Using Stanozolol in the treatment of Canine Tracheal Collaspe

This is a repost... USING STANOZOLOL IN THE TREATMENT OF CANINE TRACHEAL COLLAPSE

LISA SMITH WEBER·MONDAY, MAY 4, 2020·15 MINUTES

By Lisa Smith, Owner and founder of the Rusty Pug Retirement Ranch, a sanctuary rescue home for geriatric, special needs and hospice pugs since 2007.

Many thanks and my eternal gratitude to the best vet ever, now retired and moved so very far away, Dr. Paul Zimmer. The only vet who could ever put up with and support my constant push to try new things in hopeless situations. The pugs and I miss him so much. He was irreplaceable.

I am not a vet. Advice contained herein is not meant to replace the advice of a veterinarian.

Here at the Rusty Pug Retirement Ranch, we use stanozolol to treat collapsing trachea. Matilda was the first dog we treated with it. Thankfully my vet, who was near retirement age, remembered using stanozolol back in the 70's and early 80’s under the brand name Winstrol, for inappetance, anemia, and to increase older or rehabilitating dog's energy and vitality. He knew it had a great safety profile and was not hesitant to give it a shot and prescribe it for us after I presented him with the study referred to in this paper. Stanozolol is an anabolic steroid (NOT TO BE CONFUSED WITH CORTICOSTEROIDS LIKE PREDNISONE it is a totally different thing), and because body builders and athletes have abused anabolic steroids, it is now a controlled substance so most vets, even specialists, are not aware of it for reasons I will get into later. Scientists investigating using it for the human version of CT tried it in a small animal trial - since tracheal collapse in dogs is so similar to the human version (tracheomalacia). In that small foreign trial, all but one dog had their CT either completely reversed or the degree of collapse was improved after a 3 month course of the drug. The effects seem to be lasting. In our case, every dog administered the full, 3 month course, has not required readministering it after the initial 3 month course. The longest time from completing treatment has been almost four years now with Matilda.

Matilda, a senior pug, had severe collapse along almost the entire trachea and we had accepted her into our rescue sanctuary as a hospice. We had her in our oxygen cage at least 2-3 times a week and we did not expect her to live more than a few weeks. She was on all of the usual CT drugs; theophylline, hydrocodone/Tussigon, guaifenesin, prednisone, Lasix, Cerenia and inhalers. Nothing was working well.

Once Matilda started the stanozolol, she continued with all of the other meds as well (including the prednisone) until the stanozolol began to work and she no longer needed them. We withdrew the other meds, one or two at a time, as she improved. After about a month to six weeks, she no longer needed any of the drugs she had been on before.

We first started to notice a little improvement in Matilda at about week 2-3. Since then, she has never needed oxygen again and is now about 14 years old as of the date of this paper.

The dosage my vet prescribed was different than the dose used in the trials I referred to. He used the dosing that he used back in the 70's which was a bit higher and more frequent than the study dosing. Since then, we have noticed that those dogs who have had the best success with stanozolol followed the dose WE used, not the dose from the trial.

We use 2 mg. twice daily for 2 months, tapering off for one additional month for dogs under 20 lbs. Dogs 20-40 lbs. get 3mg. twice daily for 2 months tapering off for one additional month. I have not used it on larger dogs, so am not sure what the dosing would be for them.

Stanozolol is thought to work by re-strengthening the tracheal rings. Because stanozolol is a controlled substance, and not commonly used, it can be difficult to source, especially if you live in Canada or other countries besides the US. Here in the US, several mail order veterinary pharmacies will send it. I use Wedgewood, formerly Diamondback Drugs, in AZ. Your vet will need to have the special certifications to prescribe controlled substances. It is fairly economical. Back when Matilda got it, we only paid about $60 for the full 3 month course. Now that more and more owners/veterinarians have learned about it, it has gone up in price to about $150 or so for the three month course, depending on the dosage and if you are using the standard 2 mg. tablets or having it compounded.

