Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - drugs the vet gave me today

Hello all I am sorry for so many questions but am wondering about the dosage I got when I brought Molly home this morning. I got 50 mg Azathioprine 1/2 tab daily, 20 mg predisone, 1/2 tab 2 x a day, 20mg orbax, 2 tabs 2 x a day. No tummy meds and no aspirin. I am supposed to take her back monday or tuesday and get her blood checked. What do you think? THANKS! Amy

amy txgoldenhorse@yahoo.com

Oh my gosh! I forgot to say she weighs 28 pounds! Sorry must be the stress! Thanks again!

amy txgoldenhorse@yahoo.com

Yes, no aspirin or NSAID's are recommended with Prednisone so that's OK. And, you might want to ask about giving her Pepsid or another stomach protectant as the Prednisone can cause some irritation and in some cases ulcer. Willow took one Pepsid every day when she was on Prednisone.

Lori USA

Amy, We give Holly who is now around 14lbs, 1/2 of 10 mg of pepcid every day, and we also give her 1/2 tablet of suclfarate to coat her stomach. Like Lori said the pepcid protects from ulcers from the prednisone and the suclfarate coats her stomach, but must be given at least 1-2 hours before the meds. Linda

Linda Sapphire

Hi Amy, So glad to hear the little gal Molly is doing better! To clarify the NSAID/Pred debate, some vets now are ok with LOW DOSE of aspirin daily during the initial crisis to thin the blood. Each vet has a different opinion on this, but at CSU, they feel that in their studies, dogs that got a low dose of aspirin tended to fair better, as many dogs perish due to blood clots in the initial crisis. It's worth asking about. Tiggs was give a 1/4 of a baby asprin (about 20mg max per day and he weighed about 64 lbs at dx). If you have a compounding pharmacy near you and your vet is on board with trying asprin, you could have a very, very low dose compounded given that MOlly is so tiny. Pepcid or I think Sulfacrate is almost always given to dogs on these meds, I would push for it, because it's so hard on their tummies. Definitely inquire. Also, I think max for an immunosuppressive dose of Pred, it's usally one mg/kg of body weight twice per day- but many vets have different opinions here again. Patrice could probably tell you Dr. Dodds protocol. So Tiggs was initially on 120mg/day- which is very, very hard on them. Also Tiggs has always only been on 30mg tabs of AZA per day (one pill per day). Also, AZA takes many weeks to work, so it's kind of secondary to the Pred, which should start to work within a week or so. I'm sure others will have other answers and insights. Best to you and Molly! melissa and tiggs

melissa slc

Sorry, my math on the Pred is probably not 1mg/kg, but 1mg/lb. So, like I said, Tiggs max for a 60 lb dog was 60mg in the am, 60 mg in the pm, for a total of 120mg/day. This was very, very hard on his body, and he is still suffering the effects from this, even though he is only on 5mg/day here five months later.

melissa slc

Wow thanks all for your help! Lori and Linda I will give her tummy pills thanks! Melissa I will ask about aspirin and I did think her pred was way too low. 1/2 pill twice a day is only 20 mg a day total! I thought I had read it should be more agressively used at first. I was disappointed that when I picked her up and paid the 1100 dollar bill the vet did not even come give me check out instructions!!!! I had to ask about pvc that day and about what to feed her. Dang man that about floored me. Not only is my doggie terribly sick I just shelled out some big bucks, he shoulda given me a talk before I took her home. :(( Molly seems ok, being very guarded here. I had to take my son to a scout party 2nite but I ran home twice to let her out and give her pills. She slept while I was gone. She seems to have an appetite, anyone with ideas on best diet please chime in. I am making a run to PetsMart in the am since she can not get on the couch or her chair while I am not here so i want to get her a nice comfy bed while I am at work. I left light classical music playing while we were gone. I almost put it on Animal Planet but it was that show "It's Me or the Dog" and I was afraid Victoria might scare her! HAHA! Kidding, I like her and her show. Anyhow, fingers and toes crossed here in Texas, will have my baby in bed with me 2nite though! :) Amy

amy txgoldenhorse@yahoo.com

You know, I thought the dose was low too but who am I to question, LOL. I would just keep her on her regular diet right now. You will notice she's going to eat very well once that Prednisone kicks in. You might also want to ask your vet about a liver protectant too. I gave Willow tons of milk thistle and also our vet gave us two things Denosyl and Marin.

