Long-acting cortisone injections in dogs.

Depo Medrol (2) This is a bottle of Depo Medrol.  It is one of the more commonly used long-acting cortisone injectable products.  One of the more common uses is to give long-lasting relief from allergic itching.  Allergies are a malfunction of the body's defenses, so you give enough cortisone to suppress the body's defenses a little.

I'm not crazy about using this in dogs.  You inject a blob of this stuff into the dog's thigh muscle.  The drug begins leaching into the bloodstream.  The bigger the blob, the higher the blood level of drug.  So, when you first give it, the blood level of drug is very high.  As time goes by, the blob gets smaller and smaller, so the blood level gets lower and lower.   Eventually, the blood level gets low enough that it won't suppress the itching anymore. 

Cortisone Graph (2) The problem is this: you never really know what the blood level actually is and how much is left.  We know that the average dose in the average dog will take 8 weeks to be totally gone, but it could take longer, maybe 12 weeks or even longer.  The problem comes in when the blood level of drug is too low to stop the itching, but there's still a significant amount of drug left on board.  The dog starts itching again, so you give him another dose.  That's the second peak on the graph.  Now you've got the new dose, plus the leftovers.  He's not itching, but you may have boosted his cortisone levels to an unsafe level. 

So, what's unsafe about it?   Aside from the effect on his liver and pancreas and adrenal glands and carbohydrate metabolism and skin, you might be suppressing his immune system.

Stinky profile (2) Here's Stinky, the Shih T'zu.  He doesn't look too bad from a distance (although this is a day after a good bath and trim).  He (I do believe) had an allergy problem.  His previous doctor prescribed tablets with a little cortisone, plus antihistamine.  He also started in March giving him a stiff dose of Depo Medrol every two months.  Some dogs might do okay with that.  On the other hand…

Legs stinky (2) Take a closer look at his legs.  Stinky (like many dogs) has always harbored a few Demodex mites (a present from his mother).  Unfortunately, when Stinky got a big enough load of Depo Medrol on board, it suppressed his immune system just a little too much and the mites took off like gangbusters.  These legs don't look good, and this is two days after his bath, trim, and starting antibiotics for the secondary skin infection, and ivermectin for the mites.

Eyelids stinky (2) These eyelids are what really hurt him, though.  They were so painful that we had to anesthetize him to clean them up the first time.  We can treat the mites, and we can treat the secondary Staph bacterial infection.  The bad thing is this: it's only been three weeks since his last Depo Medrol injection.  That means his immune system is going to stay suppressed for a while.  We may not make much progress this first month.  Drugs help, but we need his own body defenses working in order for him to get well.

There is a place for Depo Medrol in veterinary medicine.  You need to be pretty sure what you're dealing with, though, because once it's in there, you can't take it back.

93 thoughts on “Long-acting cortisone injections in dogs.

  1. Johainess says:

    Giving your dog Medrol causes suppression upon its immune system. I am now experiencing the back lash of trusting Veterinarian’s treatment to Demodectic Mange by using this as an anit-inflammatory. It IS NOT a treatment to mange. IT IS A STEROID AN ANY STEROID USE IS A Contradictory TO TREATING MANGE BECAUSE IT SUPPRESSES THE IMMUNE SYSTEM UNTIL IT DESTROYS IT AND CAUSES MORE IRREVERSIBLE PROBLEMS TO YOUR DOG’S HEALTH SUCH AS HIS LIVER!!!

  2. Doc says:

    Hello, Debra Jean,

    These are prescription medicines that cannot be sold unless the veterinarian has examined the dog. It’s not the sort of thing that you can just use willy-nilly. They are potent medicines that can really help, but they can be unsafe if used improperly.

    If your dog has a problem that you believe would benefit, it will be best (as well as necessary) for you to have the dog examined by your veterinarian.

    Thanks for reading and writing.

  3. Nanci Dallas says:

    i have a st.benard puppy he only 1 yrs old my vet recommenned cortizone for him wat do you guys i need help here please!!!!

  4. Doc says:

    Without knowing your dog’s situation, it is difficult for me to advise you. Most dogs can take some form of cortisone safely. It becomes unsafe when the dosage is not monitored, and the dog is not monitored for side-effects.
    Ask your veterinarian for a more detailed explanation of the treatment. I am sure that he/she will be happy to answer your questions.

  5. Tiffany says:

    What are the side effects of cortisone shots. My 60lb lab-beagle mix received one a week ago. She drank and peed a lot the first 2days-I expected that. Now she has loose stools and an upset tummy. The vet says not related and I’m to pick up some meds from them to settle her stomach. After reading stuff online I’m terrified that I hurt her health by allowing this. According to a specialist I was seeing last summer for protein in her urine, she has some kidney disease. I’ve seen renal disease as a side effect, which makes me feel like he should have never given her this.

  6. Doc says:

    Don’t beat yourself up so much.
    Most dogs do not have any significant problems when treated with cortisone short-term.
    The most common side-effects are excessive urination (requiring the dog to drink more water to replace lost fluid), and increased appetite. The appetite doesn’t mean the dog actually needs more food: they just WANT more.

    Excessive, long-term use can certainly cause other problems, but a single shot, even a long-acting shot, would not make most dogs sick.

    It is important to discuss your concerns with your veterinarian. Sometimes it’s hard to remember everything when you get there. You might consider writing down all the things you are concerned about so that your doctor can take a look at it and give you the information that you need.
    Communication is a big part of what we do, and it needs to go both ways. You might even take a note in and drop it off with a request to speak to the doctor later when he/she has had time to look at your pet’s medical record.

    Thanks for reading and writing, and good luck.

  7. Betty Estes says:

    I have a 5 yr. old Pekingnese that is allergic to flea bites. Her vet gives her Depo-Medrol shots and says she needs them monthly but with the economy like it is I can’t afford to take her to see him that often. I need to know if there’s any way I can get that med. online and if so where do I go to order it. She is miserable most of the time because she itches so much..She’s losing her hair in spots and smells to high heaven! The shots DO help!!!

  8. Shelia says:

    I have 2 black Labs. Thet are sisters both are 5 years old. They both suffer from seasonal allergies. The Vet wants to either give them Prednisone or Depomedrol. Which would you suggest? The one had Depomedrol shot last year..it helped her itching and chewing on herself…but she got a UTI about 4 weeks after the shot. Not sure what to do here.

