This page covers medications veterinarians use for inflammatory and immune-related conditions in dogs and cats: allergic skin disease and itch, inflammatory bowel disease (for dogs, a veterinary expert panel now suggests the term chronic inflammatory enteropathy instead (ACVIM-endorsed consensus)), asthma-type airway inflammation in cats, and immune-mediated disease such as immune-mediated hemolytic anemia in dogs. Corticosteroids (steroids) are used commonly to treat allergy and inflammation in animals, including itchy skin and allergic lung and gut disease (Merck Veterinary Manual).
Bayview Pharmacy compounds three of the medications veterinarians prescribe for these conditions: prednisolone, budesonide, and mycophenolate mofetil. We prepare them as flavored oral liquids, small capsules, and a transdermal ear gel, so your veterinarian can match the medication to your pet's size and to what your pet will accept. They are part of our veterinary compounding line, alongside methimazole for cats, cisapride, and ursodiol.
How does it work?
Prednisolone is a glucocorticoid, a type of corticosteroid. Glucocorticoids calm inflammation and suppress parts of the immune response (Merck Veterinary Manual). Prednisone, a closely related steroid, has to be converted by the liver into prednisolone before it works. Cats absorb prednisone poorly and convert it poorly, so veterinary references advise giving cats prednisolone instead (Merck Veterinary Manual).
Budesonide is also a corticosteroid. In people it is used for Crohn's disease and ulcerative colitis, where it decreases inflammation in the digestive tract (MedlinePlus). After it is absorbed, the liver converts about 90 percent of it into less active forms, which in theory limits whole-body steroid effects. Even so, a veterinary study found that dogs with IBD given budesonide still had suppression of the hormone system that controls their own steroid production (Merck Veterinary Manual).
Mycophenolate mofetil is an immunosuppressive medication: it weakens the immune response (MedlinePlus). For immune-mediated hemolytic anemia in dogs, an ACVIM consensus statement lists it among the immunosuppressive drugs that can be used with a steroid (ACVIM consensus statement).
What is it used for?
Allergic skin disease and itch. Veterinarians use steroids at anti-inflammatory doses to ease itch and limit damage from scratching (Merck Veterinary Manual). Other options for allergic dogs include oclacitinib and cyclosporine, among others (Merck Veterinary Manual).
Inflammatory bowel disease. In cats, IBD is a condition in which the gastrointestinal tract becomes chronically irritated and inflamed, with signs such as vomiting, weight loss, diarrhea, bloody stools, lethargy, and decreased appetite (Cornell Feline Health Center). Your veterinarian may recommend a food trial first (Cornell Feline Health Center), and for dogs suspected of having chronic inflammatory enteropathy, an expert panel recommends diet trials as the first step, before invasive tests (ACVIM-endorsed consensus). Corticosteroids may be recommended, and some pets need more potent immunosuppressive drugs (Cornell Feline Health Center). Budesonide is one of the steroids used for IBD (Merck Veterinary Manual).
Asthma-type airway disease in cats. Oral steroids such as prednisolone, or inhaled steroids, are used to treat feline asthma (Merck Veterinary Manual).
Immune-mediated disease. For dogs with immune-mediated hemolytic anemia, the ACVIM consensus statement describes prednisolone or prednisone as the initial treatment, with other immunosuppressive drugs, including mycophenolate, among the options (ACVIM consensus statement).
Whether any of these medications is right for your pet, and how it fits with diet, other treatments, or an approved product, is a decision your veterinarian makes.
Liquid, capsule, or ear gel?
Flavored oral liquids (prednisolone 5 or 10 mg/mL; budesonide 1 or 2 mg/mL) are measured with an oral syringe, which lets your veterinarian order a dose that falls between tablet sizes. They can suit small dogs, cats, and pets that will take a liquid but not a pill. Other medications can be made the same way as a custom oral suspension.
Small capsules (prednisolone 2.5 mg, budesonide 1 mg, mycophenolate 70 mg) hold one measured dose in a strength made to your veterinarian's order.
The transdermal ear gel (prednisolone 7 mg per 0.1 mL in Lipoderm, with a TopiClick applicator) is applied to the inner ear, most often for cats that cannot be given medicine by mouth. How well a medication passes through a cat's skin varies from drug to drug. The steroid dexamethasone reached very low or undetectable blood levels when applied to the skin in single-dose studies, and several other drugs were poorly and unevenly absorbed from transdermal gels (dvm360). The sources we reviewed did not include an absorption study of transdermal prednisolone itself, so your veterinarian watches your cat's response closely and may switch to an oral form.
How is it given?
Liquids and capsules are given by mouth, and the gel is applied to the inner ear. Your veterinarian sets the dose, which is specific to your pet, and the schedule. Shake liquids well before each dose and measure with the oral syringe provided. Wear gloves when applying the ear gel (dvm360) and wash your hands afterward. Give mycophenolate capsules whole and do not open them (MedlinePlus). If you hide a dose in food for your dog, never use a human product sweetened with xylitol, which is toxic to dogs (FDA).
