Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - cyclosporine

Does anyone have any experience with lowering the dosage of cyclosporine? My 5 lb dog has been on 10mg twice a day for 4 months now and I would like to go to once a day. My veterinarian is not taking much interest( or maybe doesn't know) and won't return my call about this matter. We lowered the Pred and have been completely off that now for 8 weeks and her PCV has been holding at 38 for 6 weeks. Everthing else is perfect for the CBC. I would like to start the cyclosporine by going from twice a day to once aday and see what happens. Any ideas? I don't want to keep her on a high dose if she doesn't need it. Thanks

Kimberly Florida

Kimberly - My vet initally cut my dogs cyclo. when we reached "normal" levels to a once a day dosage -- in the morning. I don't know if that helps, but good luck! Jenelle & Monster

Jenelle Pueblo

Kimberly, We had Holly originally on cyclosporin but then found out through a trough test that her body was not absorbing it, so her internist told us to stop cold turkey and after that we switched over to aziathoprine (Imuran). We did not have to do a slow decrease on the cyclo like the prednisone. How are your dogs retic count is it normal range? Linda

Linda Sapphire

Her last blood draw was 11/15/2007 and it was a full panel. The hemoglobin was 12.2 (12.0-20.00 NORMAL) the PCV was 39.7, RBC 5.92 ( 4.5-9.3 normal) platelet count 399 ( 170-400 normal) white count perfect. 10/30/2007 PCV 39, RBC 5.6, platelet 388 10/16/2007 PCV 40.2, RBC 5.7, platelet 402 10/9/2007 PCV 35, RBC 5.0, platelet 380 Just taken off Pred completely 7 days ago 10/02/2007 on pred and cycl PCV 39.9, RBC 5.6, platlet 396 SHE HAS MAINTAINED GOOD NUMBERS AFTER THE TRANSFUSION ON 8/4/2007.SHE IS DOING GREAT.AGAIN THE DR DIDN'T CALL ME BACK....ITS BEEN 10 DAYS AND I HAVE LEFT 4 CALLS SO I WILL DO THIS ON MY OWN I GUESS. ALL I WANT TO KNOW IS IT SAFE TO CUT HER DOWN TO 1 CYCLOSPRINE A DAY FROM 2. Thanks. Kimberly

Kimberly Florida

I believe a trough test is recommended prior to decreasing the dosage. That is a special test where the blood is analyzed to determne the absorption of the cyclo. A regular CBC result will not tell you. Just as Linda stated Choe also was taken off cyclo a few months ago after about 8 months on it when his CBC results dropped and it was evident the cyclo was not piggybacking to hold up his counts. (His hct did, fortunately go back up with an increase of pred). Why don't you ask for a trough test beore you change the dose? Jan

jan philly

Is there any other vet in the clinic avaiable for you to speak with? Geez, that's disgraceful that no one calls you back. Can you shw up in person and demand to see a 'person.' Burns you up big time.

jan philly

Cyclo just about killed Shadow - she had a much more adverse reaction to it than she did to prednisone. Every dog reacts differently to the "standard" AIHA cocktail. You need to find a vet who will listen and talk to you - no matter at what hour you call him/her. This disease exacts its toll on dogs and the people who love them. (How many hours have any of us slept since our dogs were diagnosed? - TOO FEW is my guess!) Shadow's local vet has never once refused a call - even when, when I thought Shadow was crashing again - I called her at 9:45 at night, and her dad - who has been fighting leukemia for two years (we live in a small town, so everyone knows everyone else's business)- answered the phone and said Sheila (Shad's dr.) was asleep, but he'd wake her up. That's what this disease demands - and this forum provides: people who understand and will respond at any time, any hour, any day. I'm sorry I don't have any answers for you or your friend. It does sound to me as if s/he has been on a HUGE dose, given her weight, of cyclo. I (and Shad's vets) thought it was a challenge to treat a 20-lb dog, given the dosages in which the "cocktail" was avaiilable. How the heck do you treat a 5-lb dog and what size pill splitter do you buy? Best wishes to you and teen-incey. Sandly & Shadow

Sandy Utah

Kimberly, The only thing I would be concerned about at this point is the reticulocyte count. This is where the anti-bodies that attack the red blood cells are monitored. Even thought Holly's PCV has been holding normal range for the last several months, but of course we have had her still on prednisone, her retic count started to rise which meant the antibodies were still there and attacking her red blood cells. We had been down to 2.5mg of prednisone every third day, but because her retic count went above normal range the internist wanted her back at 5mg prednisone a day. Have you had a reticulocyte count done to see what it is at? Is your Dr in and just not returning your calls? Or are you just leaving messages, maybe out of town? Like Jan said maybe you could just go there in person and demand to see the Dr. I would! Linda

Linda Sapphire

Kimberly, We started on cyclosporine at 225 mg (100 lb dog) as per Dr. Dodds instructions. Once a day m-f and off s/s. We decreased it gradually once the pcv and his condition both showed good results, and not at the same time as any prednisone decreases. We waited 3 weeks between any decreases, did a complete blood count. We are now down to 50mg once a day m-f, off s/s. We use atopica so it was tricky to avoid sometimes dropping the dosage more than the recommended 25-30%. We are waiting now to drop again but want to get the prednisone dose regulated to 5mg eod. Your numbers look excellent, how is her general condition? Putting on lost weight and muscle? Hair growing back? Good appetite? Exercise tolerant? Participating in the household and happy to be around you? Is she taking longish walks without trouble? All these things tell us in our household that Chance is doing just fine. I can actually tell the vet what I think the numbers will be even before they draw blood. And his numbers are not as high as yours are. We don't believe they ever will be as he had his spleen removed. Are you giving this dose every day? Dr. Dodds advised us to pulse dose from the very beginning, mon - fri, sat sun off. Could you try this? Dropping from 20mg to 10mg is a 50% decrease. I would hesitate to do this. But dropping to a m-f dose would lower the weekly dose by 40mg. That would be a very good start. Try that for a few weeks, do another cbc and then decide if you can drop down to 10mg a day. The pulse dosing has been very safe for us. patrice

Patrice New York State

Yes. 10 mg twice a day every day for 4 months.Thank you so VERY much. Your right. I will start by doing M-F and skipping S/S. Since she has been off the Pred completely she is doing great. Hair. Man has she grown hair. She is a Pomeranian mix, 5lbs and is all hair. Runs, plays, eats good, doing great. She NEVER lost any weight or muscle tone through all this. her PCV to start was 6 and she had 1 transfusion. Thanks again. I feel so much better. I will try that for 2 weeks and then do the CBC and go from there. Kim

Kimberly Florida

Jan,no he is the only internal medicine vet around here. I wish there was someone else in the practice I could talk to. Tomorrow I am off work so will go stand outside the door and see what they say.For now I'm going on what Patrice has advised. Thanks. Kim

Kimberly

This thread was discussed between 30/11/2007 and 02/12/2007

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