dexamethosone for cat

Question
Hi,
My cat has/had bronchitis and my vet recently took x-rays and along with her regular medication for "feline asthma" or bronchitis, he gave me dexamethosone to give to her. he never gave me a time period i should give it to her until. And recently my cats gotten lazy and shes eating alot, drinking alot, and she looks fatter, and this all has happened over the matter of two weeks of giving her the medication. Do you know anything about this medication and whether I should keep giving it to her or not? I was reading it has cortisol in it, and someone I know told me that that medication shouldn't be given to anyone, humans or pets, unless its the last resort since it has cortisol in it. Would you be able to help me some? I'm really worried. I'm discontinuing giving her the medication and I'll bring my cat into the vet asap but I just needed to know for my peace of mind til I can take her into the vet. Theres a snow storm here so everything is closed and pretty much stuck under a foot or more of snow.
Thanks

Answer
Hi Farwa,

Dexamethasone is a glucocorticoid.  It is a wonderful drug in the right situations, but unfortunately, it has a lot of side effects, some of which you're seeing in your cat.  

Dexamethasone is a steroid, same as prednisone or prednisolone.  It is frequently given for asthma, bowel/GI conditions, and eye infections--basically any condition that causes inflammation, steroids are frequently given.  Therefore, it makes sense that your vet rx'd dexamethasone for bronchitis and asthma.  

One of the side effects of giving a steroid is increased appetite.  It is not uncommon at all for cats taking steroids to develop a HUGE appetite and eat everything in sight--and then ask for more!  Unless the cat is on the steroid indefinitely, don't change the diet, because chances are, the cat is just eating what it would normally eat, but because of the increased appetite, it's just more hungry and will want more food, and for the short haul, it's fine if the cat eats more than usual.  So, I wouldn't alter your cat's diet because this side effect is to be expected.  It won't hurt your cat if she's just on the steroid for a short period of time. And steroids in and of themselves can cause weight gain, so again, your cat being heavier could be true, as she's likely gaining weight as a side effect from the steroid.

Another side effect is increased drinking/thirst.  Steroids, while great at tackling illnesses, can have several detrimental side effects, one of them being diabetes.  Fortunately, diabetes usually only occurs when your cat has been on steroids for longer than a couple of months, and/or is on steroids frequently.  So, if your cat has only been on the steroid for a wk or a couple of wks, then likely what you're seeing is just the side effect of increased thirst--a completely expected side effect while taking steroids.  

Now, on to the rest of your question about whether to stop the medication due to cortisol.  Yes, glucocorticoids have cortisol in them, but as I said above, steroids are used frequently in inflammatory cases, and are very effective.  Cortisol is produced by the adrenal glands which sit just above the kidneys.  Cortisol is produced in our own bodies whether we take steroids or not.  However, when you start taking a steroid, you have all this extra cortisol floating around in your body, and that triggers the adrenal glands to stop producing cortisol because there's no need for them to produce it anymore. So, the adrenal glands stop producing natural cortisol, and the synthetic steroid replaces the body's own natural cortisol.

However, the body needs cortisol, and when you suddenly stop taking the pill (or whatever way you're taking the steroid), suddenly all the cortisol is gone, because your body has stopped production, and can't start production fast enough to prevent symptoms of an adrenal crisis.  Now you can run into problems if the cat has been on the steroid for more than a wk. Call your vet and ask for a tapering dose.  Steroids can never, ever be just stopped without a taper, unless the cat has only been on them for a short period of time, typically a wk or less.  Without the cortisol, you can cause a significant crisis, which can even lead to death. So, whatever dose your cat has been on, get her back on that dose, and immediately call your vet for a tapering dose.  Your vet should have given you a tapering dose when he rx'd the steroid.  If you suddenly stop steroids, the adrenal crisis that you will cause can result in severe, all over body pain, vomiting, diarrhea, convulsions, lethargy, dizziness, low blood sugar, fever, and even death.  It's a serious crisis.  

Usually steroids are decreased by 5-10mg/day depending on the dose your cat has been on.  For instance, my cat has IBD, and when she has a flare, she's put on steroids.  I give her 5mg 2x/day, usually for 1-2 wks, then, providing her diarrhea has improved or stopped, I decrease the dose from 5mg 2x/day to 5mg 1x/day for 1 wk; then I go to 5mg every other day for 1-2 wks; and depending on how long she's been on steroids, I may stop the drug after that, or may drop even more to 2.5mg every other day for 1 wk, then stop.  It just depends.  But tapering is not a quick process, and usually takes a couple of wks depending on the dose and the how long the cat has been on the drug.  So, please, if your vet hasn't formally told you to stop the dexamethasone, then restart it, and call your vet and ask him what taper schedule he wants your cat to be on, unless it's only been a wk or less, and then you should be able to stop it  safely without a taper (usually, but remember every cat is different).

Hope this info helps, and if there's anything else I can do, please feel free to ask.

Savannah