Do not stop a steroid suddenly or change the dose on your own. After long-term use, the body's own steroid production can shut down, and stopping abruptly can trigger a crisis with lethargy, weakness, vomiting, and diarrhea (Merck Veterinary Manual). Your veterinarian will tell you how to lower the dose when the time comes.
Side effects & safety
In dogs treated with prednisolone or prednisone for immune-mediated disease, the most frequently reported effects were increased thirst, increased urination, panting, and lethargy (ACVIM consensus statement). The approved prednisolone tablet label also lists vomiting, diarrhea, poor appetite, weight loss, and changes in liver enzymes on bloodwork (PrednisTab label). Long-term use can lead to a Cushing's-like condition with hair loss, muscle loss, and more infections; it can bring on diabetes or make existing diabetes harder to control; and it can slow wound healing. Steroids also raise the risk of stomach and intestinal ulcers when given with NSAID pain relievers (Merck Veterinary Manual).
Budesonide's whole-body effects are thought to be smaller because the liver breaks most of it down, but dogs given budesonide still showed suppression of their own steroid hormones, so the same cautions about stopping suddenly apply (Merck Veterinary Manual).
Diarrhea has been reported in 20 percent or more of dogs taking mycophenolate, and it may not start until one to two weeks into treatment (ACVIM consensus statement). In a study of healthy cats, stomach and bowel upset was common at the higher doses tested, and the authors did not recommend mycophenolate for routine treatment of immune-mediated disease in cats (Journal of Veterinary Internal Medicine). Mycophenolate lowers the ability to fight infection (MedlinePlus). Your veterinarian may schedule rechecks and bloodwork during treatment. Contact your veterinarian if you notice any concerning change.
Which pets should not take it?
The approved prednisolone tablet label says not to use prednisolone in animals with viral infections, stomach ulcers, corneal (eye) ulcers, or Cushing's syndrome, and warns that steroids given late in pregnancy can bring on early labor with serious complications (PrednisTab label). Steroids need extra care in pets with diabetes and in pets already taking an NSAID, and prednisone, which needs the liver to activate it, is not recommended for animals with poor liver function (Merck Veterinary Manual). In a study of healthy cats, mycophenolate caused stomach and bowel upset at higher doses, and the authors did not recommend it for routine use in cats (Journal of Veterinary Internal Medicine). Tell your veterinarian about your pet's full history and every medication and supplement so they can decide whether these medications are appropriate.
How should it be stored?
Store as directed on the label, keep containers tightly closed, and do not use after the beyond-use date. Keep all of these medications out of reach of children and other pets. Handle the ear gel with gloves (dvm360). Keep mycophenolate capsules whole; if one opens, avoid touching the powder or breathing it in. Anyone who is pregnant or could become pregnant should avoid contact, since mycophenolate can cause miscarriage and birth defects in people (MedlinePlus). Ask your veterinarian or pharmacist how to dispose of unused medication.
Why is this compounded?
The approved prednisolone tablet we confirmed, PrednisTab, comes in 5 mg and 20 mg tablets and is labeled for dogs only (PrednisTab label). Not every pet will take a tablet, cats are usually given prednisolone rather than prednisone, and small dogs and cats can need doses that fall between tablet sizes. Budesonide and mycophenolate are prescribed to people for bowel, kidney, and transplant conditions (MedlinePlus; MedlinePlus), and veterinarians prescribe them for dogs and cats. Bayview compounds these medications as flavored liquids, small capsules, and a transdermal gel, in strengths and forms the available products do not cover, when your veterinarian decides an approved product is not suitable for your pet. The rest of what we compound for animals is in our compounded medications catalog.
Clinical details for prescribers
Regulatory status. Prednisolone, budesonide, and mycophenolate mofetil are not federally controlled substances (DEA). These preparations are compounded for an individual animal on a valid prescription within a veterinarian-client-patient relationship, as extralabel use under AMDUCA (21 CFR 530.3); animal drugs compounded from bulk drug substances follow FDA's GFI #256 (FDA). FDA-approved animal products confirmed: PrednisTab prednisolone tablets, 5 and 20 mg, dogs, NADA 140-921 (FDA); Apoquel (oclacitinib), dogs at least 12 months of age, NADA 141-345 (label); Atopica (cyclosporine capsules), canine atopic dermatitis, NADA 141-218 (label); Atopica for Cats (cyclosporine oral solution), feline allergic dermatitis, NADA 141-329 (FDA).
