Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ruger switching meds is this safe???

HI all. I am soooo nervous, especially with all the loss lately. Ruger is one month since diagnosis. HisPCV has been holding steady at 30-32 for the last 2 weeks. He is on 40 mg prednisone and 75mg azzathaprine eod. His check up yesterday revealed that his liver values had doubled in the last week. His dr. is taking him off the azzathiaprine and starting him on lefluminide(arava) today. With a PCV only 32 is this safe? Anybody else completely switched meds? He is eating well but still has no energy. Did turn out to be an infection in his leg. Still not completely healed after 2 weeks on clavamox. They are leaving him on this until it is healed. Any suggestions/input would be appreciated. Thx

jaime Parker

What are his liver values? Maybe you can just start to wean the azathioprine instead if there's no destruction anymore. I'm unfamiliar with avara so hopefully someone else can chime in. I'm not a big fan of completely stopping any drug. This should be done gradually UNLESS the problems are severe.

Johnny

Jaime, Something does not sound right and I would not switch until you get answers of why are they prescribing ARAVA, its an arhtritis drug??? This is raising huge red flags to me and hopefully someone else can chime in on this like Johnny asked what are his liver values, From what I understand you are are supposed to wean off azi, but I am not sure if thats the case since he has only been it a month. I would ask abuot cyclosporine. I would also have apancreatic test done since it cause cause the liver enzymes to rise. What is Rugers weight and Dosage of pred? Laurie

Laurie CA

Jaime Just be very very careful on this drug leflunomide as remember what I told you happened to Nollaig on this drug,make sure they check Ruger's white cell count AT LEAST every week as Nollaig was on it 2 weeks then her white cells went down, they reduced the dose and her white cells went up again.But then they got complacent and thought she just had an initial reaction but it wouldn't happen again, and so didn't test her white cells for 2 weeks and she caught the life threatening infection(a tummy bug that got out of control as she had no fight). You need to be especially careful as Ruger is already fighting an infection on his leg so needs his white cells to do this. The vet told me there's not really a lot of scientific evidence for the efficacy of this drug in AIHA/IMHA so just make sure you ask plenty of questions because at the end of the day you have to make the right decision for Ruger.Read up as much as you can on this drug. Leflunomide was used successfully on a dog called Watson that Joanne knows so maybe ask her a bit more about that case. I hope that whatever happens Ruger's health improves and he gets his energy back. Let us know how Ruger gets on. Kathleen and Nollaig

Kathleen North Ayrshire

I bumped up the thread on leflunomide. Please read that thread very carefully.

Joanne MN

Hi Jaime I remember you said that Ruger had already had his Pred dosage dropped quite a bit. I am nervous that his PCV is still not normal and stopping any drug without weaning it also worries me. Patrice is not a fan of leflunomide. This was discussed in a previous thread and I will find it and bump it up for you. Samantha and Millie

Samantha Geelong Australia

Why won't your vet try Cyclosporine, I have not heard anything positive about leflunomide. Cheryl & Ginger

Cheryl & Ginger Pinville PA

Jaime, although the people on this forum are not and don't claim to be veterinarians,they have an incredible knowledge about this disease and the treatment of it. Joanne and Patrice have researched the subject more than a lot of vets. My vet has always welcomed anything i brought to her from this forum and so should yours. I would also hightly recommend to get in contact with Dr. Dodds at hemopet@hotmail.com I think it is not a good idea to switch drugs so close to the weekend, if it is not a life threatening situation. Kahlu's liver enzymes had skyrocketed too, but the liver is an amazing organ and can heal from this damage. His values came down after the meds were tapered down. Keep us posted and best wishes, Brigitte

Brigitte BC Canada

Thanks Joanne. I was trying really hard to remember where I heard of this drug....dumb me didn't even think to look back in the threads! DUHHHHH Milk Thistle, Milk Thistle, Milk Thistle, Milk Thistle Great herb for the liver. Personally I think ALL dogs coming down with disease (or any dogs on medication for that matter) should be using this herb. It's amazing how well it helps to protect the liver from damage!