Stanozolol in the huge doses used by body builders and athletes, and in racehorses that are doped for performance, is dangerous to the liver and other organ systems and can cause " 'roid rage". However, the dose used to treat CT in dogs is much, much smaller per pound, and at those doses, has few, if any, side effects. Usually the only things you may notice are an increased appetite, more energy and alertness, and if your dog was anemic, your vet may note improvement in that.

One dog in the study was withdrawn due to liver enzyme increases, but it was not clear if that was due to the stanozolol or other reasons. In use for CT I have noticed that dogs who are diabetic may need to have their insulin adjusted and I would recommend dogs with preexisting liver, heart or kidney failure be monitored while on it.

The reason that stanozolol is not well known in the veterinary world and why it has not (yet) been extensively tested or taught in vet schools is that it is a VERY old drug, and is not eligible for patent protection. Even the process of using it for CT is not patentable as it has been previously described in the animal trial of the human drug study. Drug companies finance the vast majority of research and trials in both veterinary and human medicine. They invest millions in trials. They recoup this investment by having patent protection for the new drug, or the novel use of an older drug. They are able to give it their own brand/trade name that is the only version available until the patent expires and it becomes available under the generic name to be sold by any drug company. I am sure you know that newer drugs are much more expensive until the patent expires and the generic becomes available.

Consequently, there is no financial incentive for drug companies to do the extensive (and expensive) large scale trials and to develop curriculum to teach and promote stanozolol in veterinary schools and continuing education seminars. It is destined to slowly be adopted by grassroots efforts and word of mouth from one vet to another. Additionally, most corporate vet clinics and large multi-vet specialties have established standards/protocols of treatment for each condition or injury and their vets are not allowed much leeway, if any, to prescribe or treat outside of those established protocols due to liability fears of "rogue" treatments driving up insurance/malpractice rates. As a result, the only vets that are usually willing and/or able to try stanozolol on a patient are those who have independently, privately owned practices (and those are getting more rare every day) and older vets, usually 60+ years old, that remember using it before it became a controlled substance and fell out of use in veterinary medicine.

By the way, Matilda, the hospice pug with horrible CT; now 4 years later, is still with us here, and her CT is completely reversed and has remained so all of this time. She is now about 14, and we know time will catch up with her and she will eventually succumb to some process of age or injury, but it isn’t going to be CT that takes her. Since Matilda, I have used it personally on literally dozens of dogs in our care here, and have had excellent results. Not all are completely cured, like Matilda was, but all of mine have at least had good, solid improvement.

Stanozolol will not help other conditions that sometimes occur concurrently or as a result of CT and also cause coughing , such as chronic bronchitis, laryngeal paralysis/collapse, everted saccules, elongated soft palate, congenitally narrowed airways, enlarged heart or tumors that may be pressing on the trachea, congestive heart failure, asthma, etc., but stanozolol has even helped those dogs by relieving the tracheal collapse and making the surgery to fix some of those other problems possible because the trachea is strong again.

Please feel free to contact with questions or to relate your experiences. I am also more than willing to discuss stanozolol with your veterinarian. My email is truckmountgirl@gmail.comand my cell phone number is 951-218-1600. I am located in Southern California.

References:

https://www.researchgate.net/publication/51054374_Conservative_Management_of_Canine_Tracheal_Collapse_with_Stanozolol_A_Double_Blinded_Placebo_Control_Clinical_Trial

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11147&catId=29562&id=3846454

https://www.cliniciansbrief.com/article/tracheal-collapse-dogs

https://onlinelibrary.wiley.com/doi/full/10.1111/jsap.12436

Below is the Plumb’s listing for stanozolol:

Stanozolol

(stah-no-zo-lahl)
Winstrol®-V
Anabolic Steroid (Systemic Drug)

Prescriber Highlights

Anabolic steroid; FDA-approved controlled substance that is no longer marketed in the US. Potentially useful in dogs for medical treatment of tracheal collapse.
Contraindications: Pregnant animals, breeding stallions, food animals. Extreme Caution: Cats, hepatic dysfunction, hypercalcemia, history of myocardial infarction, pituitary insufficiency, prostate carcinoma, mammary carcinoma, benign prostatic hypertrophy, & during the nephrotic stage of nephritis. Caution: Cardiac & renal dysfunction with enhanced fluid & electrolyte monitoring.
Adverse Effects: Potentially high incidence of hepatotoxicity in cats. Other possible effects: sodium, calcium, potassium, water, chloride, & phosphate retention; hepatotoxicity, behavioral (androgenic) changes, & reproductive abnormalities (oligospermia, estrus suppression).
Category “X” for pregnancy; teratogenicity outweighs any possible benefit.
Drug Interactions; lab interactions.

