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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Advice on Tapering
| Hello all, Today I met with my vet about Indy's latest blood test results - HCT up to 33%! Weight also up to 24 lbs but that is another story. My vet wants to drop Indy's Prednisone dosage from 30 mg a day total to 15 mg per day. I am unhappy with this and worried about relapse. She says that because he is also on Azathioprine and it is starting to work well, that it is ok, and she is concerned about the side effects of the Pred. In my mind, I would think that 25 mg/per for 2 weeks and then a re-check is more mine and Indy's speed. Especially since he's gained 6 lbs, so 20mg=20lb dog is similar to 25mg=25lb dog. What are your thoughts on this? I definitely do not plan on dropping to 15 mg until the next blood check, I think the lowest I would be comfortable with is 20mg/day. {I am not a huge fan of my vet if that hasn't been made evident. But I feel like the devil I know is better than the devil I don't, plus I feel like I have gotten this far with her, and it is very close to my home so going to the vet weekly/bi-weekly is not a big deal} Also, I have attached Indy's recent blood results: https://docs.google.com/fileview?id=0B1UO3XMy1SZCM2RjOWY5MTktMWIwYS00NDNkLTkzNjAtNjZkNzk0Zjc5YTFj&hl=en&authkey=CM-etYgC You can see this time and last time. And for reference you can find his older ones here: http://picasaweb.google.com/lsreid/IndySBloodTests# Thank you!! :) |
| Indysmom Pittsburgh |
| Indysmom, I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased. “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA |
| Joanne MN |
| I am no expert and I am sure you will get reponses from others with more knowledge than me. Our specialist also wanted to reduce the Prednisone by 50% which I was not comfortable with. I have ulcerative colitis which is also an autoimmune disease and I have been on Prednisone many times. My colitis doctor would freak if I weaned by prednisone by 50%, slow weans have always worked best for me. The only time I have weaned faster is if I started on a super high dose, but that is just the first wean to get the dose down then start the slow wean. My regular vet agreed with me and we chose to do a slow wean. We weaned Calypso similar to what Johnny wrote. When we were on 30mg we weaned 5mg every 3 to 4 weeks. Rechecking a hemoglobin before weaning again. Once we got down to 10mg I think we weaned by 2.5mg Best wishes, Wendi |
| Wendi Ohio |
| The vets at U of I would not let us lower anything until Buster's PCV was normal for at least 2 weeks. They told us a relapse is harder to get under control. That being our biggest fear, we decided to take their advice and go slow and steady. So far, so good. Good luck with whatever you decide is best for you and Indy. Prayers, Ronda and Buster |
| Ronda Illinois |
This thread was discussed between 21/09/2010 and 22/09/2010
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