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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Neoral Increase
| I received a call from the specialist this morning. Darcy's Cyclosporine absorption level is 120. It should be around 600. The specialist has increased the Neoral(brand name of Cyclosporine) from 100 mg/day to 200 mg/day! This is a little scary for me. My baby weighs 26 pounds. I'm praying that she doesn't have any bad effects from this large dosage. I take her back next Tuesday for a recheck of her Cyclosporine and PCV levels. On the bright side, Darcy is still acting fine --- hearty appetite; happy tail wags; loads of kisses, etc. I'm still thanking God for his healing touch, because, with a PCV of 13%, it is a miracle that she is doing so well. Please continue to pray for Darcy. Karen |
| Karen NC |
| Karen, thanks so much for the update on Darcy. I've heard that it may take a while to get the dosage "right" -- but she sounds like such a fighter and a love. Do take heart that she's acting fine -- what they call these "clinical signs" are the main things you should pay attention to. Big prayers coming your way. Sharon and Angel Raven |
| Sharon CT |
| Hi Karen, I don't post to the board much, but I check in every now & then. When my dog relapsed for the 2nd time (after the initial crisis) we had to do cyclosporine (we tried Imuran & it suppressed her bone marrow) & after our trough test we had to go up from 100 to 200mg. My girl weighs 38-40 lbs. I was told for immuniosuppression the target levels from the trough test [12 hrs since last dose] should be 200-500 mg/ml. Anyhow, I believe that increase was the thing that spared the high doses of pred & has helped her get on the road to a sustained remission. It was Oct 2005, so it's been 3 yrs. I can tell you that she did have a big side effect from the increased cyclo- she developed papillomas on her legs when at very high doses. Once we started reducing she never got them again. Not all dogs get papillomas... it was rough to go through bur isn't ALL of this!!! Due to the cost of Neoral Cyclosporine in researching all my options, we also switched to liquid form which we get from a compounding pharmacy & it costed (at that time) OVER 3X less to try it via liquid & syringe vs pill form. I was willing to try anything & luckily it has worked for us. My girl sits nice & just drinks it as I syringe it to her & she's really good about the whoile routine- it's beef flavored, she doesn't seem to mind the liquid form at all. 3 yrs later she is still on 70mg cyclo 2X per day & 5 mg pred OED. She has no side effects & lives a pretty "normal" life! She has a huge love of life & is very healthy! We compete in agility, obedience & rally, she's been a therapy dog... I guess I'm just trying to offer a little HOPE which I know if always needed & well appreciated here :) We will keep Darcy in our thoughts & prayers! Take Care- Joyce & Bayla |
| Joyce M Plover |
| Karen -- I hope Patrice or someone else more knowledgeable weighs in about the big increase in the dosage. In the meantime, I'll keep you and Darcy in my thoughts and prayers. She seems like an amazing little beagle -- it is great to heare that she is sounding so beagly with her happiness and her playfulness and kisses. And she still has her appetite! You guys are doing great! Please take care. |
| Brenda VA |
| Karen, It is great that Darcy seems to be feeling pretty good. The clinical signs of recovery are very important! Dogs can't fake feeling better! When Chance was on high doses of prednisone and was still non-regenerative after nearly 2 months, I contacted Dr. Dodds for help. She recommended that I put Chance on cyclosporine immediately. At that time (June 2007) she was recommending either Neoral or Sandimmune. We could not find either one anywhere in the Rochester area. Our vet asked me to write her and ask if we could use Atopica. My vet already had it in stock. Jean wrote back immediately and said "Great. Put Chance on NO MORE than 225mg atopica Monday through Friday." This is about 25 mg more than the normal dose give to dogs his weight (100 lb) for atopic dermatitis. This type of dosing is called "pulse dosing." Pulse dosing assumes that the body becomes "used to" the medication and it becomes less effective if given every day. Cycling through two days a week without it ensures that it will remain highly effective. Dr. Dodd's recommendations for 2008 are a bit altered from the 2007 ones. Here are the drug dosing instructions for 2008: "Treatment: (Discounting any current meds!) 1. Prednisone 2mg/kg PO BID (BID is twice a day) divided; start at same time as Dex SP is given 2. +/- Azathioprine (Imuran) 2mg/kg PO (PO is by mouth) SID (SID once a day) if dog is not responding to the prednisolone. 3. +/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs." (refractory means it's not working) These instructions are for the first few days of medication. kg equals not quite half of pounds. So Chance at 100lbs is about 45 kg. SID stands for once a day. So 10mg times 45 kg is about 450mg! Much higher than we started at. Here are Dr. Dodd's Send Home Instructions: 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. 2. Dogs usually require low dose prednisone every other day for a year or more. 3. Azathioprine 2mg/kg PO SID if needed, then reduce to 1 mg/kg SID, then to 1mg/kg every other day or three times per week. 4. Continue cyclosporine, if needed originally, at 2.5mg/kg SID" So 2.5mg times 45 kg is 112 mg. We eventually got Chance down to this dose (actually 125mg Atopica) after a month or so. I have read the atopica canine study that determined what the effective dosing rates would be and the potential side effects. For these studies, canines would be given extremely high doses of Atopica to determine what side effects there might be. It's interesting to note that there were side effects, but in most cases they resolved when the dosage was decreased. In general, canines seem to be much more tolerant of cyclosporine than humans. It is from human medical literature that the trough test for cyclosporine comes. This test is a blood test done at the 12 hour mark from the initial dosing of cyclosporine. In human medicine they found that there was a certain blood level that needed to be maintained to ensure that humans did not begin organ rejection. It's interesting to note that I found literature that indicated that this is not necessarily the case in canines. Dr. Dodds indicated to me that I did not need to do a trough test when I asked her. I was grateful for one less blood test. In general dogs are just more tolerant of cyclosporine and seem to do remarkably well with it. It has been extremely successful in treating canine allergies. Chance started getting allergies when he was about 2.5. My vet dermatologist eventually put him on allergy shots which was a near perfect cure. She told me that not even 10 years before that some owners had to put their dogs down for severe allergies. So this new treatment, Atopica, is really a life saver for many dogs. I would consider this new dosage, 200mg for 26 lbs, to be a bit high as compared with Dr. Dodds hospital recommendations of "+/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs." 10mg times 13 kg is about 130 mg. But please don't take anything I say as medical advice. Please write Dr. Dodds at hemopet @ hotmail .com (take out spaces) and ask her about this dosage. She may say that for a short term this might be a good dose. In any case, getting the prednisone reduced is a high priority. The side effects from that are far more significant than any of the cyclsporine side effects. Please let me know what she says, I would be very interested to know. good luck patrice |
| Patrice NYS |
| Thanks for the Darcy update, we've been curious how you guys are doing. She is so amazing! melissa and tiggs |
| melissa slc |
This thread was discussed between 24/11/2008 and 25/11/2008
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