Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - How much does Cyclosporine cost?

We are still trying to figure out what might be going on with Tiggs. Today our vet drew another sample for a Pathologist to examine (this is our third CBC in a week). His RBC is low (4.58) but his white count is normal. PCV is slowing dropping, but more worrisome apperently is the size of the RBCs? Apparently this is called the MCV, and Tiggs are at 82. Liver was slightly elevated, but not near toxic - a small miracle given the drugs these poor guys are on. Now of course, I'm trying to interepret this data as much as I can, but the vets concern is that since we've been doing so well, and haven't changed a thing, and the Aza isn't to blame, then we have something else going on causing the drops. We will do more tests after the Patho reviews, but one thing we may need to consider is a drug change. Everyone is always saying how "expensive" the Cyclo/Atopica is...what are we talking here? What kind of dosage would be needed for a 65 lb dog? Also, we'll discuss other tx options and more med options, but just curious about the cost on that, since it seems like it could be the most helpful. What about the Dexamethasone? Anyone on this, and at what cost? Thanks for any advice everyone! melissa and tiggs

melissa

Hi melissa........no advice today, just sending love, hugs, prayers and best wishes for you and Tiggs! Hang in and know we are here rooting for you. God Bless sharon and angel Brandy

sharon pa

Hi Melissa, Tiggs, Kent took cyclo briefly but couldnt handle it. The best price I found was at costco - do shop around because there are WIDE differences in prices. I dont recall the exact amount it cost, but it was around 70$ or 90$ for about 10 days worth for Kent. You have to have exactly the right amount, so we bought a larger dose and smaller dose to make the right amount. Kent was 35 lbs, now 30 pounds. I remember that i looked up the manufacturer and that they had a special program for low-income or to get the drug subsidized - i would have applied were Kent to have continued taking cyclo. I'm sorry i cant answer your question fully - do call around and get prices. Take care, hugs to tiggs from Kent Christine and Kent

Christine Fl

Melissa, I started Darcy on Cyclosporine about a week and a half ago. Her PCV had dropped to 25%. The previous week she had been at 38% after a transfusion. PCV has gone done another 5% after another week, but since we've added in the Cyclosporine and Soloxine she acts like she feels so much better and I think her gums are a tad pinker. Darcy is around 26-27 pounds and the dose of Cyclosporine she's on is a 25 mg. capsule given twice daily (so she gets a total dose of 50 mg. a day). Tiggs might require a higher dose. Costco was the cheapest place I could find and you don't have to be a member. However, if you are a member you save maybe $3.00 more. The cost for one month's supply of the 25mg. at Costco is $59.60. Keep in mind that you might not have to give it to Tiggs forever and/or that the dosage level might be dropped somewhere along the line. Initially, Darcy was put on only Prednisone. When her PCV level continued to drop, even after a transfusion, the specialist said that we needed to add in either Azathiropine or Cyclosporine. When she told me how expensive the Cyclosporine was, I decided to go with the Azathiropine. She didn't fully explain to me that the Cyclosporine would get into the system much quicker than the Azathiropine. When Darcy's level dropped from 38% to 25% I knew I had to do something. That's when I searched for the best price I could find, bit the bullet, and made the purchase. I reasoned that if the Cyclosporine worked it would be worth the money. After all, if it would bring her RBCs up so that she didn't require another costly and maybe dangerous transfusion then it would have been worth it. I am definitely not an expert. I'm not telling you to put Tiggs on the Cyclosporine. That's a decision you will have to make. I'm wondering if you have consulted Dr. Dodds? She is always willing to give advice and I contact her whenever I'm in doubt. I hope this helps. Praying for you and Tiggs, Karen

Karen NC

Sierra takes 100/mg day of cyclosporine. At Costco, it costs about $112/month (a little over $25/week) for us. Note: this is for a generic form of the brand name Neoral.

