Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Are we on the right meds?

I am wondering if my bulldog Chloe is on the proper meds/dosage and would like to ask your opinions. About a month ago she was diagnosed with a PCV of 20. She was taking Prednisone 80 mg. per day and doxyclcine. Her PCV continued to rise from 20 to 22, 26, and then 30. At which time my vet cut her Prednisone to 20 mg. per day. A week later she was low again (never did find out the number) with diarhea and vomiting. She had a blood transfusion when her PCV fell to 14..and when her pcv rose to 21, they let her come home from the hospital. So her pcv from yesterday is 20 and they will be checking her again tomorrow. Today, my vet added another med to her regimen - Imuran. So here is what she is on presently: (1) Prednisone 80mg. per day (she is a 54 lb. dog) (2) Imuran 50mg. per day (3) Pepcid AC 1 tablet per day Do you think these meds/dosages are correct? I have an apointment with a specialist on 3/31, I hope and pray that Chloe can hold on that long, and that these meds will work..

My Chloe Michigan

At which time my vet cut her Prednisone to 20 mg. per day. ****edited**** Sorry, I meant to say 40mg. per day.

My Chloe Michigan

The least amount of prednisone a dog should be on at the oneset of the AIHA/IMHA is 1 mg per pound of the dogs weigh per day. Many vets will give an even higher dosage at the onset of the disease. I have seen some dogs who have been given up to 3 mg per pound per day. Imuran is given at a dosage of 1 mg per pound of the dogs weight per day at the onset of AIHA/IMHA. I personally would be fine with the dosages of both drugs you are giving at the present time if Chloe were my dog since you are givng 1.5 mg of pred for each pound of weight and just about 1 mg of Imuran per pound of weight. It should be noted that according to the Veterinary Drug Handbook, it can take up to 6 weeks to see a clincal response with Imuran. We do see that drug start to work sooner in some dogs but in some dogs it can take the full 6 weeks to "kick in". To see what has worked in terms of treatment options for other dogs you might want to read the SUCCESS STORIES pages at the Meisha's Hope AIHA/IMHA Web site: http://www.cloudnet.com/~jdickson/successstories.htm

Joanne MN

Just to be safe I would add Sulfacrate to help protect her stomach from the beginning. I did not, and my dog had a perforated ulcer from the high dose prednisone. Good Luck, Ron

Ron B San Mateo

Ron, how long should my dog be on Sulfacrate?

My Chloe Michigan

I am posting a link to information about Sucralfate specifically for dosing with canines. We used it before each dose of prednisone approximately 1.5-2 hours before the meal on an empty stomach. It can interfer with medicine absorption so it's very important to keep that time space before giving meds. We continued to use it until we were around the 10-15 mg prednisone dosage daily. But we continued to use pepcid before meals after that. Once we reached about 5mg pred a day, we dropped both. Patrice http://www.petplace.com/drug-library/sucralfate-carafate/page1.aspx

Patrice NYS

We are still giving Holly 1/2 sucralfate in morning and 1/2 in evening at least 1 hour before any other meds and she is down to 4mg prednisone. But about 2 months ago, she was throwing up for 4 days and we thought maybe a bleeding ulcer starting because she has been on prednisone for 1 year now.

Linda Sapphire

When Chloe's PCV rose to 30 a few weeks ago, should my vet have reduced her medication at all at that time? Or should he have waited 2 weeks? I read on another thread that when a dog is "stable" for 2 weeks - then reduce meds by 25% For the past week, Chloe' PCV is 20. Will she be able to recover after the relapse?

My Chloe Michigan

Well in our case Holly starts to slide down if we try and reduce the pred to fast, so we usually wait a month before each reduction and test each time prior to the reduction. Yes her PCV will go back up but you will need to up the prednisone again to hold her stable. Like I said Holly has been fighting for 1 year this month and still is not out of the woods and still on prednisone and Imuran. So it can be a long and expensive roller coaster Linda

Linda Sapphire

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: "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 from a publication that is several years old this is the prednisone reduction schedule that many of the veterinary teaching hospitals use when dealing with AIHA/IMHA. As you will see this info says “Once the disease is in remission, the dose of prednisone can be lowered " and so forth. At a PCV of 30 a dog is NOT in remission. Redcuing the pred too soon and giving a too low dosage at the onset of the disease is a mistake that far too many vets make when dealing with AIHA/IMHA. Sad to say it is the dog who will suffer for these mistakes with relapses. Yes, Chloe CAN recover from this relapse. If you have not read the Success Stories at the Meisha's Hope Website http://www.cloudnet.com/~jdickson/successstories.htm I urge you to do so when you can. Many of these dogs have had relapses and have recovered from them as they did the intinal epsoide.

Joanne MN

PS. As Linda said, it is important to test before each pred reduction to make sure a reduction is warranted.

Joanne MN

This thread was discussed between 20/03/2008 and 23/03/2008

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