Abstract
Budesonide is a potent glucocorticoid and weak mineralocorticoid that has reduced systemic effects due to high first-pass hepatic metabolism.1 Oral formulations are used to treat irritable and/or inflammatory bowel disease (IBD) in humans, domestic dogs and cats.1,2,3,4 Oral budesonide was used to successfully manage a bottlenose dolphin (Tursiops truncatus) with ultrasonographic lesions suggestive of IBD. Treatment was initiated at 0.051 mg/kg daily for 2 weeks, then tapered slowly to the lowest dose that prevented recrudescence (0.014 mg/kg three times weekly). Oral budesonide resulted in clinical improvement in two additional dolphins with liver disease and anorexia and one beluga (Delphinapterus leucas) with gastrointestinal disease. During therapy, liver enzymes decreased in all three bottlenose dolphins, consistent with findings in humans.3
Although systemic glucocorticoid effects of budesonide are decreased compared with traditional corticosteroids, suppression of the HPA axis has been observed in humans and dogs.1,5 Baseline serum cortisol in the beluga was below detectable limits after treatment at 0.06 mg/kg for 10 consecutive weeks and remained below detection until the dose was tapered to 0.018 mg/kg for five weeks. Bottlenose dolphins produce low levels of corticosteroids in the absence of renal exhaustion, and commercially available cortisol assessment was not sensitive enough to evaluate the effects of budesonide.6,7 While budesonide appeared effective for management of liver or gastrointestinal disease in bottlenose dolphins and belugas, more cases are needed and investigation of the effects on the HPA axis is recommended.
*Presenting author
Literature Cited
1. Plumb DC. Plumb’s Veterinary Drug Handbook. 9th ed. Wisconsin: PharmaVet Inc.; 2018:192–194.
2. Angelucci E, Malesci A, Silvio D. Budesonide: teaching an old dog new tricks for inflammatory bowel disease treatment. Curr Med Chem. 2008;15:2527–2535.
3. Miehlke S, Barreiro-de Acosta M, Bouma G, Carpio D, Magro F, Moreels T, Probert C. J Gastroenterol Hepatol. 2018;33:1574–1581.
4. Dye TL, Diehl KJ, Wheeler SL, Westfall DS. Randomized, controlled trial of budesonide and prednisone for the treatment of idiopathic inflammatory bowel disease in dogs. J Vet Intern Med. 2013;27:1385–1391.
5. Tumulty JW, Broussard JD, Steiner JM, Peterson ME, Williams DA. Clinical effects of short-term oral budesonide on the hypothalamic-pituitary-adrenal axis in dogs with inflammatory bowel disease. J Am Anim Hosp Assoc. 2004;40:120–123.
6. Houser DS, Champagne CD, Jensen ED, Smith CR, Cotte LS, Meegan M, Booth RK, Wasser SK. Effects of oral megestrol acetate administration on the hypothalamic-pituitary-adrenal axis of male bottlenose dolphins (Tursiops truncatus). J Am Vet Med Assoc. 2017;251(2):217–223.
7. Houser DS, Wasser S, Cockrem JF, Keller N, Romano T. Variability of hormonal stress markers collected from a managed dolphin population. Defense Technical Information Center Archive: DTIC AD1014234. National Marine Mammal Foundation, San Diego, CA, USA. 2013.