Johnny

Johnny, yes, thats why its ringing a bell now. Wow we all jumped on this fast. I would highly suggest you contact Dr Dodds as Brigitte suggested. You can email her and she responds within 24 usually and I think her consult fee is $30. She is at the forfront of this disease. Take care Laurie

Laurie CA

Good luck with it all Jaime - I think its a fine line for our vets trying to work out the medication, which one, how much etc. etc. These guys here on this board are veterans. Please dont worry about our doggies, there has been loss, and it certainly is a very difficult illness, but those success stories on Joanne's site are amazing. Take heart from those. I look forward to hearing more good things about Ruger - he has fought through a lot already. I guess too, all dogs are different, some can come off all medications and never have anything else, but others have to stay on something all their lives, and maybe the PCV for Ruger, whatever it settles at, is his "normal". You will know Im sure. Silka

Silka Melbourne Australia

The only reason I can see for stopping azathioprine suddenly is if your vet suspects Ruger is having side effects from azathioprine (liver toxicity, which can be fatal if kept on the medication). If you are worried about leflunomide, you should consider cyclosporine if you can afford it. If the rest of you folks are truly interested in leflunomide, I would direct you to the research that was done at UC Davis veterinary school by Dr. Claire Gregory. Dr. Gregory was one of the pioneers in kidney transplants, and was lucky enough to be able to use this drug in an experimental setting (see Watson) but was unable to continue to use the drug therapeutically because it was so cost prohibitive. Please see the article "Leflunomide effectively treats naturally occurring immune-mediated and inflammatory diseases of dogs that are unresponsive to conventional therapy" in Transplant Medicine.(C. R. Gregory, b, A. Stewartb, B. Sturgesb, T. DeManvellea, b, A. Cannonb, T. Ortegab, M. Harbb and R. E. Morrisa). In that study, very few side effects were reported. The liver damage reported in people has not been seen in dogs (though this remains possible). The low white blood cell count has been reported, and we had a case of ITP that would not respond to other drugs (azathioprine, prednisone and cyclosporine, together) that finally responded to leflunomide. He developed a low WBC count, the dose of the drug was lowered and this dog is doing great. Remember that azathioprine also can cause liver failure and it is the standard of care along with prednisone for IAHA. In regards to cyclosporine, there is no evidence nor studies indicating that it does start working in 1 week and based on its mechanism of action we would actually expect it to take at least two weeks to be fully effective. That said, I think anectdotally that it does begin working sooner than 2 weeks. If Ruger is a large dog, cyclosporine can cost upwards of $20/day and leflunomide is now generic so is much less. I caution those of you out there that make bold,non scientific statements to people whose animals are in desperate need of help. There are very few veterinarians that even know leflunomide exists, and I suspect most of those prescribing it have good reason to. I hope all of your animals are well.

Alana Davis

Alana Not sure where you are purchasing your cyclosporine at but I have NEVER spent anywhere near $20.00 per day for my 78 pound Golden who has been on 200mg per day in the past. I think if you do a little more research you might be able to find it much cheaper then costing upwards of $20.00 per day. Once the PVC is in the normal range and stable you being to reduce it and the cost does come down even more. I hope your animal is well too (most of us really think of our dogs as so much more than animals) Cheryl & Ginger

Cheryl & Ginger Pineville PA

Dear Alana, I assume you are from a veterinary background, so it's great to get your input on this topic. I can assure you there is nobody on this forum that 'makes bold non-scientific statements to those whose animals are in desperate need of help'. This forum has been a saviour for me in terms of advice and support over the last year as I have fought IMHA with my dog Millie. People who give advice on this forum do so from their own experiences and research, and never intend it to replace the advice of a vet. There are some very knowledgeable people on this forum whose opinions and advice I greatly respect. The advice I have received from my time in this forum have helped to empower me as an owner to ask questions of my vet and seek the best treatment for Millie. Sadly some of us have discovered that our vets as great as they are, do not have a lot of experience with treating IMHA/AIHA. My local vet was one of these, and I can safely say that Millie would not be alive today if I hadn't discovered this site and the caring people that visit it nearly every day to help others. Samantha.

Samantha Geelong Australia

This thread was discussed between 15/01/2010 and 19/01/2010

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