Uses / Indications

Labeled indications for the previously marketed veterinary stanozolol product Winstrol®-V(Winthrop/Upjohn) included “…to improve appetite, promote weight gain, and increase strength and vitality…” in dogs, cats, and horses. The manufacturer also stated that: “Anabolic therapy is intended primarily as an adjunct to other specific and supportive therapy, including nutritional therapy.” In a review of the evidence supporting anabolic steroid use in horses, the authors conclude: “Level 1 evidence for the efficacy of anabolic steroids in horses for therapeutic uses is not found in the biomedical literature. Evidence in other species exists for the efficacy of anabolic steroids in treating anemia and increasing muscle mass after illness or injury, but that evidence is not unequivocal, and the applicability to horses has not been demonstrated. There is little evidence in other species for the efficacy of anabolic steroids for increasing appetite”.

A study in sheep, using an experimental model of osteoarthritis, found that intra-articular stanozolol reduced osteophytes formation and subchondral bone reaction, and promoted articular cartilage regeneration.

2 Intra-articular administration once weekly to horses with both acute and chronic osteoarthritis improved physical characteristics of synovial fluid as well as lameness scores.

Like nandrolone, stanozolol has been used to treat anemia of chronic disease. Because stanozolol has been demonstrated to enhance fibrinolysis after parenteral injection it may be efficacious in the treatment of feline aortic thromboembolism or thrombosis in nephrotic syndrome; however clinical studies and/or experience are apparently lacking for this indication at present. In humans, stanozolol may also raise plasma antithrombin III and plasminogen levels.

A controlled study in dogs using stanozolol as a conservative treatment for collapsing trachea (without bronchitis), reported that at the end of the study (75 days), 93% of dogs in the stanozolol group had an improvement of the tracheal collapse grade. Eight of the 14 treated dogs were deemed cured.

Pharmacology / Actions

Stanozolol possesses the actions of other anabolic agents but it may be less androgenic than other anabolics used in veterinary medicine.

In the presence of adequate protein and calories, anabolic steroids promote body tissue building processes and can reverse catabolism. As these agents are either derived from or are closely related to testosterone, the anabolics have varying degrees of androgenic effects. Endogenous testosterone release may be suppressed by inhibiting luteinizing hormone (LH). Large doses can impede spermatogenesis by negative feedback inhibition of FSH.

Anabolic steroids can also stimulate erythropoiesis possibly by stimulation of erythropoietic stimulating factor. Anabolics can cause nitrogen, sodium, potassium, and phosphorus retention and decrease the urinary excretion of calcium.

For medical treatment of tracheal collapse in dogs, it is postulated that stanozolol could increase tracheal wall strength via enhancing protein or collagen synthesis, increasing chondroitin sulfate content, increasing lean body mass, and decreasing inflammation.

Pharmacokinetics

In horses (n=26), following a 0.55 mg IM injection of compounded stanozolol suspension, peak levels occur at 7 days. Median half-life was 3-4 days, but ranged from 1.6-14.7 days.5

In horses (n=10), following a 5 mg intra-articular injection into both tarsal joints, a maximum plasma concentration (1.7 ng/mL) was observed 6 hours post-dose. Elimination half-life was between 4 – 12 hours, and was completed cleared from plasma within 36 hours after dosing.

In humans, stanozolol is extensively metabolized by the liver.

Contraindications / Precautions / Warnings

Stanozolol is contraindicated in pregnant animals and in breeding stallions and should not be administered to horses intended for food purposes.