  9. Doc says:

    Hello, Shelia,

    Please discuss this with your veterinarian. He/she is best equipped to advise you, as your dogs are actually in his/her care.

    Both these drugs are forms of cortisone. Prednisone tablets are short acting, so you can adjust the dose up or down, or stop it if you need to.

    DepoMedrol is long-acting, and difficult to know what your blood-level is at any given time, or when it’s all gone and safe for more.

    I personally only use the longer-acting injections when I have a patient with a known seasonal allergy who won’t be needing long-term year-round therapy.

    However, it is certainly possible to use DepoMedrol safely. Different doctors have different preferences in handling these situations.

    Discuss your questions and concerns with your veterinarian. Ask for the pros and cons in your situation so that you can make the best decision.

    I really cannot give you specific advice.

    Best wishes.

  10. Doc says:

    Hello, Maureen,

    I am no authority on that subject. There have certainly been thousands of dogs receiving these injections with no apparent heart problems.

    When a bad event occurs in a patient who has been receiving a medication, that event is reported. It can be linked to the medicine, even if there is absolutely no proof of cause and effect.

    Thus, it gets listed as a potential side effect later on.

    If you have concerns about your own health, you should really consult your own physician. I have no expertise in this area.

    Best wishes.

  11. Doc says:

    I cannot imagine any direct way that Depo Medrol would cause blindness.

    Since it is a form of cortisone, it can suppress the body’s defenses. If you had an infection that was sub-clinical and you knocked out the body’s defenses, the infection could take off.

    There aren’t a lot of infections that go to the eyeball (though Blastomycosis is one that does come to mind).

    If your pet has lost (or is losing) its vision, then you should ask for a referral to a veterinary ophthalmologist.

    I doubt it is related to the drug. A specialist’s exam of the eye would be the best way to determine the nature of the blindness and what to do about it.

    Good luck.

  12. Susan Brewster says:

    I have 2 Chihuahuas, 1 weights 10 lbs and 1 @ 15. My vet gave them 1 cc each June 1st, same symptoms but the scratching, biting and pulling out hair stopped. July 2 they started again. waited until July 11 and took them back for another dose. Lasted about 1 week. I don’t want them to have to take the shot every month. What is the alternative to Depo? No fleas, mites etc, just allergies. Thank you!

  13. Doc says:

    Hello, Susan,

    The best person to advise you is the veterinarian who is seeing your dog. I can only give some general information.

    It is very important to rule out other causes of itching, such as the mites and fleas that you mentioned. One also considers skin infections with bacteria or yeast.

    It is possible to give oral forms of cortisone. Some dogs (20% or less) respond to antihistamines. Many dogs benefit from bathing to decontaminate the skin regularly (once or twice weekly). There are also new products that help restore the skin’s natural barriers, like Allerderm, or Douxo. Oral fish oil helps some dogs.

    With such a rapid recurrence of the itching, especially after the second shot, I would be concerned about a number of possibilities. Your veterinarian has probably already discussed these with you.

    If there is a constant, heavy exposure of what you’re allergic to, then the medicine doesn’t work as well. A common example of this would be a flea-allergic dog who was covered with fleas.

    Another example is the food-allergic dog. Food allergies are unlikely to be something new in the diet. The specialists tell us that it generally takes months for the dog to become sensitized to a food substance. Therefore, it is something he has been eating for some time.

    Medicines rarely help the food-allergic dog. It is necessary to do a dietary elimination trial. The dog is fed NOTHING but a hypo-allergenic diet for four to 12 weeks. This might be a novel ingredient diet (like kangaroo and oats, or rabbit and green pea), or it might be a hydrolyzed antigen diet (like Purina HA or Hill’s Z/D), where the protein is broken down into smaller chunks of amino acids.

    This has to be done for a long time to allow every bit of the old diet to leave the intestinal tract. Most food-allergic patients will show some improvement by four weeks, but may take much longer to get itch-free.

    Most allergic dogs have multiple things they are allergic to. After the dietary elimination trial, if they are still itching, one could look at allergy testing. I wouldn’t go to that expense first, though. The testing doesn’t help tell you about food allergy. That takes the dietary elimination trial.

    Most itchy dogs can find relief, but many take continuing management, rather than being “cured”.

    Thanks for reading and writing.

  14. Ajeet Kacker says:

    Our Lab 9 years has been suffering from Arthritis for many years now. The poor boy is in severe pain for the last 4 days. The advised cortisone shots. He was given the shots but the pain is still there. Really worried for him..
    Please advice.


  15. Doc says:

    Hello, Ajeet,

    The first thing to do is let your veterinarian know that your dog is still having problems. If he/she doesn’t hear from you, they suppose that all is well.

    Many dogs with severe arthritis require multiple types of treatment to get the best relief. Your veterinarian can help with this.

    An anti-inflammatory is the usual first step. While some doctors use a type of cortisone, others prefer a non-steroidal anti-inflammatory drug (NSAID). These include medicines like Rimadyl, Deramaxx, Metacam, and so forth. They should NOT be combined with cortisone, nor with each other.

    There are other treatments that can be added to the anti-inflammatory.

    Other types of pain-relievers can be added, such as the mild narcotic, Tramadol.

    While it can take about 4 weeks to show benefit, nutritional supplements with glucosamine and chondroitin can help. Examples would be Cosequin, Glycoflex, Comfort MSM, and others.

    Adequan injections (polysulfated glycosaminoglycan) can be very helpful for a lot of dogs. They are given at 4 to 7 day intervals for at least four injections. If helping, the interval between injections can be lengthened, often to a couple of months. The mechanism of action isn’t entirely understood, but there are no side-effects.

    Acupuncture treatments can be very helpful for some patients.

    Finally, your veterinarian can also check to see if there is some other problem that is more serious than the arthritis (though that is serious enough), like a bone tumor.

    Let your veterinarian know what is going on.

    Good luck.

