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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Starting to Wean Meds-Scared of Relapse
| Hi Everyone, We are about to start weaning Henri's medications. Henri is current medications are: 7.5mg/day prednisone, 12.5mg/every other day AZT, 25mg/2x day Cyclosporine, and pepcid. The internist want us to start the weaning process by reducing his cyclosporine dose to 25mg/1x day (50% reduction). She plans to do a blood check a week after the reduction. She said by now the AZT is working and he no longer needs the cyclosporine. Also, since the smallest dose of cyclosporine only comes in 25mg gel capsules--we have to reduce to by simply removing 1 capsule (25mg). I am terrified Henri will relapse. The onset of his crisis seemed so rapid, I am worried that I might leave home to do an errand and come back to find him dead. Am I overly worried? Are relapses more gradual in onset when you are weaning meds? Any thoughts would be appreciated. Sincerely, Ella Neumann Henri, West Highland White Terrier, 6-months, diagnosed with vaccine-induced IMHA on 02/25/09, last weight: 11-lbs, lowest hematocrit 11%, last hematocrit 39%, on last blood check agglutination had resolved, regenerative anemia. |
| ella Seattle |
| Hi Ella. I remember being on pins and needles when we started to reduce Duck's meds. It's good that the internist wants to do a blood check a week after you start the reductions. But, everything that I've read recommends reductions of no more than 25% to 35%. An option you do have with cyclosporine, is buying it in liquid form, brand name Neoral. That will give you the freedom to use doses that you couldn't achieve with the capsules. Unfortunately, a bottle of Neoral is expensive. I pay $285.00 Cdn./bottle and it lasts us for about six months. But at least you know you have that option. If you are interested in the liquid form and need time to pursue that, you could start by reducing the prednisone instead. It seems to me that the prednisone has a greater number of undesirable side effects anyway. Just a thought. Hope this helps. I wish you and Henri smooth sailing through this transition. Take care. deb and Duck |
| Debbie BC Canada |
| Thanks, Debbie for the information on liquid cyclosporine. I will keep that in mind as we continue to reduce the cyclosporine. I was wondering, when dogs have relapsed during the medication weaning process, does that usually occur with the first few reductions? How common is relapse during the weaning process? Thanks to everyone, Ella and Jeff Neumann Henri, West Highland White Terrier, 6-months old, 11-lbs, diagnosed with vaccine-induced IMHA on 02/25/09, medications: 7.5mg/day prednisone (down from 10mg), 12.25mg/every other day AZT, 25mg/day Cyclosporine (down from 50mg), and Pepcid. Bella, West Highland White Terrier, 3yo, Primary Addison's Disease diagnosed 04/28/08, maintained with 0.40ml/28-days Percorten, and 0.33mg/day prednisone. |
| Ella Seattle |
| Ella, It's interesting that you also mention your other WHT Bella as having Addison's Disease. You probably understand why you give her prednisone every day to support her poorly functioning adrenal glands. And that is generally why prednisone doses are decreased slowly in AIHA dogs, to support the adrenal glands while they "wake up." In this case, rather than being called Primary, it is called Iatrogenic Addisons, or caused by high doses of glucocorticosteroids suppressing the adrenal glands. So once you reach a "subclinical" dose of prednisone, the decreasing process is really for the adrenal glands, not to suppress the immune system. Having multiple suppressive drugs as part of your protocol is a good thing that allows you to reduce that prednisone to eliminate those bad side effects. It's a good idea to only decrease one med at a time and alternate them over time. In other words, don't completely reduce one drug down to nothing all at once and then start the next one. When I did Chance's reductions, I worked on getting the pred down to a much lower dose and then worked on the cyclosporine for a bit. I actually finally reduced and eliminated the cyclo but kept up a low dose of pred for a very long time. Dr. Dodds advised me that because his condition had been so serious, I might never get him off the pred the rest of his life. my best, patrice |
| Patrice NYS |
| Its interesting to see how everyone's dogs are on different combos of meds and how they wean off in different ways. My dog Cyclops started out on Pred and Azathiaprine but we switched to Cyclosporine and weaned her off Pred. She got sick Dec 15th, had a number of transfusions and by the 20th of January she was totally off the Pred and on Cyclosporine alone. We just now moved from 150mg 2x/day to 125mg 2x/day and we are going to try this for 30 days and then if all is well we will reduce to 100mg 2x/day. But I share your fears about reducing things too quickly. My vet feels that my dog will be on some sort of Cyclosporine dose for the rest of her life, but hopefully a smaller dose than where she is now. I like having her on just one drug because the Prednisone is so hard on the body. Not that cyclosporine is any picnic either. But the liver functions are greatly improved from where we were on the Pred. |
| Michael Arkansas |
This thread was discussed between 30/03/2009 and 18/04/2009
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