redmal So Cal

This is Maggie's story. She is a 7 year old Yellow Lab. In April, a lump came up in her neck. Our vet said that she was over weight 106 lbs, and we knew she was a little plump. So she was put on a diet, her treatment was antibiotics and prednisone. Her blood work looked good, but it was showing that she had no platelets. Well the lump went down and she finished her dose of steroids and we thought all was well. The lump came back and our vet recommended removal and biopsy. So in May the lump was removed. It came back benign. In July we started to notice that she was very lethargic. We took her back to the vets and found that her HCT was down to 11 (The range should be 37 -55). Her red blood cells were killing themselves. She was immediately hospitalized and was put back on prednisone and Dexamethasone. 2 days later she had to be given a blood transfusion, her HCT came up to 14. After another couple of days it came up to 17. She lost most of her coat, her hair fell out by the handful. We had an ultrasound and it wasn’t cancer. We had a Coombs test and that confirmed that she has AIHA (Auto-Immune Hemolytic Anemia). We were able to take her home from the vets when it got to 25 which was just over a week. She is on so much medication. We take her every week to have her blood checked and it is beginning to take its toll on her liver. She takes 5 Cyclosproine, 4 Prednisone, 2 Azathioprine 1 Famotidin daily. Her liver is elevated so now she is on 2 Denamarin in the evening. Last week she developed a nasty infection in her front right leg and the vet had to drain out all the infection so now she takes 2 Amoxiciline daily 2 hours after all her other medication, the good news was that her HCT was up to 32.87. The swelling in her leg went down, but she has a sizable hole in her elbow which continues to weep. Now she has a graze on her back right leg that won’t heal. This week she started sneezing and has nasal congestion. She seemed very lethargic wasn’t eating and drank very little water. I took her back to the vets and her HCT dropped to 25 they put her on fluids and sent her for another ultrasound. Found no Cancer, but her liver is enlarged. We are trying everything we can and she is a fighter. I am feeding her pasta, liver, chicken, vegetables, anything that we can. I came across a website that gave a recipe for Liver Cleansing which is cod, potatoes, sweet potatoes, squash, green beans and zucchini. So I am going to try that tomorrow. Today her breathing was strained, and after a bout of sneezing she had a nose bleed. My husband and I are really concerned about Maggie’s quality of life. We don’t have any children so she is our daughter and we love her dearly. Yes the Cyclosproine is expensive, but we are going to keep fighting this. If she will hang in there and fight, so will we. She’s sat her by my side as I am typing this and her tail is wagging and her eye’s are so bright. It’s as if she knows what I’m writing and she’s saying don’t give up on me mummy.

Karon SC

Funny, but the internal specialist never mentioned to me that Cyclosporine is the generic of Atopica. I was totally clueless. Since Atopica was specially formulated for dogs, I'm wondering if it is better than the Cyclosporine. I'm guessing that it is even more expensive. Also, I've learned that Azahioprine is the generic form of Imurran. Are these generics less effective than the originals? I've told Dr. Dodds what Darcy is on (Carafate, Soloxine, Azathioprine, Cyclosporine, PetTinic) and she said that this treatment protocol should work. She hasn't mentioned generic versus non-generic. Any thoughts? Karen

Karen NC

Karen, I'll find out what I can when I go on friday to our Internal Medicine doctor. I haven't heard anything about generic versus non-generic in the drugs until the doctor quoted the $400-$450 cost of cyclosporine and someone on this site mentioned they were able to get it for less at Cosco. When I called the docs office they said Cosco was probably the generic version and she felt that it did not get absorbed as well as the name brand. Interesting, if Aziathioprine is the generic of Imuran she has him on the Aziathioprine. I am interested to know what others have found out. I'll report what I can after friday. Chris

Chris apr39@comcast.net

Sorry I have been away from the computer. We talked about this in a thread last year. Novartis manufactures Neoral for humans and Atopica for dogs. An older form called Sandimmune is the original version of cyclosporine. I found an article that addresses the difference in formulations and generics for humans (Dated 2004) and the risks of using certain generic forms. http://www.pharmacytimes.com/issues/articles/2004-07_1312.asp This article says about these two drugs: "Sandimmune, the original formulation of cyclosporine, mixes poorly with gastrointestinal fluids, resulting in low and inconsistent absorption. The Neoral formulation was developed to allow higher and more consistent absorption. In a study of the Neoral formulation, both the absorption rate and the systemic availability were faster, compared with the Sandimmune formulation, for all dose levels studied (200 to 800 mg), and the relative bioavailability of Neoral ranged from 174% to 239%, compared with Sandimmune, depending on the dose." This next section addresses what can happen to humans if they receive the Neoral if they have been taking Sandimmune and vice versa if they have been on Neoral and are switched to Sandimmune generic. "Clinically, this means that patients taking Sandimmune (or a Sandimmune generic) could be exposed to considerably more drug if switched to Neoral (or a Neoral generic), with the potential for toxicity. Of particular concern, and the subject of this article, is that persons taking Neoral (or a Neoral generic) could be exposed to considerably less drug if switched to Sandimmune (or a Sandimmune generic). This switch could have serious consequences because decreased bioavailability of cyclosporine is associated with an increased risk for acute rejection— ie, decreased function/failure of the transplanted organ or "graft." Obviously, there is no mention of Atopica or dogs in this article because it addresses the use of cyclosporine for organ transplantation patients. The criteria, however, seems the same *to me.* Atopica is manufactured specifically for use in dogs and is guaranteed in the same way Neoral is to be highly bioavailable and standard in dosage. Dosage is weight determined so there is no chance that a dog can get too much or too little. The capsules are easy to dispense. I found the cost pretty high for a 100lb dog, but then again, we weren't on it for longer than 2 months at a really high dose and were done with it in less than 6 months. It wasn't until Chance was put on this drug did he have any regenerative response. An interesting point is that when Dr. Dodds advised us to use cyclosporine she was still recommending Neoral or Sandimmune. My vet asked if we could use the Atopica that she had on the shelf. I passed it by Dr. Dodds and she agreed that we should try it. I was surprised to see recently that Dr. Dodds has changed her protocol to include the Atopica! So perhaps it was our use of Atopica that was one of her first experience with how effective it is. patrice