Formulations. Prednisolone flavored oral suspension 5 and 10 mg/mL; prednisolone 7 mg per 0.1 mL transdermal gel in Lipoderm with a TopiClick applicator; prednisolone 2.5 mg capsules; budesonide oral suspension 1 and 2 mg/mL; budesonide 1 mg capsules; mycophenolate mofetil 70 mg capsules. Other strengths and forms are compounded to the order.
Published dosing, for reference only:
- Canine atopic dermatitis: prednisone or prednisolone 0.5 to 1.1 mg/kg PO q24h for induction, with a target of 0.25 to 0.5 mg/kg PO q48h (Merck Veterinary Manual).
- Pruritus, chronic allergic bronchitis, and feline asthma: anti-inflammatory prednisolone dosages of 0.5 to 1 mg/kg per day (Merck Veterinary Manual).
- Inflammatory bowel disease: prednisone 1 to 2 mg/kg PO q48h in dogs; prednisolone 1 to 2 mg/kg PO q24 to 48h in cats; budesonide 3 mg/m2 PO q24h in dogs and cats (Merck Veterinary Manual).
- Canine IMHA: prednisolone or prednisone at an initial PO dosage of 2 to 3 mg/kg/day, or 50 to 60 mg/m2/day for dogs over 25 kg, decreased by 25% every 3 weeks once the PCV/Hct is stable and above 30%; mycophenolate mofetil 8 to 12 mg/kg PO q12h (ACVIM consensus statement).
Counseling and clinical points:
- Use prednisolone, not prednisone, in cats: poor oral bioavailability and poor hepatic conversion of prednisone (Merck Veterinary Manual). Prednisone is a prodrug requiring hepatic 11-beta-hydroxylase and is not recommended with hepatic insufficiency (Merck Veterinary Manual).
- Long-term glucocorticoid therapy can cause iatrogenic secondary hypoadrenocorticism; abrupt withdrawal can precipitate an Addisonian-like crisis. After control on daily dosing, a gradual change to alternate-day treatment can reduce adverse effects of courses longer than 2 weeks (Merck Veterinary Manual).
- Budesonide: about 90% of systemically available drug undergoes first-pass hepatic conversion to less active metabolites, but HPA-axis suppression has been documented in dogs with IBD, possibly from greater absorption across damaged mucosa (Merck Veterinary Manual). Taper as for a systemic steroid.
- Glucocorticoids potentiate NSAID-associated GI ulceration and can precipitate or worsen diabetes mellitus (Merck Veterinary Manual). Labeled contraindications for prednisolone include viral infections, peptic and corneal ulcers, and Cushingoid syndrome, with a late-pregnancy parturition warning (PrednisTab label).
- Transdermal glucocorticoids in cats: dexamethasone showed undetectable or very low absorption in single-dose studies, and several drugs show poor, variable bioavailability in PLO transdermal formulations; multiple-dose results may differ (dvm360). No prednisolone-specific transdermal data were found in the sources reviewed. Monitor clinical response and consider an oral route if it is inadequate.
- Mycophenolate: diarrhea in 20% or more of dogs, possibly delayed 1 to 2 weeks (ACVIM consensus statement). In healthy cats, 10 mg/kg q12h for 1 week was tolerated while higher doses caused GI signs, and the authors did not recommend MMF for routine treatment of immune-mediated disorders in cats (JVIM). Capsules should not be opened; mycophenolate is teratogenic in people (MedlinePlus).
- Canine chronic inflammatory enteropathy: the ACVIM-endorsed panel recommends dietary trials before invasive diagnostics and suggests avoiding the term IBD (JVIM).
Dosing remains the prescriber's decision. Account setup and ordering are covered on our for providers page.
References
- Merck Veterinary Manual: Corticosteroids in animals
- Merck Veterinary Manual: Drugs for inflammatory bowel disease
- Merck Veterinary Manual: Atopic dermatitis agents for dogs
- Merck Veterinary Manual: Feline bronchial asthma
- Cornell Feline Health Center: Inflammatory bowel disease
- JVIM: ACVIM-endorsed consensus on chronic inflammatory enteropathy in dogs
- JVIM: ACVIM consensus on treating IMHA in dogs
- JVIM: Mycophenolate mofetil in healthy cats
- dvm360: Medicating cats, transdermal drugs
- DailyMed: PrednisTab label
- FDA: NADA 140-921 PrednisTab summary
- DailyMed: Apoquel label
- DailyMed: Atopica label
- FDA: NADA 141-329 Atopica for Cats summary
- FDA: Animal drug compounding
- eCFR: 21 CFR 530.3
- DEA: Controlled substances list
- MedlinePlus: Budesonide
- MedlinePlus: Mycophenolate
- FDA: Xylitol is toxic to dogs
Inflammation, Allergy & IBD Medications for Pets are compounded veterinary preparations and are not FDA-approved. A prescription from a licensed veterinarian is required. This information is educational and is not a substitute for your veterinarian's instructions. Your veterinarian determines whether a medication is appropriate and sets the dose.