  16. jenny says:

    My 12 year old 40lb beagle/wiener cross has a hematoma in her ear flap – cause unknown but chicken peck is suspected… Do not want surgery, but aspiration and then a shot of Depo-Medrol is booked for Tuesday a.m. Not sure why this shot is recommended for this problem? Was thinking of aspiration only and then some natural home remedies since I’m anti-pharma to begin with and this drug sounds horrible… like all the rest.

    Would you recommend this shot after aspiration to prevent blood from coming back? My vet said this “never” works… and it seems this drug is mostly used for allergies and arthritis. I have usually found good results with alternative remedies. Any you would recomment?

    Thank you so much!


  17. Doc says:

    Hello, Jenny,

    You might read this post on aural hematomas:


    Some people inject the Depo-Medrol into the ear itself.

    My personal experience with aspiration and wrapping, with or without injections, has been pretty disappointing.

    I’ve had good results with a lot of dogs with the prednisone therapy (no aspiration), and with surgical drainage.

    I’ve rarely had to do the more extensive “quilting” type of surgery.

    There is a guy named Daniel Whitton who is working on developing a clamping device to keep the fluid from coming back. His work is interesting, but not commercially available, nor widely tested yet.

    I’m not sure what type of alternative remedy would be helpful here. My part-time associate trained for one year at the Chi institute in Florida, studying acupuncture and traditional Chinese herbal medicine. She hasn’t recommended these for the hematomas.

  18. Adam says:

    How long do the side effects last after a depo Medrol shot? Am I going to have 8 weeks of this thirsty urinating dog? And to be honest it doesn’t seem like “increased urination” should be the side effect. How about “loss of bladder control”? If my vet would have told me the truth I would have gone a different route.

  19. Doc says:

    The drug will stay in the system at significant amounts for six to eight weeks in most dogs, and at detectable amounts for 12 weeks.

    The side effects are usually worst in the first four weeks.

    They don’t really lose bladder control, it just fills up so often that sometimes they can’t believe it’s “time to go” already and they don’t make it to the door (or you’re not home to let them out).

    It will get better.

  20. Carol says:

    On 6/4/12, my 12 1/2 yr old 17lb. Shiba Inu had a tumor the size of pecan removed from the roof of her mouth and it tested as OsteoSarcoma. She was given Rimadyl for A few days, I took her back to the vet because she was making weird noises, coughing and wheezing, he gave her a Depo-Medrol injection. I am trying to find out how this would help her condition since I all the info I find is it is given for allergies and arthritis.

  21. Doc says:

    Hello, Carol,

    A malignant tumor in the roof of the mouth is very bad news. One cannot amputate the head to get rid of it, as one might with a tumor in a leg.

    Depo Medrol is a long-acting form of cortisone. Perhaps it was given for its anti-inflammatory and anti-swelling effects, since it may be difficult to give pills to a dog with a painful mouth.

    You would really need to ask your veterinarian what the rationale is. He/she is best equipped to answer that question.

  22. terri rotellini says:

    Hello, I have a 5mo old Blue pit. I believe we have done everything possable to help his itching and scratching. He has had 2 mite scrapings and no mites. We have changed his food and I even went as far as cooking chicken and rice.
    Our Vet has also given him antibiotics and dog benidryl, we bathe him twice a week with oatmeal shampoo and have also used skin so soft plus other dog hot spot treatments to no avail. Would a short term acting cortisone shot or pills benefit at this time? Help! Gunner needs some relieaf. Thanks!

  23. Doc says:

    Hello, Terri,

    I can appreciate your frustration. It would be unusual for a dog that young to have environmental allergies, but food allergy is a possibility. The dietary elimination trial should be continued for at least four weeks. If chicken was being fed previously, even as an ingredient in the dog food, then that wouldn’t be a good choice.

    I have had dermatologists tell me that itchy dogs of that age should be treated for scabies mites, even if you can’t find them on skin scraping. Revolution (selamectin) applied three times at two-week intervals is what I have seen recommended most often, and it is what I use personally. Sometimes is necessary to rule out the scabies mites as the source of itching.

    Using cortisone tablets, like prednisone, could be tried to see how much it helps, but we don’t usually see the environmental allergies (dust, molds, pollen, etc.) in dogs so young. Food allergies usually don’t respond to medication, so the dietary elimination trial is important.

    There are no hard and fast rules in these situations. If you continue to have difficulties, your veterinarian may refer you to a veterinary dermatology specialist.

    • Lew Olsen says:

      It takes years for dogs to develop a food allergy. A 5 month old dog unless being fed something really terrible would not likely have a food allergy and hydrolyzed food cornstarch reduced to 100% glucose when metabolized. It’s a shame that vets don’t have more of an education on nutrition. Lew Olson, PhD

      • Doc says:

        Hello, Lew,
        Your point of view is in conflict with that of several veterinary dermatologists. They see adverse food reactions in very young dogs. Is this a true allergy? Maybe not, which is why the term “adverse food reaction” is used.

  24. Marilyn Weiss says:

    I have a female Shitzu that will be 13 in August
    and we were told she has a tumor on her lungs
    Lung Cancer!! This came on so fast it’s heartbreaking. He showed it to us on the exray.
    He wanted to put her down that day and we said No!!!!
    Two days later, since she was not suffering at all he gave her a Cortisone shot and send us home to enjoy her for as long as can be.
    She is acting great. Like energized.
    Pees and drinks a lot and eats well.
    What can we expect next? Should we go for
    another shot. Cannot put her down.

  25. doc says:

    Hello, Marilyn,

    It is difficult for me to advise you as there are many things I do not know here (not to mention not having seen either your dog or your X-rays).

    Since she is “not suffering at all”, I was wondering why she had her chest X-rayed.

    If she truly has lung cancer, it is certainly difficult (sometimes impossible) to surgically remove it all.

    Without a biopsy (taking a piece of the tumor to see what it is) you don’t know what type of chemotherapy might help.

    If she has lung cancer and the cortisone makes he feel better, then I’d say “Why not?”

    How long it will last is hard to predict, depends on the type of medicine, and the extent of her situation. The cortisone may be calming down inflammation around the tumor. It also tends to just perk up appetite, relieves your arthritis inflammation, and often “peps you up” (though some few individuals get moody on it).
    There are side-effects with long term repeated usage, but if you’re dying of something else, I wouldn’t be worried too much about that.