Lori USA

You know, about the food thing, I probably mentioned before...but Hills A/D, available at your vet's office, not sure about Petco/Petsmart, but it's high in calories and we used this alot for the first couple of weeks, just to get tiggs to eat. I think if I even smell that stuff again, I'll probably gag, but he seemed to like it, and it really helped keep the calories in for the short term. we also did alot of steamed white rice, and then added in some boiled boneless/skinless chicken, which I put in the food processor. Also, I've said before, Cerenia is the nausea med Tiggs needed to help keep food and water down in case she is gurgly or nauseous. I too have heard great things about Milk Thistle, and I keep meaning to grab it at the store one of these days. Snuggle that baby tight tonight! melissa and tiggs

melissa slc

The other thing you could try is baby food. Willow really liked that even when she wouldn't eat anything else--I just got the 1st or 2nd stage ones that were all meat and let her lick right from the jar.

Lori USA

Dr. Dodd's protocol: In Hospital: "1. Prednisone 2mg/kg PO BID divided; start at same time as Dex SP is given" (Kg is not quite 1/2 of pounds. Example: 100 lb dog is 45 kg. So 2mg x 45 kg = 90 mg by mouth twice a day) Sending home: "1. Prednisone 2mg/kg PO divided BID for at least two weeks, taper very slowly every 10-14 days for another month until platelet count is above 100,000 or PCV is above 21 and stable. Then decrease dose, whenever the blood tests remain stable for two weeks. Eventually the steroids should be given every other day for maintenance." (Taper by no more than 1/4 to 1/3 previous dose, approx. every 2-3 weeks. Precede each taper with a blood test. Do not decrease multiple drugs at the same time.)(Subclinical dose or a dose that no longer provides suppression of the immune system is approx 1-5mg depending on the dog's weight. This is when to begin starting the every other day dosing. Instead of going from, say, 1mg every day to 1mg eod (which is halving the dose), go to 1.5 eod for instance) While on high doses of prednisone, provide stomach protection with pepicd (generic is fine, do not use extra strength). Dose for up to 50 lb probably one tab a day, over 50 lb 2 tab a day. Give 1 hr before meals) Sucralfate can be given in anticipation that prednisone may be causing ulcers. It coats the esophogus and stomach to provide healing. Best give when there will be an overnight fast to keep it away from drugs that need to be absorbed. In dogs that are highly hemolytic (and unstable), low dose aspirin will help prevent inappropriate clotting. What that dose really should be, I have yet to find a good source of information. Your vet's clinical experience would be a good guideline. my best patrice

Patrice NYS

At the onset of AIHA/IMHA the least amount of prednsione that should be given is 1 mg per pound of the dog's weight per day divided into two doses. (The veterinary drug handbook says for AIHA/IMHA 1-4 mg/kg PO (by mouth) daily divided bid (twice per day) 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 In regard to asprin one study has found it to be useful. You can learn more about that study at this URL http://www.ncbi.nlm.nih.gov/pubmed/15934255?dopt=Abstract

Joanne MN

Lori-thanks I will try that milk thistle and baby food. Melissa thanks for the info and you made me laugh about the gag thing! I have some triggers like that too! LOL! Patrice and Joanne thank you for the dosaging info I will print it and take it to my vet. Well, we seem to be holding ok(hope and hope some more) Molly is laying with me on the couch wearing her Cowboy colors fixing to watch them hopefully not lose again. :) Amy

amy txgoldenhorse@yahoo.com

We just wanted to welcome Molly home!!! We will continue to keep Molly in our prayers and so glad she is home with you. Cheryl & Ginger (Eagles Fans)

Cheryl & Ginger Pineville PA

Hi Amy, About the aspirin, while we had a vet that did suggest we give our dog aspirin, he did not have anything available to prescribe for us, instead suggesting just cutting up baby aspirin into the tiniest possible bits, trying to give her about 1/20th (or less!) of a baby aspirin each day. We kept this up until her PCV maintained above 30 quite reliably.

Brian Vermont

Amy, Best of wishes for Molly's recovery. The stomach protectant that the other's mentioned is so important while on the pred. My dog Spencer had some complications because we were not given that bit of important info in the beginning. I hope she enjoyed the football game! I have to cheer on the cowboys too since Wade is the coach. He used to be in Buffalo. :) Kim and Spencer

Kim NY

I know when I posted the URL to this site: http://www.ncbi.nlm.nih.gov/pubmed/15934255?dopt=Abstract a while back ago which mentioned ultralow dose aspirin someone asked the question in regard to what was the dosage that was considered ultralow dose aspirin. I knew I had the full article from JAVMA (Journal of the American Veterinary Medical Association) somewhere that had that answer but for the life of me I could not find that journal. Today as I was looking for another resource I found that journal and the answer to the question of what is ultralow dose aspirin according to this study. It is 0.5 mg/kg/d or for those of us who do pounds 0.23 mg/lb/d.

Joanne MN

This thread was discussed between 13/12/2008 and 17/12/2008

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