Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cyclosporine dose

OK everyone has convinced me to start the cyclosporine. With Darren's help and by changing some other drugs we will be able to try it. I am very excited but I have a few questions. What is the typical dose when starting cyclosporine? Ruger weighs 36.9 kilos. Everything I read on the internet is the dose for dermatitis of 5mg/kg. Ruger's Dr. has him starting on 10mg/kg. Is this too high? or is this normal for AIHA? Do most of you give it with food or without? She wants me to start it with food but everything I read says to give it without. What are your experiences with it? Any insight is much appreciated. Thanks!

Jaime Parker

Jaime, This is Dr. Dodds's recommendation in the past: "Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs." 37kg * 10mg = 370mg SID (once a day by mouth) for one week. 37kg * 5mg = 185mg SID (once a day by mouth) thereafter. I would try it with a light meal as it can cause gastrointestinal problems like diarrhea. You can watch for things like that. Those are the most serious side effects in the short term. Long term side effects tend towards unusual skin problems, but are not common. I personally noticed that Chance would act "spaced out" when he was on high doses (220mg) so you can watch for that. It seems harmless and wanes around 2-3 hours. Dr. Dodds also had us pulse dosing, using it Monday through Friday with Saturday and Sunday off. It was very effective dosing for his non-regenerative state and he responded very well within about 3 weeks or so. It certainly surprised not only my local vet, but also the specialist. my best patrice

Patrice NYS

Jaime, I should add the "going home" dosage, sorry. This would be considered at week 3 going forward if there has been a good response. "Continue cyclosporine, if needed originally, at 2.5mg/kg SID" 37kg * 2.5mg = 92 mg (Once a day by mouth) Do some math when you are buying your Atopica so you don't end up with a lot of 100mg caps left over at this point. It might mean using two 50mg caps for a bit, but will allow you to use up what you have.

Patrice NYS

Patrice, Thanks for the info. That makes me feel tons better. I was worried the dose was too high. Hopefully it works to stop the spherocytes!

Jaime Parker

Good luck Jaime. I hope this is what turns Ruger around. Please keep us posted on his progress. Samantha & Millie.

Samantha Geelong Australia

There's one thing I never really understood and that is why in the protocols she recommends the cyclo be taken once daily and not twice daily. The drugs has a half life of only 19 hours so shouldn't it be taken twice daily for full effectiveness? Plus, IF you wanted to do trough testing to check the levels it has to be done right before the next dose is to be taken. If this is done 24hrs after the dosage then of course the levels will be much lower...wouldn't they? Just a thought really. If htis is the case and you are giving the cyclo only once daily I would recommend not even having the trough test done and rather monitor the absolute lymphocyte count until it reaches 1/3 of the normal range. Then the drug should be adjusted slowly to maintain these counts. I'm pretty sure that Dr. Dodds doesn't even bother with the trough tests and uses the lymph counts instead....but you should ask her or your vets. This is only an opinion. Most of the people I know taking the drug take it twice daily though. Johnny & Tessy

Johnny

Hi Jamie and Rutger I took the information below from the Meisha's Hope website thought it might help you. Cyclosporine has revolutionized organ transplantation in humans since its introduction in 1983. It has also been used in autoimmune diseases in humans and now is starting to be used in veterinary medicine for the treatment of autoimmune diseases, such as autoimmune hemolytic anemia. It is very important to measure blood cyclosporine levels when the drug is being used.The therapeutic range for cyclosporine is from 300-500 ng/ml (nanogram/milliliter). One reason that frequent blood testing is necessary with cyclosporine is that there can be a great deal of variability in its absorption. One dog may absorb a larger percentage of the prescribed dosage then another. Cyclosporine concentration blood tests called trough tests are not able to be done "in-house" at veterinary clinics nor do most outside labs run cyclosporine levels. Trough tests are usually sent to veterinary teaching hospitals, to be run. The blood for the trough test must be drawn at the exact time a dosage of cyclosporine is scheduled to be given. This allows the lowest amount of cyclosporine in the body to be measured on the trough test. Since cyclosporine saturates the tissue, the dosage may need to be adjusted from time to time, another reason trough testing is so important. Because cyclosporine interacts with a variety of other drugs it should be used with caution with other medications. To get the full benefit from cyclosporine the dog must be on a very strict feeding and dosing schedule. The diet must be consistent without any deviations in amount, type of food or feeding time. Because cyclosporine has a half life of only 19 hours it must be given every 12 hours. Cyclosporine is sold under many brand names including Neoral, Gengraf and Atopica. Ginger took a 100mg 2x a day, once every 12 hours and I was told not to give it with food or her thyroid meds. from what I remember the thyroid meds may interfere with the cyclosporine. She never had to have the trough test as her PCV went from 28 to 35 after a month of being on it. Good luck and make sure you give it a few weeks to begin working. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Thanks everybody. Ruger is taking 200mg twice a day. I am going to ask about the trough tests as they are expensive as well and if they are not necessary then why do them. So far he is tolerating it well. No vomiting, still eating well but he is getting some wierd multi colored diarrhea. Hopefully it is just from the meds and will subside. I cannot find canned pumpkin anywhere. The grocers told me it is because of a bad crop this year but suggested the canned butternut squash. Not sure if this would help. Anybody ever tried that instead? Wish I would have stocked up on the pumpkin but who knew? Thanks again.

Jaime Parker

Jaime, glad to hear Ruger is tolerating the Cyclosporin. Strange about the pumpkin. Keep looking at otherstores. Just make sure it is plain pumpkin and not the pie filling. I think squash would work as well, it is the fiber that you want. Maybe you can cook your own squash, would be cheaper. I fed cooked beets, about 2 tbsp grated, they were always a hit. Best wishes, Brigitte

Brigitte BC Canada

I found canned pumpkin at a pet food store, so you might want to check there. Cheryl & Ginger

Cheryl & Ginger Pineville PA

There was a run on pumpkin here because of news of pumpkin shortage. Have you tried health food stores if you have those. I would try some cooked oatmeal, that has a lot of fiber. Glad to hear Ruger is tolerating the meds so far Laurie

Laurie CA

This thread was discussed between 31/01/2010 and 01/02/2010

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