Because of reported hepatotoxicity associated with stanozolol in cats, it should only be used in this species with extreme caution.

The manufacturer recommends using stanozolol cautiously in patients with cardiac and renal dysfunction with enhanced fluid and electrolyte monitoring.

In humans, anabolic agents are contraindicated in patients with hepatic dysfunction, hypercalcemia, patients with a history of myocardial infarction (can cause hypercholesterolemia), pituitary insufficiency, prostate carcinoma, benign prostatic hypertrophy, during the nephrotic stage of nephritis, and in selected patients with breast carcinoma, and used with caution in children due to hormonal effects and possible effects on bone growth.

Adverse Effects

The manufacturer lists only ‘mild androgenic effects’ in dogs, cats, and horses and then only when used with excessively high doses for a prolonged period of time.

One study in cats, demonstrated a high incidence of hepatotoxicity associated with stanozolol use and the authors recommended that this drug not be used in cats until further toxicological studies are performed.

Potentially (from human data), adverse reactions of the anabolic agents in dogs and cats could include: sodium, calcium, potassium, water, chloride, and phosphate retention, hepatotoxicity, behavioral (androgenic) changes, and reproductive abnormalities (oligospermia, estrus suppression).

Reproductive / Nursing Safety

In humans, the FDA categorizes this drug as category X for use during pregnancy (Studies in animals or humans demonstrate fetal abnormalities or adverse reaction; reports indicate evidence of fetal risk. The risk of use in pregnant women clearly outweighs any possible benefit). In a separate system evaluating the safety of drugs in canine and feline pregnancy,7 this drug is categorized as in class D (Contraindicated. These drugs have been shown to cause congenital malformations or embryotoxicity).

It is not known whether anabolic steroids are excreted in maternal milk. Because of the potential for serious adverse reactions in nursing offspring, use with extreme caution in patients that are nursing.

Overdose / Acute Toxicity

No information was located for this specific agent. In humans, sodium and water retention can occur after overdosage of anabolic steroids. It is suggested to treat supportively and monitor liver function should an inadvertent overdose be administered.

Drug Interactions

The following drug interactions have either been reported or are theoretical in humans or animals receiving stanozolol and may be of significance in veterinary patients. Unless otherwise noted, use together is not necessarily contraindicated, but weigh the potential risks and perform additional monitoring when appropriate.

ANTICOAGULANTS (eg, heparin, warfarin): Anabolic agents as a class may potentiate the effects of anticoagulants; monitoring of clotting times/PT’s and dosage adjustment, if necessary, of the anticoagulant are recommended.
CORTICOSTEROIDS: Anabolics may enhance the edema that can be associated with ACTH or adrenal steroid therapy.
INSULIN: Diabetic patients receiving insulin may need dosage adjustments if anabolic therapy is added or discontinued; anabolics may decrease blood glucose and decrease insulin requirements.

Laboratory Considerations

Concentrations of protein bound iodine (PBI) can be decreased in patients receiving androgen/anabolic therapy, but the clinical significance of this is probably not important. Androgen/anabolic agents can decrease amounts of thyroxine-binding globulin and decrease total T4 concentrations and increase resin uptake of T3 and T4. Free thyroid hormones are unaltered and there is no evidence of dysfunction.
Both creatinine and creatine excretion can be decreased by anabolic steroids.
Anabolic steroids can increase the urinary excretion of 17-ketosteroids.
Androgenic/anabolic steroids may alter blood glucose levels.
Androgenic/anabolic steroids may suppress clotting factors II, V, VII, and X.
Anabolic agents can affect liver function tests and liver enzymes (BSP retention, AST, ALT, bilirubin, and ALP).

Dosages (note I did not include dosages for other species)

DOGS:

Anabolic agent per (former) labeled indications: Small Breeds: 1 – 2 mg PO every 12 hours; or 25 mg deep IM, may repeat weekly. Large Breeds: 2 – 4 mg PO every 12 hours; or 50 mg deep IM, may repeat weekly. Treatment should continue for several weeks, depending on response and condition of animal. (Package Insert; Winstrol®-V) Note: Because the product is no longer marketed commercially, all compounded product use is extra-label.

