Easier said than done because it takes very little to get him unstable again. The goal is to try and get him on to Budesonide.

So far, I've decreased his evening dose of Dexamethasone by half... 4 days and so far so good. He's still eating, no throwing up, no diarrhea.

Right now, he's getting:
Morning:
0.37mg Dexamethasone
2.5mg Pepcid AC
2mg Chlorambucil (Leukeran) every second day
2 units of Lantus

Evening:
0.18mg Dexamethasone
2.5mg Pepcid AC
2 units of Lantus

Does anyone have any experience with switching like this?

Thanks
Odiesmom

 

Hi there, wow, sounds like you have your hands full!!! We use Budesonide, but switched from Pred to that, and w/o the other meds in the picture (other than insulin).

I am going to cross-post for you on the main Health board so you will get more eyes on this - since he has diabetes, it's ok to post on that board, and I suspect it gets a lot more traffic than here.

 

Thanks Joanna.
Seems like maybe no one else has dealt with this particular transition.

How do you find the budesonide?
Odie did not respond to Prednisone at all, we tried adding Tylosin, then eventually switched to Dexamethasone.

 

If you vet thinks the budesonide might help it is worth a try, then certainly it is worth doing so.

But if symptoms start to return, I would go back to your previous protocol quickly to nip it in the bud.
For kitty's with multiple health issues it is important to prioritize those issues. You can always shoot around the dex. I did. My Winnie was on dex for several years -- she could not go off, so we just shot insulin around it.

Best of luck. And please let us know how things work out.

 

I haven't seen Dex mentioned a lot, so it wouldn't surprise me if you are the test case! There is a web site too for IBD kitties that perhaps would have more info - have you tried that? Sorry I can't find my bookmark for it I know I found it off of someone's signature here.

Budesonide has worked very well for Bix, but he also did very well on Pred (minus the diabetes, arghhhh), so I don't know that a comparison would apply. He's also not on Leuk, and doesn't have pancreatitis that I know of. For him the Budesonide starting working well within maybe 2 or 3 days, so hopefully you will know pretty quickly whether or not it will work for him. He started on 1mg SID and now gets about 1mg BID as he has gradually worsened over the years. If Odie is a tough case, you might ask the vet about starting at a higher dose than the base one (1mg SID), and then if it works well you could try backing off the dose. I don't know if that is possible with Budesonide, just a random thought.

Also there are several of us who get it in different compounded forms so it will go down more smoothly - I'm not sure how your vet will prescribe it, but just to know there are options - I use a liquid compounded with chicken flavor (from a vet pharmacy), others get it in some other forms too.

Are you posting for him too in Lantus Land? They can help you with insulin questions if you have any, and there is usually a lot of traffic over there so you might find there are others with more steroid advice there as well.

 

Would definitely suggest B-12 injections for the IBD, regardless of type; refer your vet to TAMU protocol here http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml.

If diarrheal IBD, would suggest trying raw food diet, either made at home http://www.catinfo.org/makingcatfood.htm or store-bought (Nature's Variety has BOGO offer here http://www.naturesvariety.com/tryit).

If constipating IBD, raw food diet *may* decrease OR INCREASE constipation issues; please monitor carefully.

If constipating IBD, suggest switching from Pepcid to Zantac (which helps intestinal motility); see article here for constipation meds http://www.theveterinarian.com.au/clinicalreview/article757.asp.

Agree you need to work diabetes around other issues; we ended not being able to wean Gwyn off prednisone, so always shot the insulin around the meds.

Can't help with Dex -> Bud, sorry.

 

found this thread on the old board on budesonide for p-titis and ibd. thought it might help

http://www.felinediabetes.com/phorum5/r ... ?8,1133149

 

Thanks
We're starting the switch... first dose of Budesonide last night.

2 days of adding Budesonide but changing nothing else (Dex 1/2 tablet AM and 1/4 tablet PM)
5 days of Budesonide and reducing his Dexamethasone to 1/2 tablet once a day
10 days of Budesonide and reducing his Dex to 1/2 tablet every second day
continue on Budesonide only

Pepcid and Chlorambucil continue as normal.

We have no idea how this is going to go. So far his BG is much lower than normal this morning, no idea why since we only expected it to start dropping after reducing the Dex. I did not give him insulin.