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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Help, ? on reducing Azithiropene too soon
| I am in conflict with my vet on his dosages/reduction for Wylie and I want to discuss on Sat when she goes in so need your input. My vet says he has treated lots of AIHA cases over the years, his protocal is once a good hct is shown reduce the drugs A little history, Wylie 11 years old and 50# diagnosed 4/08, at the time lowest HCT 32, suspected spleen due to growth, that was removed and she was on 10 mg a day for 46 days weaning down, last one 7/1 7/1 her HCT was 39, August Hct 42 Fast forward 11/1, she had a relapse HCT down to 27, prescribed pred and azi, (and at first he didnt believe me because he said he never had a dog relapse) which I guess is good news. He has been wonderful and does listen to my concerns and even changes things of I dont agree. so here is her meds starting 11/1 20 mg pred 30 days, then every other day 30 days 12 days ago her HCT was up to 42 yea! Now here is tmy concern Azithyropine, 50 mg every day 7 days, then every other day for 30 and thats it. I am so confused as Azi is supposed to take 4-6 weeks to kick in, why only have her on for 37 days days when the azi may not be working yet and to stop? I think its started working though, her gums are pinker than I have ever seen And last question, why are dogs on pred and azi for a year or 2 when they have high HCT? I read about Patrice and the non regen kind, that makes sense but but the others, but how do you say okay we should do this slowly over 3 6 9 months or even longer like life? Thanks so muich Laurie |
| Laurie CA |
| My vet uses the protocol that says a very slow reduction in one med at a time, starting with Pred first- 25% every 2-3 weeks (or more even) of STABLE disease. We've gone many visits with no reduction if Tiggs is fluctuating, even a little bit. Then her plan is once he is off of Pred, to move the Aza to every other day for an undetermined time. I for one am terrified of the day that Tiggs is off of meds, but obviously, the side effects of long term use are very serious. Aza is a second line drug, or whatever they call that, and your right, it's supposed to take a long time to work. I'm sure Patrice and others will have good advice. Good luck, don't be afraid to ask questions! melissa and tiggs |
| melissa slc |
| My Sunny died from the side effects of prednisone and azathiaprine. His muscles were totally wasting away. I wish I would have reduced his meds sooner. I was afraid. I'll never know if it would have saved him. Probably not. It's so difficult to know what to do. Have you talked to Dr. Dodds? Leslie |
| Leslie Oceanside |
| Laurie...I think you are lucky that Wylie's PCV has never been very low. There are people who after four or five months of treatment wish their dog could get up to Wylie's lowest number. You have a little more leeway in medication changes because he has never been down to teen or single digit PCV numbers. I think the normal goal is to slowly reduce the prednisone keeping the other anti rejection medications stable. Each prednisone reduction is made only after verifying an increased PCV. When the prednisone reductions are down to levels that allow the dogs side effects to subside, then the Immuran, cyclosporin or other drugs are then reduced. Most of the really severe side effects result from the prednisone, but without it a majority of the dogs would not make it as long as they do. If I had to error, I would be inclined to keep the reductions slower rather than faster. If you want to e-mail me I will forward you a protocol from Jean Dodds which may help you make your decision. Good Luck...Ron |
| Ron B San Mateo |
| Laurie, Wylie's case is probably much different than Darcy's, but the specialist took her off the Aza. all at once when she developed pancreatitist. She also lowered her Prednisone from 30 mg. to 5 mg. There was no tapering off of either drug. I guess that's because the pancreatitist was life threatening. I have been reading the side effects of Aza. and Pred. and learned that those two drugs, as well as other steriods can cause pancreatitist. Fat foods contribute to it, but steroids can cause it. We added in the cyclosporine and she bounced back, but her numbers have never been as great as your Wylie's, not even after transfusions. |
| Karen NC |
| Laurie, Our Holly has been fighting this disease for 20 months now. For the last 4 months her PCV has been in the 50's, yet our local vet did not want to reduce any meds. So I consulted with Dr Dodds, we had a ultrasound done and all was good, so for the past month, Dr Dodds had us reduce 2 mg of pred to every other day for 2 weeks, then we started the aziathioprine decrease to every other day, but on the off days of the prednisone. We go in on Monday for bloodwork and hope for good news and then will contact Dr Dodds again to see what she says next to do. Will let you know. Linda |
| Linda Sapphire |
| Thank you for all of the feedback. Again it just seems strange to presribe azi for only 45 days and stop, if its just kicking in. And I was surprised he prescribed it in the first place since she responded so well to pred the first time and with little side affects. We have been lucky, the time we we found out, was because we were monitering her liver from a previous illness so she didnt have a chance to go very low and then respond so well to treatment. And again lucky on the relapse to notice the subtle signs of no energy on her walk even though her daily routine was just fine and no real noticeable change in her gums. That is great news about Holly! Glad to hear you are able to dose down now with that great HCT level. Laurie |
| Laurie CA |
This thread was discussed between 04/12/2008 and 05/12/2008
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