VetNet®
VetNet® AIHA discussion forum
VetNet® Forum
Lifelong Learning Network
www.vetnetlln.ac.uk
Veterinary Recruitment
Premier Partner Program
Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cut dosage already?
| When Cookie was diagnosed last week the vet gave us instructions to start cutting the prednisone after a week. She wants her to stay on for only 6-8 weeks. She's currently on 2 10mg tabs twice a day. She would go down to 1.5 tabs twice a day starting Friday. The cyclosporine would stay the same (it is at 100mg once a day, and she is to stay on that for 6-8 months) But I feel like it's too soon? I don't even know if her PCV is going up yet (I think it has probably gone down, actually) At the same time, I think maybe the vet wants to minimize the negative affects and that would be nice but not if it compromises her life (already the muscles in her head are wasting away; it's so bony, and her eyes are wandering) |
| Monet Sammamish |
| Monet, It is too soon to reduce the prednisone. The prednisone has barely even had time to start to work since it takes 5-7 days for it to "kick in". I have seen the mistake of prednisone being cut too much too soon and it is the dog who suffers for it. 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 I personally have real trouble with any vet who says at the onset of this disease how long he wants on a dog on prednsione since he has no idea how the dog will respond. |
| Joanne MN |
| Hi Monet, Although I am a fan of dropping the first time early, in your case you are on a more reasonable dose to start. I also think some decent level of recovery is required. I did not wait as long as some would like me to have waited, but prednisone was working hard in Dylan and it could be dropped, but she had a great recovery and stablized quickly. I did not decide this ahead of time. Unfortuantly that is not how I see Cookie's case, yet. But I do think getting prednisone down to a more reasonable dose for immune suppression, once there is recovery is important to maximize recovery. If cyclosporine is really working, prednisone can be removed more quickly, but you need to be careful in doing so and there is no fixed schedule. Fixed schedules are scary with this disease. I agree with Joanne, any vet who thinks this can be treated on a fixed, predetrmined schedule has no idea of what they are up against. They will help the easy ones, but not necessarily the harder ones. You need to drop prednisone when the conditioons are right, not because of some artificial timeline. Each reduction takes time to make sure they stablize from the changes and that they are improving and not worsening. In some dogs this takes longer. Some think I dropped Dylan too quickly, but I was always sure of what was happening. Even so, she is not free and clear yet. I have to keep a close eye on her for signs her improvment has stopped, or she is relapsing. I expect her recovery to continue higher yet, or I would think something has stopped it. I would be very concerend about hurrying without good reason. You are very right about the negative side effects of prednisone. Reducing it as soon as possible, knowing either that cyclosporine is working, and as in Dylan's case, strong and stable recovery. Eyes wondering is more likely an effect of Cyclosporine, I think. It is better to suffer some loss from prednisone in the short term if the disease is present and in Cookie's case it is clearly still present. They can recover from prednisone once it is lowered and removed. They may not recover from AIHA. Good luck to you both, Richard and Dog Dylan |
| Richard Burnaby |
| Has the crit gone up? Several factors play into this decision. If it were me I WOULD NOT want to reduce yet. She on a lower than normal dosage of pred to begin with. If the crit hasn't gone up then discuss upping this to 50mg daily (25mg morning and 25mg evening). ALSO, I realy think the cyclosporine dosing should be changed. Cyclo has a half life of around 16-19hrs so almost all vets/specialists recommend giving a split dosage BID and *NOT* SID. I'd consider upping this dosage to 150mg total daily so that you can give 75mg in the morning and then 75mg 12hrs later in the evening. The dosage change of course would depend on the numbers and if cookie is responding to the current protocol. Lots of HUGS, thoughts and prayers, Johnny & Tessy |
| Johnny |
| Monet, Hope this finds Cookie doing better!! Have you had testing done again? Johnny, Its so odd....my specialist started Mr. B on cyclo once a day at the beginning. After reading YOUR comments about its half-life, I questioned my regular vet, who put in a call to the specialist....I was told to change it to twice a day, and we upped his dosage as well. So far, still waiting for him to stabilize. Keep fighting, Monet and Cookie!! Sally and Bentley |
| Sally Louisiana |
This thread was discussed between 28/07/2011 and 30/07/2011
Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index
This thread is from the Vetnet archive. The live Vetnet forum is active now.
