Addison’s disease in dogs is treated with lifelong hormone replacement, typically a combination of two medications: one to replace mineralocorticoids (which regulate sodium and potassium) and one to replace glucocorticoids (which help the body handle stress and maintain energy). With consistent treatment, the prognosis is excellent. Dogs diagnosed with Addison’s disease have a median survival time of about 5.7 years after diagnosis, with many living to 11 years old or beyond.
What Addison’s Disease Does to Your Dog
Addison’s disease, or hypoadrenocorticism, means your dog’s adrenal glands no longer produce enough of two critical hormone types. Mineralocorticoids keep sodium and potassium in balance, which is essential for heart function, blood pressure, and hydration. Glucocorticoids help the body respond to stress, regulate blood sugar, and support digestion. When both drop too low, dogs become lethargic, lose their appetite, vomit, develop diarrhea, and can collapse during stressful situations. Some dogs have a subtle form where only glucocorticoids are deficient, which makes the condition harder to catch because standard bloodwork may look normal.
Emergency Treatment for an Addisonian Crisis
If your dog is in crisis, meaning they’ve collapsed, are severely dehydrated, or have a dangerously slow heart rate, this is a veterinary emergency. The immediate priority is aggressive IV fluid therapy to restore blood volume and correct the sodium/potassium imbalance. Saline solution has traditionally been the go-to fluid, though many veterinarians now prefer balanced crystalloid solutions that also help correct the acid buildup that accompanies a crisis.
Your dog will also receive injectable glucocorticoids right away to replace the cortisol their body can’t make. If blood sugar has dropped too low, dextrose is added to the IV fluids. Dangerously high potassium, which can cause fatal heart rhythm problems, may need to be brought down with insulin to drive potassium back into cells, followed by dextrose to prevent a blood sugar crash. Blood glucose is monitored every 30 to 60 minutes until it stabilizes.
Most dogs respond dramatically to crisis treatment. A dog that came in barely responsive can often be eating and walking within 24 to 48 hours. Once stable, the focus shifts to the long-term medication plan that will prevent future crises.
The Two Medications Your Dog Will Need
Mineralocorticoid Replacement
The cornerstone of Addison’s treatment is replacing the mineralocorticoid hormones that keep electrolytes in balance. About 80% of veterinarians in a large European survey prefer an injectable medication called desoxycorticosterone pivalate (DOCP, sold as Percorten-V or Zycortal) as their first-line choice. The standard starting dose is 1 mg per pound of body weight, given as an injection every 25 days.
The alternative is fludrocortisone, a daily oral tablet that has both mineralocorticoid and some glucocorticoid activity. Some owners prefer it because it doesn’t require vet visits for injections. However, veterinarians who have tried both options tend to switch patients to DOCP over time. In the same survey, 44% of vets reported transitioning at least one dog from fludrocortisone to DOCP, primarily because DOCP produced faster normalization of electrolytes, better clinical stability, and improved owner compliance (since you only need to remember an injection roughly once a month rather than daily pills). Cost can be a factor, though. DOCP injections, especially for larger dogs, tend to be more expensive, which is one reason some owners stick with fludrocortisone when their dog is responding well to it.
Glucocorticoid Replacement
Most dogs with Addison’s disease also need a small daily dose of prednisone or prednisolone to replace cortisol. According to the American Animal Hospital Association, many dogs do well on less than 0.1 mg/kg per day, and 0.25 mg/kg per day is enough for virtually all clinically stable dogs. This is a very low dose compared to what’s used for allergies or inflammation, so side effects like excessive thirst and urination are typically minimal.
If your dog is on fludrocortisone, the built-in glucocorticoid activity may be enough on its own, and a separate prednisone prescription might not be needed. Dogs on DOCP almost always need prednisone as well, since DOCP only replaces the mineralocorticoid side of things.
Adjusting for Stress
One of the most important things to understand about Addison’s disease is that a healthy dog’s adrenal glands naturally ramp up cortisol production during stressful events. Your dog’s adrenals can’t do this anymore, so you need to compensate. The AAHA guidelines recommend doubling or tripling the daily prednisone dose before known stressful events. This includes boarding, travel, surgery, dental cleanings, visits to a busy veterinary clinic, or even a household disruption like moving or hosting a large gathering.
If your dog starts showing Addisonian symptoms between scheduled doses, such as loss of appetite, lethargy, vomiting, diarrhea, or bloody stool, that’s a sign the current glucocorticoid dose isn’t keeping up. Increasing the dose and contacting your vet promptly can head off a full crisis.
Monitoring and Bloodwork Schedule
After diagnosis, your dog will need frequent blood tests to fine-tune medication doses. The key measurement is the sodium-to-potassium ratio in the blood. A normal ratio indicates the mineralocorticoid dose is right. If potassium creeps up or sodium drops, the dose or injection interval needs adjusting.
Expect bloodwork at roughly two-week intervals during the initial stabilization period, then at each DOCP injection visit (every 25 days) for the first several months. Once your vet finds the dose and interval that keep electrolytes consistently normal, monitoring typically stretches to every three to four months. Some dogs end up needing their DOCP injection slightly more or less often than every 25 days, and the only way to find your dog’s ideal schedule is through this monitoring process.
The DOCP dose can often be reduced over time. Many dogs stabilize at a lower dose than the starting amount, which also brings the cost down. Your vet will gradually taper based on bloodwork rather than making large changes all at once.
What Treatment Costs Over Time
Addison’s disease requires lifelong medication and regular blood monitoring, which adds up. The biggest variable is your dog’s size: a 70-pound dog needs significantly more DOCP per injection than a 20-pound dog. Monthly costs vary widely depending on your location, the medication chosen, and whether a generic DOCP is available, but you should expect ongoing expenses for the injectable or oral mineralocorticoid, daily prednisone (which is inexpensive), and periodic blood panels. The initial stabilization period with more frequent vet visits and bloodwork is the most expensive phase. Once doses are dialed in, costs become more predictable.
Long-Term Outlook
The prognosis for a dog with well-managed Addison’s disease is excellent. In a recent study of 66 dogs, those treated with DOCP had a median survival time of 5.7 years after diagnosis, and the median age at death was 11 years, with some dogs living to 17. Dogs with the atypical form (normal electrolytes, only glucocorticoid deficiency) fared similarly, with a median survival of 5.6 years and deaths occurring around age 11 to 13. These numbers reflect dogs dying of all causes, not just Addison’s complications, meaning many of these dogs lived out a normal canine lifespan.
The critical factor is consistency. Missed DOCP injections or skipped prednisone doses can trigger a crisis, sometimes within days. Most owners develop a reliable routine quickly, and once you’ve found the right dose and schedule, day-to-day life with an Addisonian dog looks remarkably normal. Many dogs return to full energy, healthy appetites, and their usual personality within weeks of starting treatment.