Tracheal collapse: (extra-label): In the study, dogs in the treatment group received 0.15 mg/kg PO every 12 hours for 2 months then tapered for 15 days.4

Monitoring

Androgenic side effects.
Fluid and electrolyte status, if indicated.
Liver enzymes if indicated.
RBC count, indices, hemoglobin, if indicated.
Weight, appetite.

Client Information

May give with or without food; give with food if vomiting or stomach upset occurs.
Can cause behavior changes, including more sexual behaviors.
Cats may be prone to developing liver problems while receiving this medication.
Pregnant women should handle this drug with caution.
Controlled substance in the US. It is against federal law to use, give away or sell this medication to others than for whom it was prescribed.

Chemistry / Synonyms

An anabolic steroid, stanozolol occurs as an odorless, nearly colorless, crystalline powder that can exist in two forms: prisms that melt at approximately 235°C and needles that melt at ≈155°C. It is sparingly soluble in alcohol and insoluble in water.

Stanozolol may also be known as androstanazole, estanozolol, methylstanazole, NSC-43193, stanozololum, win-14833, Menabol®, Neurabol®, Stanol®, Stromba®, Strombaject®, and Winstrol®.

Storage / Stability

Stanozolol tablets should be stored in tight, light-resistant packaging, preferably at room temperature.

Compatibility / Compounding Considerations

No specific information noted.

Dosage Forms / Regulatory Status

VETERINARY-LABELED PRODUCTS: None.

Winstrol®-V tablets and injection were previously marketed. Stanozolol may be available from compounding pharmacies.

The ARCI (Racing Commissioners International) has designated this drug as a class 3 substance. See Appendixfor more information. A pharmacokinetic study concluded that following a single IM injection (0.55 mg/kg) of stanozolol suspension in exercise-conditioned Thoroughbred horses, a withdrawal guideline of 60 days is recommended.5

HUMAN-LABELED PRODUCTS: None.

References / Revisions

Reviewed and updated by James A. Budde, PharmD, FSVHP, DICVP. Last update September 2017.

Fajt VR, McCook C. An evidence-based analysis of anabolic steroids as therapeutic agents in horses. Equine Veterinary Education. 2008;20(10):542-544.
Spadari A, et al. Effects of intraarticular treatment with stanozolol on synovial membrane and cartilage in an ovine model of osteoarthritis. Res Vet Sci. 2013;94(3):379-387.
Spadari A, et al. Clinical Evaluation of Intra-articular Administration of Stanozolol to Manage Lameness Associated With Acute and Chronic Osteoarthritis in Horses. J Equine Vet Sci. 2015;35(2):105-110.
Adamama-Moraitou KK, et al. Conservative management of canine tracheal collapse with stanozolol: A double blinded, placebo control clinical trial. Int J Immunopathol Pharmacol. 2011;24(1):111-118.
Moeller BC, et al. Pharmacokinetics of stanozolol in Thoroughbred horses following intramuscular administration. J Vet Pharmacol Ther. 2013;36(2):201-204.
Romagnoli N, et al. Disposition of Stanozolol in Plasma After Intra-articular Administration in the Horse. J Equine Vet Sci. 2016;47:16-19.
Papich M. Effects of drugs on pregnancy. In: Kirk R, ed. Current Veterinary Therapy X: Small Animal Practice. Philadelphia: Saunders; 1989:1291-1299.
Williams B. Therapeutics in Ferrets. Vet Clin NA: Exotic Anim Pract. 2000;3:1(Jan):131-153.
Ivey E, Morrisey J. Therapeutics for Rabbits. Vet Clin NA: Exotic Anim Pract. 2000;3:1(Jan):183-216.
Clubb SL. Therapeutics: Individual and Flock Treatment Regimens. In: Harrison GJ, Harrison LR, eds. Clinical Avian Medicine and Surgery. Philadelphia: W.B. Saunders; 1986:327-355.
Gauvin J. Drug therapy in reptiles. Seminars in Avian & Exotic Med. 1993;2(1):48-59.