Patrice NYS

Personal communication I had with Norvartis Animal division indicated to me that Neoral (NOT Sandimmune) and Atopica are the same drug. They also emphasized the Atopica is only tested and approved for treating atopic dermatitis and would not comment on any use for hemolytic anemias. Whatever the patent durations are, once expired, there will then be a generic form of Atopica. I have used generic forms of Neoral for more than 4 years now with Sierra and have had excellent results. Atopica did not exist 5 1/2 years ago when Sierra was first diagnosed. Neoral, or its generics were our only option. At an initial cost of $600-$800 per month - just for the cyclo, not including blood testing and other tests/procedures, it soon became clear that I could not continue to afford the brand name. My vets at the time felt that Gengraf (a generic form of Neoral) was definately worth a try and it was their suggestion. This was about half the cost of Neoral. After 8 months, Sierra's dosing went down by 1/2 - a relief for my credit cards. And the cost of cyclosporine (excluding brand names) has gone down as well. We are now dosing the same dosage as 3 years ago, but it's costing only half as much. If one is pressed to make a decision between treating their dog with Atopica versus not treating at all due to the expense, are the generics really not worth a try? The above article from pharmacy times is comparing 2 different forms of cyclosporine whose absorption was different and not bio-equivalent. Sandimmune is not a microemulsion as are both Neoral (including its generics) and Atopica.

Ronda So Cal

Thank you all for commenting and sharing your knowledge and research. I really appreciate it! Right now, we are in a holding pattern before trying any new meds. Vet still trying to get a patho and internal vet to review results to be sure we aren't in relapse mode and that the cell size is ok (apperently they were large?), and consult about the red count still being low with PCV dropping 5%. Tommorrow we'll have another PCV to see where we're at, and hopefully get a few experts to chime in. He did start Doxycycline over the weekend and seems to be tolerating well. Energy came up for a couple days, but today was a mellow one. Thanks again all! melissa and tiggs

melissa

My dog Brandy is 63 pounds and she is currently taking 100mgs of cyclosporine twice a day (200 total mgs per day). I have not checked out Costco, but we are getting ours at Walgreens. If your family joins their "W" program for $35.00 per year, you are able to get the generic for $80.00 for 30 pills. I thought that was expensive until I found out what it normally would cost. It's worth checking it out. Deb and Brandy

Deb Grand Rapids MI

Melissa: Our GSD mix Sheba was approx. 46lbs. when she came home from ISU's VTH after being diagnosed with IMHA back in April. Originally she was on 250 mg. of Atopica per day (125 mg. AM and 125 mg. PM) along with 50 mg. of Pred. It was running us about $350.00 per month for the Atopica and less than $10.00 for the Pred. Sheba's Pred was reduced first (totally off now) and two weeks ago the doctors had us halve her Atopica dosage to 125 mg. once per day (scary!). So far she seems to be doing okay. We'll know for sure tomorrow when we get her blood work done. (Her PCV has been holding steady at 46 for quite a while now.) Luckily we were in a position where we could afford the medication they prescribed. But if we hadn't been I would have definitely asked about generics - especially after reading all of the positive results others on the board have had with them. Whatever your decision - think positive and know that we are all praying for you and Tiggs. Rita

Rita IA

Melissa,When Barkley was on Atopica (100 mg) I hunted on the web and found a site where I could get his medication for $75 for a 15-count pack. The site was valuevet.com. When I told my vet about this he then offered to match their price, which saved me another $6.00 on shipping. Hope this helps. Cheryl (and always Barkley)

Cheryl Medford

This thread was discussed between 27/09/2008 and 04/10/2008

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.