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

After Darcy's transfusion last week and her bout with pancreatitis, the specialist took her off the Azathioprine and lowered her Prednisone to 5 mg. a day. Since she came home last Friday morning, she's acted like she feels great --- eating, barking, running around, sleeping in the bed with us, just like the old Darcy. Her PCV after the transfusion was 38% and had dropped to 26.5% when I picked her up on Friday. Her gums and inside of her ears have been pink, but not as pink as they should be. However, last night they turned a nice shad of pink. I was thrilled! Today I spoke with the vet about the Cyclosporine. The test revealed that her levels were low, so the specialist has increased the dosage from 50 mg. a day to 100 mg. a day. Darcy is in the 26 - 28 pound range. I will start with the extra dosage this evening. I mentioned to the specialist how pink Darcy's gums and ears were last night and that the weren't so pink today. She said that she'd probably just been flush, like humans get flushed sometimes. She is so negative! I'm still trusting in God that her bone marrow has started making new RBCs. I know that the Azathioprine can supress the bone marrow and cause anemia, so I'm thinking it's a good thing that she's off it and that her Prednisone has been lowered. I take her back to the specialist on Wednesday for a check of her PCV and her thyroid level. Please remember us in your prayers. Thanks, Karen

Karen NC

Dear Chris and Darcy, Thinking and praying for continued success. Hang in there Darcy!

Karon SC

Thank you Karon and all the others who are praying for Darcy. I remember all of you in my prayers, too. Darcy's blood test today revealed that her PCV level had dropped from 26.5% to 23.5%. Not so good, but she acts like she feels great, is barking her head off wanting more and more food. Last week the specialist received the Cyclosporine level results and at that time she told me that Darcy's levels were low. She had been on 50 mg. per day. Today the specialist said that the test showed NO Clyclosporine. We increased her dosage this Monday evening. She is now on 100 mg./day. The specialist said today that if this doesn't work we may have to go to the name brand. I just got off the phone with the pharmacy. They told me that the generic form has exactly the same ingredients as the name brand, the difference being size, shape, or color of pill. Now I don't know what to think. If Darcy doesn't respond to the Cyclosporine, I may opt to remove her from all the meds (she's also on 5 mg/day of Prednisone and Soloxine) and take a holistic approach. Any thought on this? Karen

Karen NC

Weird! The only generic that is different is Sandimmune. Changing from Neoral/Atopica to Cyclosporine shouldn't make a difference. I'd be curious to know why they think that. I wonder if you should have the capsules themselves tested? 100 mg a day for a dog her size is a big dose so I hope this kicks in. I would be very leary of going off of everything. That's just me though. I guess the way to look at it is this; you need to decide what is right for her (and you). If something drastic happened either way, you need to be prepared and not second guess yourself or make yourself nuts with guilt. Be sure to talk to your doc about your feelings over this too. Remember, you pay the bills and it is your pet..so, you make the calls as to what you need from your doctor. Best of luck :)

Courtney SLO

Karen, Good luck with the cyclosporine. I know there was a discussion about this several weeks ago on this site. Our Internal Medicine doc said she felt the generic did not get absorbed as well so we went with the name brand Atopica since that is specially formulated for dogs. It was expensive - a little over $400 for Alex's size. The next med if this didn't work would cost anywhere from $20-$50 a day for his size. That is not an option for me. I don't know of anyone who has taken a holistic approach but I admit it's crossed my mind a time or two I've just been afraid to do it. Chris

Chris PA

The box of Cyclosporine Capsules that I got at Costco has a brand name "barr" at the top. The front of the package reads: CycloSPORINE Capsules, USP [MODIFIED]. There is a warning: "CycloSPORINE capsules, UPS [MODIFIED] is NOT BIOEQUIVALENT to Sandimmune. Do NOT use interchangeably without a physician's supervision." At the bottom of the package it says that Sandimmune is a registered trademark of Novartis Pharmaceuticals Corporation. When I called the Costco pharmacy, they said that Neoral is the brand name for Cyclosporine. Now I see Sandimmune on the box. I can't figure out what the brand name is, who the manufacturer is, which version is best for my dog, etc. The cost for 120 - 25mg softgel capsules is around $112. Does any of this sound familiar to anyone or can anyone shed more light on this drug? Thanks, Karen

