Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cyclosporin

Our vet did call this evening and said that Internist wanted to start Holly back on Cyclosporin 35mg twice a day, and stop the azathioprine. She is beteween 14-15lbs. Just wondering if this is similiar to what others are taking. Linda

Linda Sapphire

Linda - that must be the pill form right? Cecil had to take the liquid form of Cyclosporine. It was when he sterted on cyclosporine that he really turned the corner. I hope the same for Holly . . . Barbara

Barbara Portland

Since the hospital stopped Trixies azathioprine in tablet form and started her on Zantac (liquid form) close to 3 weeks ago, she has certainly improved. She is now regenerating red cells and they are remaining, her wbc are back to normal also. Tricia

Tricia UK

Linda, If you choose this route ask for cyclosporine in the veterinary form as Atopica manufactured by Novartis. It is a higher quality form of cyclosporine and more easily dosed to canines (comes in a nice capsule). Your cost may be a little higher, but Holly is small and it won't break the bank. According to the Novartis product information page dosage is 5mg/kg. This is when it is prescribed for atopica (or dog inhaled allergies). Dosage for AIHA is considered experimental and Novartis will not recommend dosages for this drug for this purpose. Chance's highest dosage was 225 mg once daily m-f, sat and sun off, as per Dr. Dodd's recommendations for pulse dosing. He is 100lbs or approx. 45 kg. So 5mg times 45 kg equals 225 mg per day. As he improved we lowered this dose and finally reached 25 mg m-f. This week we finally dropped the Atopica completely. So if Holly is 15 lbs. she is approx. 7 kg. So 5 mg times 7 kg equals 35 mg per day. That would be one 10 mg and one 25 mg capsule *one* times a day. If your internist feels that Holly should start at the higher dose of 35mg *two* times a day (double the dose) dosage then she probably has clinical experience to back that up. Again, there is no drug industry standard for the dosage of Atopica for use in AIHA. I know that this drug saved Chance's life so I am always very optimistic when I hear someone being prescribed this med. Some people on this forum have not had a good response with this med, including diarrhea and other digestive upsets. The important difference with this drug versus prednisone is that it modulates or suppresses the immune system with a different mechanism. This means there are fewer dangerous side effects. Prednisone is the drug that is causing so many different problems like liver impairment, muscle wasting etc. You won't see these with Atopica. What I did see in the way of side effects was that Chance seemed "spaced out" when he was getting his high doses of Atopica. He would lie very still and stare into space for about an hour after his dose. As we reduced the dosage, this went away. I was also grateful for the weekends off. Perhaps you could ask your internist about this pulse dosing regimen that Dr. Dodds uses. That would mean 35 mg two times daily Monday through Friday with Saturday and Sunday off. I would think that if Holly stabilizes your internist would recommend lowering the dosage a little at a time. Patrice

Patrice New York State

Hi Patrice, Thanks, I have printed up so I can understand how they figure out the dosage. When she first came out of the hospital last March the discharge instructions for the cyclosporin (liquid)were: Cyclosporin 100mg/ml: Give 0.14ml by mouth three times a day, but at that time whe was around 12lbs, maybe less because of throwing up for two days just prior to her release. So that is why I was confused on exactly what dosage that was. After about 2 months when we ran out of the liquid, we then had the pills compounded at the same dosage. How do you figure the kg for their weight? I know when Holly was on the cyclosporin last year, she had no problems with getting sick and her numbers were improving, but then a trough test was done and the internist said we could switch to the azathioprine because it was more of a therapudic drug. But once we started it, I had my doubts because her WBC always ran so low and we had a hard time mainting her retic count. Thanks again, Linda

Linda Sapphire

Also forgot to mention, that the pharmacy where they compounded it say it was pure, but now our vet is checking around and might be able to get a months supply of the liquid formula for around $70. Linda

Linda Sapphire

Linda, To figure out the kg from pounds open Google. In the search engine type "convert 15 pounds to kg". Google will automatically convert for you. This works for anything you want to convert! Lovely feature that eliminates thinking... Dr. Dodds originally recommended the liquid form of Cyclosporine as Sandimmune. Now she seems to recommend the Atopica (in capsules), probably because we had a great deal of trouble finding the liquid in Rochester. Our vet suggested the Atopica and we were so successful with it, Dr. Dodds has it on her list now. I asked Dr. Dodds about the trough test because I was prepared to do that. She told me not to bother with it. She said if there was clinical response, it would indicate efficacy. Humans seem to have a much more variable response to cyclosporine and so I believe that is why the trough test was recommended. In humans, the greatest use of this drug is in organ transplantation to avoid rejection. Doctors would want to make sure that the meds were effective, otherwise the patient would reject the new organ. Since you have already used this drug and Holly's numbers seemed to improve you probably have the best indication that it was working properly. A trough test is difficult to perform, the results are variable and subject to interpretation. The theory is that the level in the blood should be at a certain level when it is at the "lowest" possible level of the day. Someone on this list, who is a vet tech, was going to do a much more comprehensive test, taking blood samples through the day, to see if this trough test was really representative of the blood levels. I don't know what her results were. The fact that Dr. Dodds allowed us to pulse dose (m-f and sat sun off) leads *me* to believe that it isn't absolutely necessary to have a constant level in the blood for the drug to be successful in suppressing the immune system (in this case a particular type of lymphocytes). patrice

Patrice New York State

Linda, I have somewhere... a report indicating that Atopica is considered one of the purest forms of cyclosporine available. This information from a conversation I had with someone on this list about 3 months ago. Check the archives. She had been using a form of the drug she was buying from Canada that ended up being not pure enough and wasn't effective enough. This owner wasted several months of treatment for her dog before finding this out. I found a report on the internet that talked about how dangerous this was to humans in organ transplantation. p

Patrice New York State

Okay, Patrice, thanks, and I will wait to hear back from Dr Dodds. Thanks for all your information! Linda

Linda Sapphire

This thread was discussed between 02/02/2008 and 03/02/2008

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