Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Prednisone Reduction

Hi all, I know this question has been brought up many times and discussed alot. I would love to hear from all of you, if possible, who are no longer on prednisone and how you did the reduction. I know I have read from many that the slower the better for the prednisone reduction so no relapse. I am going to the success stories but just thought maybe some of you would be able to help with my decision of how it went in your reductions. For the last 4 weeks our Holly has been on 2.5mg every other day prednisone, and 2mg Imuran. Her last blood work on Oct 15th, showed her PCV holding at 41.4 and retic at 0.9. I originally thought after this reduction we were going to go to 2.5mg every third day for another 4 weeks and so on, I had even discussed with our local vet. Then I faxed Holly's bloodwork to her Dr (Internist) in Atlanta who has been guiding our vet and us through Holly's recovery, and she is telling us to now stop the prednisone and recheck PCV in one week and if it holds then check retic in 4 weeks. I have not been able to speak with her as of yet, but I did speak with our local vet yesterday. He thinks that because she has held for the last month on her PCV that she will be find to stop the prednisone also, as long as we continue with the Imuran. All of her other counts are good, so no problem there. I just don't want to chance a relapse. Thanks, Linda

Linda Sapphire

Linda, We are facing our very first reduction in 2 weeks time so I know how you are feeling.......I have mixed feelings about it. We want him off the medication, but feel safe on it. Between a rock and a hard place. I will be following everyones advice here too, Jackie and Jasper

Jackie pembrokeshire; west wales; uk

Well have thought about this for 2 days now and have decided to continue with the very slow reduction and not stop it cold turkey as per the advice of our internist. End of next week we will start with the 2.5mg every third day for at least 3 weeks and continue on to 5, 7, as per JoAnns suggestion. I will feel better doing it this way, then just wanting to get her off of the prednisone to fast and taking that chance of relapse. Thanks, Linda

Linda Sapphire

I think you are wise. Isn't it amazing that we have learned so much from one another's experiences that we must at times serve as our own clinician.

Jan philly

Linda -- How's Holly's pred. reduction going? I know our regular vet kept trying to yank Monster off the pred and I just fought with her. That was until the specialist told her otherwise and that I was correct in my decision to slowly wean her off the drugs. I wouldn't have ever know if it wasn't for this board! Monster is still on pred. I'm going to reduce to eod at the end of the week per the specialist, even though Monsters numbers were down at the last count. He's hoping that will get her out of this phase and raise/stabilize her count. We're also hoping that this will help with her constant eating! It doesn't matter what it is anymore, she'll beg for anything even her pills! Jenelle & Monster

Jenelle Pueblo

Dunes had her first reduction about 3 weeks ago-her bllod has gone from 36 to 39 back to 36 this week. I'm hoping that she keeps maintaining. They said her other numbers were normal-even the liver enzymes.

Joe Ohio

Jenelle & Joe, Well tomorrow will be her last prednisone and then we start every third day. We have held her at EOD, 2.5mg for the past month and her PCV last week was 4l.4. Right before the reduction to EOD her PCV was 39.3, then we reduced and waited 3 weeks before running blood work again. I haven't even talked with the vet yet on this, as far as he knows we are stopping tomorrow, per the Internist in Atlanta. But I was very uncomfortable with that, so will probably try the every third day for two weeks and then test her, if all good then will continue to every 5th day. We just decided Holly had come to far and we have to much money into this to chance a relapse. Hope Monster and Dunes hold steady! Doggie hugs from Holly. Thanks for asking, Linda

Linda Sapphire

Linda, TC was reduced from 40 2x a day to 20 2x a day and it was to fast, we went back to 40 2x a day and if good on next blood draw will reduce to 35 2x a day. Our Vet said every dog is different, but most dogs on this board reduce slowly.

Wendy Tampa FL

Daisy is (was) a 80 lb yellow lab. Diagnosed 7/23/07. After she got home we had her on 40mg twice a day. I have been reducing her dosage from 40 to 35 to 30 to 25 and currently we are holding at 20mg 2X daily. Each reduction has been about 1 month. She probably is close to her original weight, but not muscle. My question to those who have gone before me is: As we get down to lower dosages, how low should I go with twice a day. Then do I switch to once a day or go to twice every other day? Thanks for all your help everyone. This is a great resource for all. I feel so sorry for the grief all the owners with recently diagnosed dogs are going through.

Ron B San Mateo

Hi Ron. I got the med reduction plan from an internist at Washington State University. He has been overseeing Duck's (my dog!) treatment since the beginning. I don't know how he came up with the formula but this is what we did: Duck was on prednisone 2x a day until we got to the 10 mg. dosage. We had a period of 10 mg. twice a day and then switched to 10 mg. once a day. He tolerated all of that really well but relapsed briefly when we switched to 10 mg. every other day. So we put him back to 10 mg. every day for two weeks. His PCV climbed back to normal. Now he is on 7.5 mg. every day. I think we will take Duck to a much lower dosage (5mg. or 2.5mg) before we switch to every other day. He is a beagle lab cross and weighs about 57 pounds. Here is something Joanne sent me about dosing: The Textbook of Veterinary Internal Medicine (Sixth Edition copyright 2005, page 508) says this when referring to steroid/prednisone reduction to eod (every other day): “ Dose interval is changed to an every-other-day (EOD) basis, usually when the daily dose nears a minimal anti-inflammatory range (0.5 mg/kg for dogs) Often veterinarians choose to increase the dose given on the treatment day so that the 2-day dose remains unchanged or only slightly decreased initially” End of quote Hope this sheds some light! Good luck and please keep us all posted. deb and Duck

Debbie BC

Ron, If you haven't read these sites on predisone you might want to since they may help you. http://www.marvistavet.com/html/prednisone.html http://www.peteducation.com/article.cfm?articleid=1422 As to when to go to the once per day schedule each vet has a different opinion on that. For us with my Meisha, we went to the once per day schedule at the first reduction, that is we went from 30 mg twice per day to 50 mg once per day. At what point to go to the eod schedule is also up for discussion but the quote that Debbie posted makes sense to me. I think we went to eod schedule after we had been at the 10 mg once per day schedule for a few weeks. When you go to the eod schedule you only give pred once per day since the whole point of a slow redution is to give the adreanal glands a chance to start to work on the days the pred is not given Of course a reduction should only be made when a blood test indicates such a reduction is warranted, that is the PCV has remained stable or increased since the last reduction. This is just my opinion and you certianly need to visit with your vet about it but if I had an 80 pound dog and was giving 20 mg of pred twice per day and the PCV was holding steady, I would seriously think of going to the once per day schedule at the next reducion and give 30 or 35 mg once per day. Just some food for thought and something to discuss with your vet.

Joanne MN

Hi Linda, We're a step or so behind you, having just gone to eod at 2.5 mg of pred. I'm glad you posted this, I feel like I don't know what's coming down the road on tapering and it's good to see some different viewpoints. I tend toward the slower tapering plan myself and stretched some of my vet's plans early when she recommended 2 weeks, I'd wait til 3 to drop, just to be safe.

Stephanie Chicago

This thread was discussed between 21/10/2007 and 27/10/2007

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