Vetnuus | November 2023 16 « BACK TO CONTENTS IMMUNOMODULATORY DRUGS Core List 1) Glucocorticoids (see endocrinology, neurology and gastrointestinal systems) The recommended molecules for dogs and cats using the oral route of administration is prednisolone. Dexamethasone can be used iv when the oral route is compromised. 2) Immunosuppressive drugs (azathioprine, cyclosporine/ ciclosporin, mycophenolate) Immunosuppressive drugs can produce different levels of immune suppression or immune regulation to treat different immune-mediated disease or some inflammatory disorders (i.e. myasthenia gravis, immune-mediated haemolytic anaemia or thrombocytopenia, skin diseases, inflammatory bowel disease, polyarthritis, systemic lupus erythematosus, etc.). They should not be used interchangeably. These therapies are generally used in combination with corticosteroids or used more in one species versus the other (i.e. azathioprine is only used in dogs and not recommended for cats, where chlorambucil is an alternative). Cyclosporine is licensed for the management of canine and feline atopic dermatitis and for topical use in ophthalmology for the treatment of keratoconjunctivitis sicca in dogs. Other than cyclosporine, these agents are not licensed veterinary medicines. Complementary list 1) Oclacitinib This drug is used for the treatment of canine atopic dermatitis and allergic skin disease. 2) Tacrolimus This drug is used in specific conditions for immunosuppression. In ophthalmology, the drug is used for keratoconjunctivitis sicca refractory to treatment with other immunosuppressants/ immunomodulators. NEUROLOGY Core List 1) Antiepileptic drugs (phenobarbital/phenobarbitone, iv, PO; pentobarbital iv; diazepam iv) Phenobarbital and diazepam are recommended as first-line antiseizure treatment in dogs and cats. Pentobarbital is a barbiturate that can be used as an antiepileptic, but also as an agent for euthanasia (see anaesthetic, analgesics, sedative and emergency drugs). 2) Dextrose For emergency treatment of hypoglycaemia and fluid supplementation in case of acid–base disturbance associated encephalopathy (see anaesthetic, analgesic, sedative and emergency drugs). 3) Glucocorticoids (dexamethasone iv; prednisolone PO) Glucocorticoids have anti-inflammatory and immunosuppressive properties depending on the dose. Injectable and oral formulations of dexamethasone are available; oral prednisolone is associated with lower prevalence of adverse effects in longterm therapy. Prednisolone is the preferred steroid in cats (see anaesthetic, analgesics, sedative and emergency drugs, gastrointestinal, endocrinology and immunomodulatory therapy). 4) Osmotic diuretic (mannitol) Mannitol is indicated to reduce brain oedema and intracranial pressure. It has an advantage over hypertonic saline because it does not require monitoring of electrolyte levels (see anaesthetic, analgesics, sedative and emergency drugs). 5) Thiamine Supplementation of thiamine or vitamin B1 is required in cases of deficiency in dogs and cats (in anorexic cats; inadequate diet; exposure to meat containing excessive sulphites). Complementary List 1) Antiepileptic drugs (imepitoin, potassium bromide, levetiracetam, gabapentin and pregabalin) Multi-antiepileptic drug therapy is often required as refractory cases of epilepsy are not uncommon. Potassium bromide is inexpensive and can be used in dogs with hepatic dysfunction. Loading doses of potassium bromide are required to reach a steady state faster. Loading doses are associated with a higher prevalence of adverse effects. This drug should not be List of essential medicines for cats and dogs <<< 15
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