    The best person to advise you here is the doctor who is actually seeing your dog. Share your thoughts and concerns with him.

    Best wishes.

  26. Diana Stanford says:

    My dog has severe allergies (dust mites, grass molds, bayberry) and was given a shot of depo-medrol. 20 mg in an 80 lb dog. It has been about 27 hours and she is still scratching, licking, chewing and biting herself. Any idea on how long it takes this stuff to kick in? Poor girl has been wearing a balloon collar for 2 weeks. She was previously on antihistamine, which did nothing to help. How much longer is she going to suffer?

  27. Doc says:

    Hello, Diana,

    You really should contact your veterinarian to give him/her feedback on what is happening.

    We usually see results within 24 to 48 hours. 20mg is not a big dose for an 80-pound dog, however dogs have variable responses. We don’t usually start with the top end of the dose, as it may be too much for that particular patient.

    This is why I personally prefer oral medications, as they are easier to adjust: up, down, or stopping altogether. The long-acting injection is certainly easier for everybody, but it’s harder to adjust things when you aren’t seeing the results that you want.

    80% of dogs do not benefit from antihistamines. Of the 20% that do, sometimes they will have good benefit from one, and zero from others. Dermatologists recommend trying at least 3 different ones before giving up on antihistamines.

    There is a new medicine called Apoquel that works on the itch receptors in the skin instead of trying to stop the allergic reaction. Many (not all) dogs that we have tried this on are having good results. It is a little pricey, especially for a bigger dog. No side-effects noted so far, though.

  28. Diana Stanford says:

    Thank you for the information you provided. The Depo-Medrol kicked in around the middle of day 4. She was good until day 7, then started scratching, licking and biting again. I checked with my vet and found that Apoquel is currently back ordered until April 2015. He gave her an injection of Dexamethasone S.P. 4 mg. today and prescribed Atopica 100 for the next 30 days. Hoping she gets relief soon.

  29. doc says:

    Hello, Diana,
    Atopica has been a good drug for many of our patients. Like cortisone, it does have a suppressing effect on the immune system (an allergy is a malfunctioning, over-active immune system reaction). However, it is generally quite safe, and lots of patients do really well with it.

    You might also ask your veterinarian about bathing to decontaminate the skin, and about products to help the integrity of the natural skin barrier. There are fatty-acid supplements, and topical products that can enhance the barrier function. This helps to keep allergens like pollen and mold spores from getting deeper into the outer skin layer.

    I knew that Apoquel was in a shortage situation, but didn’t realize it was that bad. We’ve still got some, and I hope it will be enough to get us into winter-time.

    Good luck. It sounds like you and your veterinarian are working together, and that’s what it takes.

  30. Diana Stanford says:

    Have you heard anything about Dinovite products? I checked with my vet and he isn’t familiar with the brand. I have a few friends who swear by them. I’ve read good and so-so reviews. None totally negative. I really need to find something to help my dog without suppressing her immune system. Dinovite does offer some of the bathing products and supplements that you suggested. I must say that I’ve found the most help here. I wish you were a NJ vet!

  31. doc says:

    Hello, Diana,

    This was posted on Veterinary Information Network by one of the board-certified veterinary dermatologists:
    I see patients who come in every day that are on Dinovite for their skin condition and it has not helped. But its got great marketing, and I probably don’t see the animals that it “cures….” It is a flavored vitamin/mineral/fatty acid/probiotic supplement, not magic, but may be helpful for some animals. If you buy the whole package, it is not inexpensive.

  32. Cindi says:

    Our Westie 9 kg,, has seasonal allergies. Every summer between August and September she gets skin allergies and rips out the fur around her armpits and chest area. Our current treatment (and only effective one to date) has been the Depo-medrol injections. She gets 3 injections between the months of August and September. The rest of the year she is fine. My question is; what could be the long term effects of this yearly treatment to her system? Could this cause damage to her liver, kidneys, or immune system, etc.. Is there something more effective out there? We have already tried many pill formed steroids and antihistamines. Please advise. Thank you!

  33. Doc says:

    Hello, Cindi,

    I haven’t seen your dog, and do not know the dosage being administered. Thus, I cannot really comment on the effects of your treatment.

    Generally speaking, the standard dose is considered more or less safe to give once every three months. Three injections in one or two months seems like a lot, but again, I don’t know your actual doses.

    If she is receiving no steroids for 10 months out of the year, she probably recovers from their effects.

    Allergic patients are always challenging. We like Atopica (cyclosporine), but it doesn’t work for every dog, and is pretty expensive.

    Apoquel has been great for a lot of our patients. It works on the itch receptors instead of the immune system. Unfortunately, the manufacturer (Zoetis) over-promoted and under-produced. It is on back order until next March (2015).

    You really should ask your veterinarian these questions. Let him/her know that you are concerned and that you would like to discuss the situation.

    The ideal treatment is effective, safe, easy, and cheap. Sometimes we cannot FIND an “ideal treatment” and we make compromises in order to give the patient relief.

  34. Dorothy Scheuer says:

    My 11 year old Shid Tzu has allergies we think from yeast.
    I use Listerine on her to stop the itching, 1/2 a Benidryl and /12 Clemastine Fumarate to try and keep him comfortable. Even give him Salmon Oil. Any other suggstions for yeast infection?

  35. Doc says:

    Hello, Dorothy,

    I know Listerine kills germs, but I’m a little worried about the alcohol in it having a drying effect on the skin.

    Only 20% of dogs get any significant benefit from antihistamines.

    If you have a yeast problem, shampoos with miconazole and chlorhexidine can really help (I like Malaseb). Some dogs need to take systemic anti-fungal drugs by mouth for several weeks (commonly prescribed medicines include ketoconazole, fluconazole, and terbinafine).

    Bad allergies will usually require some type of systemic cortisone to calm the skin while you are getting the yeast under control.

    You really need to talk to your veterinarian about this.

  36. Amanda Marie says:

    I had 21 pills of the generic of medrol for MY cervititis that the doc prescribed me at the hospital. I picked them up and put them in a safe, high place. They are 4 mg each and somehow my pit/lab/chow mix who is 11 or 12 months named Luna got them and I don’t know how much she might have eaten. Will she die? I’m afraid.

