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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Medication Question for Duck
| I wonder if some of you have been faced with this. Duck is on prednisone, cyclosporine and azathioprine and has been since May 07. For the most part, with the exception of a couple of dips during the prednisone reductions, he has maintained low normal PCV levels. In September, he had a dip to 32 when we changed his pred dosage from 10 mg. every day to 10 mg. every other day. At that point we went back to 10 mg. every day and he recovered nicely. Since then we have stuck to an every day schedule and have reduced the pred down to 5 mg. At this current dosage all the side effects have subsided and he is energetic and happy. On January 30, his PCV was 41. He is also on azathioprine (25 mg. every other day) and I believe he will need to stay on that indefinitely because he has pure red cell aplasia. From what I understand, it is the azathioprine that suppresses the immune system at the bone marrow level. Duck has tolerated this drug really well. His white cell count has never dropped below normal and is usually in the mid to high normal range. Now the crux of the matter. In June 07 his blood serum level for the cyclosporine was at 105.4. This is well below the therapeutic levels of 300 - 600. In light of this low level, I'm wondering if the cyclosporine is in fact doing any good. I wonder if we should leave him on the low dose of prednisone and azathioprine and try eliminating the cyclosporine. I would have another serum check done before we went ahead with this. Just wondering if any of you have been in a similar situation and if you have any advice for me. I e-mailed the specialist a week ago but he hasn't replied. Would this be an appropriate question to take to Dr. Dodds? Any feedback from those of you who have had similar experiences would be much appreciated. Thanks everyone. deb and Duck |
| Debbie BC Canada |
| Deb, I don't have any experience in dropping anything, never got that far but I think a number of times I have read that people have stopped the cyclo after tests showed it was not being absorbed. I think I have seen mention of it on Joanne's site as well? It definately would be a good question for Dr. Dodds. She is on a working holiday right now but I am sure she would respond to your email. Glad to hear Duck is doing so well. Penny |
| Penny Lytle Creek Calif |
| Debbie...we dropped the cyclosporin cold turkey and switched to Imuran, and it didn't seem to have any negative effects. Daisy was still on relatively high doses of prednisone when we did the switch. I am worried because at the moment Daisy cannot take any prednisone and is on a "3 on...4 off" regimin of Imuran until she heals from her operation. She is also taking Baytril and Cephalexin antibiotics to prevent any re infection from her perforated ulcer. The last thing we need is a "relapse". She never has had a PCV above 30 except a false one caused by her being dehydrated. |
| Ron B San Mateo |
| Debbie, I already passed the question about the trough test for Cyclosporine by Dr. Dodds many months ago. She advised me not to bother with it. She said that if there was a good clinical response, that would be indicative that it was therapeutic. The trough test came from human medicine orginally. Humans take cyclosporine for organ transplantation to avoid rejection. It was considered critical that the meds be at a certain blood level at the lowest level of the day. Or in other words exactly 24 hours after the last dose (or 12 in given 2x daily). In the early days of organ transplantation they were desperate for some way to prevent organ rejection. Dr. Dodds advises pulse dosing cyclosporine or using it mon-fri and off on sat/sun. We pulse dosed Chance and this drug saved his life. It appears to *me* that if we were able to give it only 5 days a week and it was therapeutic to do that, then having constant blood levels is not critical to the way the drug works. Cyclosporin works by being "cytotoxic" to a certain type of lymphocyte. The side effects are much less than prednisone because of this. Thus it was considered a better immune suppressor for organ transplant than prednisone. This explanation from Dr. Dodds. However, all that said, if you are sitting at a constant pcv of 41 and Duck is recovering nicely, no more liver problems, good appetite and elimination, muscle tone has returned, active and involved in the household.... well same at our house and we just dropped the cyclosporine. We are on 5mg pred eod and we will be looking at a reduction of 1/3 for that in about a month. If you are at the lowest dose you can go for cyclosporine do a pcv only and go one week without it to see how he does. Repeat the pcv in one week. If you see a drop in the pcv, that will be your answer. I have my doubts that you will see anything change. My best Patrice |
| Patrice NYS |
| Penny, Ron and Patrice, thanks for your responses and support. I heard from the specialist lastnight and he said the same thing that Dr. Dodds had said to Patrice - that some dogs can be below therapeutic serum levels of cyclosporine and still be getting an immunosuppressive effect from the drug. He said that basically the only way to know whether the cyclosporine is helping Duck is to take him off it and see what happens. Today I e-mailed him again with a few more questions. When we decide how to proceed next, I'll let you know. Who knows, my situation may help someone else in the future. In any event, I'm in no hurry to reduce anything further until I gather as much information as possible. Duck is doing so well and is so happy. Anyway, thanks again for your information and support. I honestly don't know what I would do without you all. deb and Duck |
| Debbie BC Canada |
This thread was discussed between 06/02/2008 and 07/02/2008
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