Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Question on Decreasing Prednisolone

First of all, I would like to say what a wonderful group this is and how much I've learned already about AIHA already from reading through the archives. My heart goes out to all of you who are or have had to deal with this horrible illness. Our 4 year old male labrador, Toby (80 lbs.), was diagnosed 4 weeks ago. His hematocrit was initially 14, dropped to 8 the next day, and then rose to 11 after a blood transfusion donated from his half-brother. He spent almost two weeks in the clinic. He came home on 7/25 with meds of prednisolone (40 mg. twice a day), Imuran (50 mg. once a day then increased to 100 mg./day for one week), Famatodine, Sucralfate, Baytril, and Clavamox. His hematocrit was 18. This weekend Toby began having trouble using the dog door in his kennel. On Monday afternoon he urinated in his kennel which he has never done before. He also has a lot of trouble getting into and out of my van. Yesterday his hematocrit was 25. The vet believes the prednisolone is making him weak and has decreased his dosage to 20 mg. twice/day. I've read that prednisone should be gradually reduced. His dose has been cut in half. Does that sound like too much? I'm worried that we're setting him up for a relapse by reducing the dosage so suddently. He is continuing to take 50 mg. of Imuran. I'll be taking him back to the vet on 8/19 for bloodwork. Any advice you care to give would be greatly appreciated. Thank you, Karen

Karen Missouri

Karen, This decrease in pred sounds way too much especially with a hematocirt of only 25 I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased.” “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA. If this were my dog I would speak to the vet ASAP about this huge reduction and also have him consult with specialists in regard to this reduction. Indeed pred can have lots of side effects but reducing it too much, too quickly can result in HUGE set backs. I am Keeping both you and Toby in my thoughts and prayers. PS with this huge of a pred reduction I personally would not wait until the 19th for more blood work. I probably would be inclinded to do blood work again by this Friday at the very latest just to keep apprised of what is going on.

Joanne MN

I agree with Joanne, I think that is too much too fast. Call your vet and explain your concerns. Wylie was at 45# and her pred was reduce by 2 mgs first every day for like 3 weeks and then very other day. I also would not wait until the 19th the the next test, Call me paranoid, but Wylie was in the low 30s and at first the vet was testing her every 3-4 days to make sure there was no drop. Do you have an internitst? If not I would email Dr Dodds. she is quick to respond Good luck with Toby Laurie

Laurie CA

Joanne and Laurie, thank you for your quick response. I thought this decrease was too much too fast. I will give my vet the info that you provided and see what she says. Thank you for your help. I really appreciate it. Karen

Karen Missouri

we reduced my dogs pred from 40mg all the way down to 10mg after we went months on high med doses which almost killed her. it really just depends, my dogs body was wasted down to the bone by high med doses so we had no time to slowly taper it off.

josh california

I forgot to mention we also did a fast draw down of Wylies pred before her surgery, The vet wanted her off before the surgery so over a 15 day period we weaned her off. SO that is something to ask too. Laurie

Laurielee CA

Thank you all for your comments. I feel as if we're caught between a rock and a hard place. The meds seem to be helping yet causing other problems at the same time. Toby's hct dropped .5 from Tuesday. We're going to check it again on Monday. Josh, if I may ask, how long did your dog take the high dosage before you cut back? I haven't contacted Dr. Dodd's yet as I'm not sure I have enough info to give her. Thank you. Karen

Karen Missorui

karen- she was on 'high' doses of meds for about 2 months before the decision was made to drastically cut back... every dogs case is different but for us this was absolutely the right choice because sway almost passed away wishing toby well,

josh california

Josh, thanks for the info. I found your blog this weekend and read your incredible story. Wow.... I could tell Toby felt much better this weekend and was able to get into the van on his own when we went to the vet this afternoon. The blood test showed that his HCT was up to 28. I think we made the right decision to decrease his Prednisone, but time will tell. I hate to get my hopes up too high. I feel so fortunate to have stumbled onto this group. My thoughts and prayers go out to all of you and your dogs. Karen

Karen Missouri

that is great, good to hear his # is stable... and also glad u found that page, hope it helps in any way possible

josh california

This thread was discussed between 13/08/2008 and 19/08/2008

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