  37. Doc says:

    Hello, Amanda,

    I would expect some excessive urination, followed by excessive water drinking.

    There is some risk of stomach ulceration. Your veterinarian could prescribe medicine to protect the stomach, such as sucralfate.

    Single overdoses don’t usually cause long-term problems, according to my reading.

    Your best bet is to consult your regular veterinarian.

  38. sharon says:

    My dog Daisy has a bad rash that won’t go away no matter what kind of medication we give her can we give her steroid Kenalog shot for some relief.

  39. Doc says:

    Hello, Sharon,
    Kenalog is the trade name for triamcinolone. It is sometimes given for relief of allergic itching. The pitfalls with this drug are the same as those described in the original post. You must not exceed a safe dose, and you must not repeat it frequently. It is generally not the best way to manage the condition.

  40. BB says:

    My 10 month old puppy had a depo medrol injection 7 days ago for skin allergies – the increased thirst and urination kicked in almost immediately but in the last 2 days or so he has become lethargic and resistant to playing. Is lethargy a normal side effect? When our previous dog received steroid injections she always became hyper so this result in our little one has me concerned.

    • MB says:

      Did your dog ever get better? Did their lethargic behavior go away? If so, How long did it take? My dog is currently experiencing the same symptoms.

  41. Doc says:

    Hello, BB,

    Sorry about the delay, but I was in Africa for my daughter’s wedding.

    I’m sure that by now you have contacted your veterinarian to let him/her know that something unexpected has occurred. It is certainly not normal for lethargy to develop as you have described.

    Best wishes, and thanks for reading and writing.

  42. Lisa Ostrofsky says:

    My cat had wobbly back legs ,he’s 15 . The vet first said he has a mass in left leg and it’s cancer. She said either a bunch of tests I could not afford and then chemo, maybe amputation. Or putting the cat down. We were devastated. Almost put him down. But then the vet decided to give a free X-ray to be sure. Then she said the X-ray showed a lot of inflammation in the leg and a nymnoid inflamed next to it. But she said it really doesn’t look like cancer on the X-ray. But said she can’t say that 100 percent. So she gave him a steriod shot of Depo 20 mg. and a pain killer Buprenex 0.5 mg.twice a day. The irst day he was a little hyper. His wobbly legs seems a little better. He has been constipated even before the meds. So I changed from strictly dry food to mixing in wet food and pumpkin.before all this he was a big water drinker. Now he’s drinking less. He had blood work that came out all good. But the vet tech said cancer does not show up on blood work. How long does the steriod take to heal his inflammation and that he cold stop wobbly. She said it might have been from a fall I didnt know about. Do you think it might still be cancer.

  43. doc says:

    Hello, Lisa,

    By “nymnoid”, I think perhaps we are actually talking about lymph node. Lymph nodes can become cancerous, and they also can be very inflamed from nearby infections.

    Lymph node cancers will sometimes shrink temporarily with cortisone (like the Depo Medrol).

    The cortisone definitely helps with inflammation, but not with infections.

    Buprenex (buprenorphine) is one of the better choices we have for narcotic-type pain control in cats.

    I am really not in a position to be able to give you specific advice about your cat’s condition, not having seen him.

    Keep your veterinarian informed of your cat’s progress and work through this together.

  44. Jan Mason says:

    My dog has been digging at her butt and floor scooting excessively. Vet said glands seem to be fine…healthy in all other ways. She is miserable. He gave her a cortisone shot but now I am worried after reading side effects. I have switched her to a frozen raw diet…will that help?

  45. Doc says:

    Hello, Jan,

    While many people think that intestinal worms cause butt-scooting, by far the most common cause is anal sac problems.

    In cases where the anal sacs are not the problem, then allergies are the next most likely culprit.

    A single cortisone shot is very unlikely to cause any problems, other than the obvious side-effects of increased urine output, requiring more drinking of water. Increased appetite is often seen, as well.

    Raw, frozen diets are controversial as to their safety. Many nutritionists are concerned about Salmonella bacterial contamination with these diets. The nutritional balance of some of these products is also questionable.

    I think it is unlikely to make any difference in your scooting problem.

    With food allergies, a dietary elimination trial needs to be conducted, and very conscientiously. A simple change of diet is not sufficient.

    Here’s an old post on this:

  46. Susan says:

    8 y/o Aussie with terrible allergies, just went in and had staph infection on skin too from all the scratching and licking. Doctor gave injection of steroid and Apoquel but upon researching it have seen many dogs growing cancerous tumors (due to immunosuppression)…any new literature out about this medicine recentlupy it what are you hearing….my vet said he’s only been prescribing since April and no side effects? I’m very nervous about using it and am trying more benign/natural things now.

  47. Doc says:

    Hello, Susan,

    I have been using the Apoquel ever since it was released, about 18 months ago.

    It is not as immunosuppressive as the corticosteroids, like prednisone, but it certainly can be. We like it for our patients with bad allergies as it has fewer side-effects than the prednisone.

    I would not combine with steroids myself, fearing more likelihood of immunosuppression.

    If you have a staph infection, I would suppose that antibiotics have also been prescribed.

    We have had one patient who has developed a fungal infection while on Apoquel, and we think it likely that the Apoquel contributed to his susceptibility. However, we have had numerous other patients with infection by the same organism who had no known source of immunosuppression, so I cannot really blame the Apoquel.

    I have no personal knowledge of the drug contributing to the development of tumors. The veterinary dermatology specialists on Veterinary Information Network feel that this is in the category of “urban legend”. I would not worry about it.

    If your other remedies are giving the dog relief, that is good. If not, I would have no reservations about using the Apoquel.

    The worst thing for us is that the supply of the medicine has been very inconsistent. We get a patient doing well on it, and then we cannot refill it for them. This has been quite frustrating.

  48. Doc says:

    Hello, Linda,

    I am interpreting your question as 20 mg (not ml) of Depo Medrol for a urinary tract infection.

    With no more information than that, I would say it is unusual.

    There are cats who have what is referred to as an idiopathic inflammatory cystitis. These do not appear to have any bacterial components. They are usually recurring. I have seen numerous speculations about whether they have some sort of latent virus present (not proven, but suspected). I have seen recommendations for reducing the cat’s environmental stress in these cases, and trying to relieve inflammation.

