Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - prednison/azathioprene

Kahlu is doing pretty good. He has tonnes of energy, eats like horse and is over all a very happy fella. He is still on 25mg Azathioprene 2x per week and 2.5 pred. every day. The only concern is his liver enzymes that are still very high. ALP 428 ALT 752 AST 66 GGT 367 These values have come down a bit, but only very slow. We have alternated the reductions. First Pred, then Aza. My question now is, what is harder on the liver, pred or Aza? or are they both having the same effect. Kahlu is getting SamE and milk thistle. I also try and feed him High protein low fat. Any input is greatly apreciated, Brigitte and Kahlu

Brigitte BC Canada

I've always heard good things about denamarin...combo of Denosyl (pretty well SamE) & Marin (ultra refined milk thistle...pharmaceutical version)...might be worth trying. Denamarin is more potent I think also. Things like silymarin, milk thistle, and marin are more protectants where as the SamE or Denosyl would be the Detox. Gotta make sure you are giving the proper dosage and make sure it's given at the right time. Sorry but I don't recall when to give it. I haven't used it with Tessy so I'm just not to sure. I do know that milk thistle given at LARGE doses also helps to protect the kidneys to a degree. I'ld also recommend getting on the liver detox diet if you aren't already. Hope this helps. Give Kahlu some hugs from me and high paws from Tessy. Johnny & Tessy

Johnny

Silybin is the refined essence of milk thistle and is a much purer form. OTC milk thistle (and contains as part of it silymarin) is one of the group of any supplement on the market and is somewhat loosely regulated. So dosages can be very different and the purity may not be equivalent from brand to brand or even bottle to bottle. You get what you pay for. Nutramax is the company that manufactures the supplements that vets dispense. Denosyl is their form of Sam-E. Denamarin is their form of Sam-E and Silybin. Marin is their form of Silybin. They claim that their manufacturing process improves bioavailability. All three of these are dispensed for liver support. I swear by Denamarin and used it for Chance. Once his liver enzymes dropped I switched to Nature Made Sam-E and County Life Liver Support Factors. This combination was as effective, if not more. my best patrice

Patrice NYS

I buy pure Milk Thistle seed in the health food store and grind it up in a coffee grinder to a powder and put in Holly's food, she doesn't mind the taste at all. Linda

Linda Sapphire

Calypso also had high liver values, higher than yours. We started Denamarin and within 45 days her liver levels were all within normal range.

Wendi Ohio

Patrice, where do you buy these: Nature Made Sam-E and County Life Liver Support Factors? Also how to you determine dosing? Thanks Wendi

Wendi Ohio

Thank you everybody for the insight on what to do with the high liver enzymes. Patrice, If you get what you pay for I should have something excellent with the milk thistle we got! It is in liquid form and only sold to vets. 100 ml are $50. Wendi, I talked to my vet about Denamarin and she told me that this is what Kahlu gets. According to her we can't get this brand name in Canada. Here it is Zentonil. She said it is the same thing. I sure hope she is right! I was wondering if for the next reduction we should reduce Pred or Aza. But since nobody had any insight, I guess they are about the same in wreaking havoc with Kahlu's liver. So I will go with what the vet suggests and maybe gut feeling? I am a bit disappointed, the BioPrep did not arrive yet. I was all pumped for the wonder drug. Thanks again and best wishes to everybody, Brigitte & Kahlu

Brigitte BC Canada

Good luck to your Brigitte! When I google Zentonil it does appear to be the same as Denamarin, but it is the first I have heard of it. I give my Denamarin 1 hour before Calypso eats after an overnight fast. Sorry I do not have much insight on Aza. Calypso is on Prednisone and Cyclosporin and they had me wean the Pred off first.

Wendi Ohio

Brigitte, isnt your vet consulting with Dr Dodds? I would have her double check with her on Kahlus dosages and his liver values since you are now low on the pred. and if the azi is the cause for his high ALT I saved this from someone else that posted her protocal Dogs usually require low dose prednisone every other day for a year or more. 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. Laurie

Laurie CA

Laurie, my vet has not consulted with Dr. Dodds for a while. thanks for reminding me of that! We will go in to see the vet next week and I will suggest that she contact Dr. Dodds. Brigitte

Brigitte BC Canada

I don't know why, but the Aza was the first drug we decreased for Slinky. I didn't ask if it was concern for liver, white cells, or what. She was on it daily for only 7 days, then eod. She stayed there (with pred) until we had several normal PCVs and then we decreased the pred several times before dropping the Aza to every 3rd day for a week and then stopping it. She was on the Aza at eod for roughly 6 months though. She did not have elevated liver enzymes or a dangerous drop in white cell count though. Good Luck Kahlu!

Stephanie Chicago

Dr Dodds had us reduce the aza first to nothing and then the pred. Holly's liver values still remain at around 450, we will see next blood draw as she is now off of the prednisone. Dr Dodds did tell me that there is a good chance that her liver values will never come down Linda

Linda Sapphire

Linda, I ahave decided not to beat myself up over Wylies ALT which is 390 and she is off meds. Did Dr Dodds tell you why Hollys liver values may never come down? I am wondering if the meds caused liver disease and thats why we won't see a drop Laurie

Laurie CA

Brigitte, I totally forgot to mention to you about what Dr. Dodds wanted us to reduce first with Tessy. She had us reduce the pred down to a maintenance dose (7.5mg) first and then move on to the aza. She seemed concerned with Tessy being on the pred for so long and thought it was the harder drug on the system. How's Kahlu been doing? Give him some hugs from Tessy & I. Johnny & Tessy

Johnny

This thread was discussed between 17/09/2009 and 21/09/2009

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