Karen NC

Karen, The box of cyclosporine that Tipsi's meds came in was yellow with the brand name Atopica on the top of it. Atopica is specifically formulated for dogs. You may want to see about switching Darcy to this brand. Tipsi had terrific results with Atopica. As always, I am keeping you and Darcy in my prayers! Layla & Tipsi

Layla Brantley Raleigh

Karen Maybe you could get the phone number for Barr Laboratories and in the mean time I would try to get some new Cyclosprine for Darcy. Keep us posted. Lots of hugs and prayers going your way. Cheryl & Ginger

C heryl & Ginger Pineville PA

The Costco pharmacist just phoned and explained that the Cyclosporine that I'm giving Darcy is indeed the generic for Neoral. He said that it could be something about Darcy's makeup that is the reason she wasn't absorbing the Cyclosporine (tested for that last week) or that the dosage hadn't been high enough. I questioned him about Atopica, and he had not heard of it. I guess this means that it's available only through the vet. I have a call in to the internal specialist, so I'll see what she has to say about whether or not we should keep trying the higher dose for a while. The thing that bothers me about that is that, in order to test her levels, the sample must be sent to the State University lab and they wait until they receive a batch of samples before they do the testing. This means a period of at least a week before the specialist receives the results. I did question Dr. Dodds about how many transfusions are too many and she replied that a dog could have as many as needed to reverse the problem. Darcy was just so pitiful after the last transfusion and it can't be completely ruled out as causing the pancreatitis. Such a dilemma that I am in! Please pray that I'll make the right decisions for Darcy and that the specialist will also do the right thing. Thanks, Karen

Karen NC

Karen, I once posted when I was fighting about feeling like I was between the devil and the deep blue sea. It is such a hard disease to fight. I know that you will make the right decisions for your dear Darcy. I am keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Thank you Penny. I just spoke with the vet and she straightened me out about the Cyclosporine. Darcy is getting the right thing. I questioned her about Atopica and she said it was Cyclosporine, too, and that she doesn't think it would be any more absorbable than what she's on now. I take Darcy back on Tuesday for a retest of PCV and they'll test her Cyclosporine levels then. I told the specialist that the thoughts of putting Darcy through another transfusion scares me and she said that it scares her, too. So, there you go. If her PCV drops to a dangerous level, I'll have a difficult decision to make. I'm praying that the Cyclosporine will kick in soon.

Karen NC

I found out that different places charge very different amounts for the same drugs. If you shop around online you can compare prices. I found out that I could save a lot of money by going to entirelypets.com, but another member of this forum got Atopica for even less than I had from a different online pharmacy. Atopica IS expensive, especially if your dog needs 200 mg/day like my girl does. However, the cost can be brought down by shopping around! Ruth

Ruth Aptos

Hi Karen, Sorry to hear about Darcy but I certainly hope she is doing better. My dog Spencer had a transfusion too I guess vets all have their own professional opinion. Spencer was on pred, Atopica(cyclosporine) and Azathioprine. Spencer had severe diarehha on cyclo. but finished it off and no longer takes it. He still on pred and aza. and is doing better. Our vet told us that aza. is the lesser evil compared to the cyclo. Spencer's blood count has been increasing which we are thrilled everytime his blood count comes back. What an emotional rollercoaster we've been on the past 2 months since his diagnosis as I'm sure you can relate to the rollercoaster feeling. I wish you and Darcy well and keep us posted... Shannon

Shannon FL

This thread was discussed between 13/10/2008 and 16/11/2008

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