    This is a great link:

  49. George Nawas says:

    Good morning,

    My dog has been itching severely due to some kind of a mosquito bite allergy. He hurt himself before I could take him to the vet for check-up but when I did, the vet told me that it is not infected and that I do not have to be worried. He gave him a cortisone shot (Diprofos to be exact) and told me to expect the side effects: frequent urination and decreased energy for the next 10 days. My dog used to be very energetic but after the shot, he is always down, sleeping, urinating much more frequently (but expected). However, it’s been 10 days since the injection and I am very worried. He is still the same. Does it need more time to leave his body or should I have him checked again?


  50. Doc says:

    Hello, George,

    Diprofos contains betamethasone, a very potent corticosteroid. Its effects could certainly last longer than 10 days. I have used this drug in the past, but not for several years, and it was a different preparation of the drug. Thus, I cannot say what is usual for this medication.

    Since your veterinarian expected things to be improving at 10 days, you should let him know your concerns.

  51. Heather Kay says:

    I have a 5 month old Dalmation mix puppy. He has had a bad case of Demodex then had a second skin scraping that showed them all dead. however is skin was still very red, itchy and patches of thinning hair. The vet I took him to recommended a depo-shot. I agreed and since then he has urinary frequency and dripping. Is there anything I can do to help this and how long will it take to get out of his system. He has never had accidents like this and I got him when he was 11 weeks old. I am worried and I didn’t need this since he has been such a sick puppy since I got him from the humane society.

  52. Doc says:

    Hello, Heather,

    I would expect the urinary frequency (and the need for more water to drink, because of that) to be pretty noticeable for several weeks. It takes two to three months for all of the medicine to leave the system, but you will probably see few side effects after the first 3 or 4 weeks.

    I hope the mites were truly eliminated, as the cortisone suppresses not only inflammation, but the body’s defense response. If mites are still present, they may begin to cause problems again.

    Other causes of continuing skin irritation could include bacterial or yeast skin infections.

    I used to finish up treatment for demodex mites by continuing until no mites can be found, and then treat for an additional two weeks.

    Some veterinary dermatologist recommend treatment until you get two negative skin scrapings (NO mites, dead or otherwise), one month apart. Three months is considered to be a minimum duration of treatment by some. Four months is certainly not unusual.

  53. sophia says:


    I see many people reporting increased thirst and urination as side effects but my pit bull has been panting heavily since receiving the DepoM shot last week (along with the urination and thirst). I plan to ask my vet about it, but I haven’t been able to yet. Is this a normal side effect or should I be concerned?

  54. Doc says:

    Hello, Sophia,

    The panting is not a common (“normal”?) side-effect, but it possibly could be a result of the Depo Medrol.

    I wouldn’t be terribly worried about panting alone, but definitely contact your veterinarian.

  55. Seamus says:

    I’m searching for the injectable Vetalog. It’s the only cortisone shot that works for him. He gets it at the start spring, just one shot during the warmer months and it lasts in his system until the cooler days. They offer it in tablet form but the injection is easier to manage.

    If you can help advise at all I’d really appreciate it.

    Thank you

  56. Doc says:

    Hello, Seamus,

    Talk to your veterinarian about this. The generic term is triamcinolone. I cannot prescribe medication for an animal where I have not physically examined it.

  57. Vanessa Pietsch says:

    I have a 3yr African Boerboel. She had an injection of this for itching. As soon as it was given in her left hind leg, the leg began to shake. Then in March the leg started to get patch of hair that was discolored and she began to limp. I thought like in humans the tissue was effected and needed to be treated with saline to dilute the medicine. Has this been seen in dogs before? I can’t find any info on this. I took her for a second and the vet said the muscle is gone! What do I do?

  58. Doc says:

    Hello, Vanessa,
    I do not have a good answer for you. One might speculate that some of the injection reached the sciatic nerve. If this nerve is damaged, then you could certainly lose function of some muscles, and they would shrink from none-use.

    This is something that is unusual, and I don’t know how it could really be sorted out at this point.

    I would seek the advice of a veterinary orthopedic specialist.

  59. Dora says:

    I have a 10 yr old mixed breed who started limping on her rear left leg. The vet did x-rays to make sure there were no growths. The Vet said it could be arthritis. She was treated with 500mg of Methocarbamol for 2 wks & when we returned for followup he took her off that med & gave her a Depo-Medrol injection (20mg). Her back leg seemed much better during the 1st 5 days, but now she’s again limping. She’s still going thru the drinking, urinating & bowel problems but I’m not having issues with that. Should I call the Vet again or should I wait longer. It will be a week in 2 days since the Vet gave the injection. I was also told that I could use the Tramadol that he gave me earlier for pain if needed.

  60. Doc says:

    Hello, Dora,
    Methocarbamol is prescribed as a muscle relaxer. Often dogs with back problems have muscle spasms due to pinched nerves and the methocarbamol helps relax this. It is not usually sedative. It’s method of action is not well understood.

    Depo Medrol will provide substantial levels of cortisone in the dog’s system for at least two months, and highest in the first weeks. It should NOT be combined with NSAIDs (aspirin, carprofen, rimadyl, previcox, meloxicam, metacam, deramaxx).

    It IS compatible with the methocarbamol and with Tramadol (a mild narcotic painkiller). Cortisone type drugs are potent anti-inflammatory drugs, but not really anti-pain.

    If she is already having difficulty again, you should certainly contact your veterinarian about it. If he/she doesn’t hear from you, the assumption would be that everything is going great. Give your doctor some feedback.

  61. Steph says:


    Is 3ml a normal dose for the depo shot? My dog is 73 pound Weimaraner/Black lab mix. Also it is normal for him to be lethargic after taking getting the shot. He got it 2 days ago. To treat an allergic reaction on this about. He was also give clavamox with it which we stopped because he was vomitting after each time taking it. And how long should the increased thirst last ?

  62. Doc says:

    Hello, Steph,

    I cannot speak to the dose. It would depend on which type of cortisone and what strength.

    Most dogs feel pumped up after getting cortisone, but it is possible to get moody.

    The increased thirst is a secondary result of producing more dilute (thus more volume) urine. They have to drink the water to make up for the loss. The duration is variable. If it is a long-acting, high dose, then the excessive urination and water drinking could last for several weeks.

