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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Prednisone - reduce or increase
| My Border Collie/Australian Shepherd (35lbs)was diagnosed with AIHA at the end of August. Her counts were at 5.8 when normal is 37-55 and she ended up with 5 blood transfusions. She is now on 60mg Prednisone 2X a day. Her blood counts are hovering around 32-35 for the past month. The vet wants to increase her meds to 80mg 2X day for one week to see if it will boost her up to "normal". I was hoping to reduce them because she is retaining so much water (even on diuretics), she looks like she is going to burst. She pants heavily, is lethargic, has muscle weakness in her back legs, and is constantly hungry. Should we increase the meds or start to reduce them and increase them after her body has absorbed the water? She is so big, we have even discussed putting in a drain. Any advice? |
| Shana Idaho |
| Shana, Has the vet added any other immunosuppressive drug to the treatment plan? Is the prednisone 60mg total per day or 60mg twice a day? (120mg?) That is a lot of prednisone for a 35 lb. dog. How is her general condition otherwise? We are very happy with our range of 35-37 hct and are decreasing the cyclosporine rapidly, and staying at 5mg per day of prednisone. Patrice |
| Patrice New York State |
| I believe that after the third week they added another immunosuppressive drug, but then discontinued it when her counts went up two weeks later. Right now, the Prednisone is totalling 120 mg per day and the vet wants to increase it to 180 mg per day. My dog takes 3 20 mg pills twice a day. From what I researched from this forum, she has the exact symptoms of Cushings. Canyon has always been an extremely active dog and incredibly intelligent. She is definitely not the same and is a shell of her old personality. I'm torn, becuase I think that decreasing the drugs will help her gain energy, but want to make sure that we are not jumping the gun and should follow the doctor's recommendations. It's hard seeing her so uncomfortable and so bloated! |
| Shana Idaho |
| Shana, I would get a second opinion on the prednisone dosage. At the onset of this illness my dog weighed 45 pounds and was on 40 mg. prednisone twice a day (80 mg./day total). Also, he was put on cyclosporine and azathioprine. That dosage of prednisone sounds way too high to me. In my experience and the experience of a lot of others on this forum, a decrease or elimination of any of the medications was not even considered until my dog achieved and maintained a normal PCV for at least a month. It sounds to me like that second medication was eliminated too soon. I would strongly recommend that you get a second opinion about this before proceeding. Good luck to you and please keep us up-dated. deb and Duck |
| Debbie BC |
| Shana..I agree with others on this forum that it sounds as if the prednisone dosage is too high. Most dogs seem to be on about 1mg per lb split into two dosages. The prednisone is the quickest way to suppress the RBC destruction and is given at "high" dosages initially until the other immunosopressant given starts to take effect(Cyclosporin or Imuran). Then the goal is to slowly reduce the prednisone keeping the other immunosupressant(s) constant. The prednisone has such bad side effects with liver functions and "muscle wasting" along with thirst, panting etc. that you want to get them off that drug without letting them "relapse" I think most of us would be happy to have the blood counts you have at two months. What you may see as water retention may be from the "muscle wasting" in the abdomen allowing the belly to expand. Good luck...Ron |
| Ron B San Mateo |
| Shana, I am not a vet, but I have been studying many sources, including a veterinary textbook for 6 months now. I, too, feel that this is too high a dose right now with the relatively good pcv value that you have right now. Chance is nearly 100lb and we were started at 40mg per day and then upped to 80mg per day. That was the highest we ever went. The cyclosporine was added later and within a few weeks we had our numbers go up. We never thought about discontinuing it! We have been decreasing both meds very moderately. Some dogs have a lower "normal" pcv range and your numbers seem to indicate that. If I were in your shoes I would ask about the liver values and find out how high they are. I think a gradual decrease might be indicated here rather than an increase! We are sitting right around 35-37 and we are down to 5mg pred! We are decreasing from 75mg cyclosporine to 50mg this coming week. His general condition is excellent, all nasty side effects of the prednisone are nearly gone. He took a 2.5 hour walk this morning so I don't find a pcv of 35 problematic. I have read in several places that the decreases should not be more than 25-30% each time. I always work it out on a calculator each time, and then round to the most conservative number. 120mg x 25% = 30. 120-30 = 90mg. 45mg 2x day. That is where I might go with this reduction. Check pcv only in one week. Patrice |
| Patrice New York State |
| Shana, A prednisone dosage of 120 mg per day for a 35 pound dog seems WAY,WAY too high. I personally would not even consider increasing it. The usual pred dosage at the onset of AIHA/IMHA is 1 mg per pound of the dogs weight per day, divided into two dosages with one dose given in the morning and one dose given in the evening. Some vets will give a higher dosage at the onset of the disease such as 2 or even 3 mg per pound but they will lower that doseage after the PCV starts to rise. You however have been giving nearly 3 1/2 mg per pound per day for nearly 2 months. Sometimes this large of a dose for this long can supress the bone marrow which will stop the PCV for rising. Decreasing the pred a bit might casue the PCV to start increasing again. At a PCV of 32-35 you are getting pretty close to a normal PCV (a range from 37-55) so a decrease in the pred might really be warranted now. This is something you should be visiting with your vet about. It might be very wise for him to consult with a veterinary internal medicine specialist in regard to the prednisone dosage as well. If you have not read my Web site on AIHA/IMHA as yet, http://www.cloudnet.com/~jdickson/ you might want to do so. Be sure to follow the links on the first page to many other sites on AIHA/IMHA and do read the Success Stories pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. |
| Joanne MN |
This thread was discussed between 28/10/2007 and 29/10/2007
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