    Let your veterinarian know what you are dealing with. If the dog needs antibiotics because he has damaged his skin from scratching, there are other choices if he cannot keep down the Clavamox.

  63. nihal says:

    hi, i have a 5yr old female lab who has a cyst in her hand. she was taking oral steroid but even with very small dosage she is drinking and panting a lot. then the vet injected the cyst with steroid. does the injection have any side effects as the oral steroid? thanks

  64. Doc says:

    Hello, Nihal,
    Usually, the small amount injected into a lesion doesn’t have the whole-body side-effects. It is certainly possible that you will see some whole-body effects, but I would expect them to be less than with the oral, or with a long-acting systemic injection (versus local)

  65. christy l burrell says:

    I have a 6 month old Puggle,He had an allaergic reaction to something 2 days in a row the first visit ti the vet he was given a Benadryl injection and Dexamethasone injection,the second day he was given a Kenalog injection.Im wandering about the side affects of these medicines,should i use charcoal to remove the toxins?

  66. Doc says:

    Hello, Christy,
    Activated charcoal can act as an adsorbent (kind of a “chemical sponge”) to bind toxins in the gut. If you use a preparation that is safe for people and use a smaller dose, it should be harmless.
    If the problem was an insect sting, I doubt that there are any toxins in the gut that the charcoal would help with.
    So many times we are unable to determine the source of the allergen.
    Kenalog is a long-acting corticosteroid (cortisone) injection that stays in the body for weeks, where the dexamethasone lasts only a couple of days.
    Antihistamines like benadryl are often helpful for something like an insect sting, even though most dogs don’t get much relief from them in regard to allergic itching.

  67. Phillip Vamvas says:

    My 10 month Old lab mix was giving a Depo shot And a 500 mg cephalexin pill six days after having a routine spay and passed away. We are looking for answers and are very distraught about this.

  68. Doc says:

    Hello, Phillip,

    I can understand why you would be distraught.

    Neither of those drugs would be expected to cause any kind of severe reaction.

    Spays are only routine for the surgeon, and then only if he/she has done lots of them (as most veterinarians have). For the dog, it is a very major operation, the complete removal of a major organ system through what is an abdominal exploratory operation.

    The operation gets trivialized in the public mind because it is so common, and because it is underpriced. As it is such a heavily price-shopped procedure, veterinarians feel pressured to stay competitive in pricing the surgery.

    There is nothing minor or routine about it for the dog.

    Post-operative complications are unusual, but they do occur. If I had lost a patient 6 days after surgery, I would wish to do a post-mortem to try to determine the cause.

    Twice (in forty years) I have had spay patients begin to hemorrhage severely from the vagina more than a week after their sutures were removed and the their incisions apparently were well healed.

    I think the medicines were not likely to have been the cause.

    I find that very few clients are willing to have a post-mortem done, even when I volunteer to do it at no charge. They just don’t want to contemplate what it involves. Unfortunately, that leaves us stuck in a mystery, which I hate.

    I am sorry for your loss.

  69. Dee says:

    Our Jack Russell was given a Kenalog shot on 5/29/18 for allergies. The next day she began peeing and very thirsty. It has now been 7 days and I am wondering how long this will go on. Should I not let her drink so much water especially at night. She gets up and down 5-6 times. I have pee pads all over the floor which she misses a lot. I asked the vet if there is any thing I should do and he said she should stop peeing so much soon. Is this true? Should I take her to another vet, or will this get better in time?

  70. Doc says:

    Hello, Dee,

    The Kenolog (triamcinolone) injection usually lasts about two weeks.

    Cortisone-type drugs (like this one) frequently cause the dog to produce a more dilute urine. This means more water leaves the body. This will happen even if you cut back her water. Cutting back her water access would result in her becoming dehydrated. Don’t do that.

    I think your veterinarian’s assessment is accurate. Unfortunately, unless the allergy is very seasonal (something in the air now, but not later), the itching will come back about the time that the peeing settles down.

    There are other options that are pretty much free of side-effects, like Apoquel tablets or Cytopoint injections, or allergy testing and desensitization injections. They are also more pricey, but not terrible.

    If the itching comes back, ask your veterinarian about other options.

  71. Brittney Day says:

    I have a 6 year old golden retriever. He weighs 65 lbs and he was given 60 mg of depo medrol for allergies and mild arthritis from possible acl tear. During the first few weeks he developed a mass on his lower jaw. Then a few week later developed ulcers on his cheek. A fews after that he developed a mass on his left testicle and one on his right paw in between webbing. He’s drinking constantly and his skin is dry. His elbows are callused and bleeding and he didn’t have this before the shot. We tested his cortisol and creatinine ratio for introgenic cushings and came up negative but he has blood in his urine and no uti. Wish I would have never given this drug and I feel the dose he got was too high for his weight. Not for sure if my dog has renal failure, cancer now or both because I feel his immune system got compromised.

  72. Doc says:

    Hello, Brittney,

    I am sorry to hear about your dog’s problems. I do not believe the cortisone could cause any type of cancer.

    The masses should be biopsied.

    If the dog were harboring a bad infectious organism, like the systemic fungi that cause Blastomycosis or Histoplasmosis, suppressing the immune system even a little can allow those germs to take off like a rocket. They can still be treated, but it is more difficult because of the immune suppression, and treatment may not be successful. It is often unsuccessful even in patients who have not had any immunosuppressive drugs.

    The excessive urination is an expected thing with the cortisone, and he needs to drink water to compensate. It isn’t iatrogenic Cushing’s, just the most common side-effect of the drug.

    The urine should be cultured to rule out bacterial infection. You can also test for the fungi with a urine specimen sent to Mira Vista labs, but a biopsy of the lumps is what I would recommend.

    Without seeing your dog and knowing the case, I can only make general comments. The veterinarian who is seeing your dog is the one best equipped to answer your questions.

    Best wishes.

  73. Brittney says:

    Is 60 mg of depro medrol for a 65 lbs dog correct for skin allergies and minimal arthritis? I feel like after reading everything online, it is high and immunosuppressive.

  74. Doc says:

    Hello, Brittney,

    I haven’t seen your dog, but a one-time dose like that wouldn’t bother me a lot. I wouldn’t feel comfortable repeating it in less than three months. If the dog needs continual allergy management, I would be more comfortable with oral medicines that I could adjust easily. Cytopoint is a newer approach that has no side effects, and can last one to two months.

    If this is a lifelong problem, then you would probably be happiest if you had allergy testing done, and then hyposensitization therapy (treatment with tiny doses of what you are allergic to in order to build up a tolerance).

  75. Ashley says:

    If a dog gets a depo shot, and starts having more irritation or more itching, is it safe to give them Benadryl? I took my 75lb dog to our local vet because his skin everywhere is red as a tomato, with bumps, large flakes of skin falling off constantly no matter how much he is brushed, and his hair is falling out. I was worried it was mange. They said it was just allergies and gave him a depo shot without my consent. And now the condition has continued to deteriorate and he’s itching more. Can I give him Benadryl to help with the itching?

    • Doc says:

      Hello, Ashley,

      It should be safe to give the Benadryl. Since I haven’t seen your dog, you should consult your veterinarian about the dosage. I would also give them the feedback about what has happened so that they know there are additional problems to handle. Dogs with allergies frequently have skin infections along with it, and these need to be treated, as well. They itch, so treating only part of the problem won’t get you where you need to go. If your doctor doesn’t get the feedback, they think everything is great. You need to let them know what has happened so that they can help handle this problem.

  76. Anja Glavač says:

    Hello Doc,

    our 7 year old lab had a (on surface) surgery. He had a keratosis on his left elbow in a size of walnut, which was thinner at the root and then wider out. We did not want to remove it until he scratch it off accidently. We decided to get the surgery done. After surgery he received 500 mg Synolox 2 times per day and some pain killers.

    Here is the second problem. Our boy is allergic since he was a puppy and he has regular ear infections (we regularly rinse his ear with cleaning spray ), he is scratching almost every day and the most severe symptoms that are really hard to watch is his obsessive paw licking and biting. (we soak his paws after every walk with anti-fungus soap and then dry it).

    Since receiving Synolox his symptoms dramatically increased (biting and licking paws). The other dog symptoms were: hard breathing. We call the vet and told him what is happening, so he decided to stop, that he might be allergic to it. The surgery was on Monday 5th of July and we stopped with Synolox yesterday. Since the symptoms were still present, we take the dog to the vet and he received Cortisone shot and Prednicortone 20 mg pills which he can start to take 12 h later after the shot.

    Could you please tell me is this a coincidence that the dog which is allergic since pup had a bad allergy, right in this bad moment when he is recovering from surgery or he really might be allergic to Synolox? We are really considering to do the allergic tests…

    • Doc says:

      Hello, Anja,

      The Synulox is an antibiotic, a combination of amoxicillin and clavulanic acid, usually very good for infected skin wounds. I wish that I could answer your question properly, but both situations are possible. Since he has has long-term allergic problems, the flare-up with the Synulox could be just a coincidence. The only way I can think of to really tell would be to give him another dose once this calms down and see if he has a similar reaction.

      A veterinary dermatologist doing allergy testing might be able to do a skin test for the medicine along with the other allergens (plant pollens, mold, house dust, etc.).

      If your dog has had long-term allergy problems and ear infections, I think allergy testing would be highly recommended. With such severely affected individuals, they usually are allergic to many things, so you can’t just stay away from them. What you can do is begin a process of desensitizing the patient to the allergens. One builds a tolerance by injecting tiny amounts of the allergens. This can greatly reduce the need for other medications.

  77. Anja Glavac says:

    * I forgot to post: He stopped with all of the medications (painkillers, Synolox) before the Cortisone shot.

  78. Kara says:

    My dog ran an allergic reaction, had no other issue. Vet issued steroid shot. 3 days later my dog now drinks massive amounts of water and urinates herself while sleeping. This is now day 11 or this. Took to vet and ruled out bladder infection. Would like to go back for blood work on kidney. Could this all be because of shot and if so can it be reversed or corrected with time?

    • Doc says:

      Hello, Kara,
      You should contact your veterinarian about this. If they did use a longer-acting cortisone shot, that might be responsible for what you are seeing. I don’t know how to reverse it, but it does get better as the drug dissipates from the body.

      If they did NOT give a longer-acting steroid, then following up with the urinalysis and blood tests would certainly be indicated.

  79. Niko Miller says:

    I have a 6 year old chihuahua who had cortisone injections and was recently diagnosed with Cushings Disease. After treating him for several months on medication Trilostane our new vet realized after researching his records (in my binder) the injections could have possibly caused his Cushings (iatrogenic Cushings ) is this also a possibility with this medication? My dog is now off all medications and will be re-tested in January. However, if this medication might work without this type of side effect.. maybe it’s something to consider? If it’s side effects are the same and prolonged use of the product are the same as what is suspected in my chihuahua after only a few shots maybe it’s something other potential customers should be informed of as well.

    • Doc says:

      Hello, Niko,
      The corticosteroid injections can cause the outward signs of Cushing’s disease if administered too often and at too high a dose. However, with this type of iatrogenic Cushing’s disease, you don’t need the Trilostane. When the cortisone wears off, the symptoms go away.

      If the dog were showing the clinical signs (symmetrical hair loss without itching, weak muscles, sagging abdomen, excessive urination and thirst), it would be well to know how long it has been since the cortisone was given. If more than a couple of months, the clinical signs are unlikely to be related to the steroid. I am assuming that basic blood chemistries have been done and that diabetes mellitus has been ruled out. Occasionally patients who receive too much corticosteroids develop diabetes and require insulin to control their blood sugar. Patients with sugar diabetes have excessive urine output and thirst, too.

      Even with DepoMedrol, I would expect most of it to be gone on 3 months. Triamcinolone in a couple of weeks. Dexamethasone in a few days.

      I don’t know how long or what drugs, or how long ago, so it’s hard to say when you need to do your testing. I don’t have experience with how long the Trilostate would be affecting results, and would be consulting a specialist on that (which your veterinarian may have already done).

      I’m certainly not an endocrinologist, but at some point I would be doing a low-dose dexamethasone suppression test as a screening test for Cushing’s, and repeating all the basic blood-work at that time.

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