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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - What to do Cranky reducing Cyclo.
| I have a question from some of the folks who have dealt with this longer than I have. One of my vets wants to start reducing Cranky's cyclosporine we are off everything but that. We are 10 months from diagnosis with PCV in the 60's for the last few months. I am terrified to try this since he has done so well. What has anyone else done? I just dont know what is the right thing to do. Thanks, Teresa and Cranky. |
| Teresa Smithfield Ky |
| Hi Teresa, For what it's worth, Spencer had been pred free for about a year and a half I think. He still takes 100mg Neoral (cyclosprine) and 75mg Aziothiaprine 2X a week. He has been doing so well as is, our vet hasn't touched the medication in over a year. He has had no long term side effects from the Neoral. He has had AIHA for 3 years now. Our vet think he may been one of those dog that needs meds for his lifetime- his PCV did go down when the neoral was reduced once before. Keep in mind every dog is different, and you may want to have more frequent PCV checks while reducing the meds. good luck--- Kim and Spencer |
| Kim NY |
| Teresa, Is Cranky by chance a Greyhound? Their pcv's tend to run in the high 50'-60's normally. Some other sight hounds also have this higher requirement. In any case it's a nice number! I guess it all depends how long Cranky has been stable. You say the last few months. That's a good long time. How is his general condition? If his health is good, nice appetite, good weight, liver and kidney values are fine, then, yes it is time to begin to reduce the meds. There is no need to keep suppressing the immune system at high doses. Dr. Dodds advised us to begin reducing the cyclosporine at no more than 1/4 to 1/3 the original dose. She also had us use a pulse dosing schedule right from the beginning. So here is what you can do first, go to a pulse dosing schedule. That is Monday - Friday dosing, Saturday and Sunday off. Continue that for as long as you feel comfortable, but probably 2-3 weeks would be fine. This is probably more for your comfort level than any clinical reason. Then reduce the cyclosporine 1/4 to 1/3 the dose. If you are using Atopica, it gets tricky with the doses in capsule form. We started at 225mg dosage. So 1/4 reduction would be 168.75mg. 1/3 reduction would be 149.98. Atopica comes in 10 mg, 25 mg, 50 mg or 100 mg. So we could go with 100 plus 50 plus 2 x 10. Or we could go with 100 plus 50 plus 10. Or with 100 plus 50. Do you get the idea? Be careful to order sizes that you know you can use. In other words, as we got lower, we ordered in increments of 50mg rather than 100mg so we could use them all up. We dosed at the new lower dosage for about 3 weeks, did a FULL CBC and then lowered to the next lower dose. We did not lower both prednisone and atopica at the same time! Do one or the other but not both. So we bounced back and forth between the two, getting them down to lower levels. I guess you can see it took a very long time. Our preference was always towards getting the prednisone lower because of the serious side effects (and this was via Dr. Dodds recommendations.) About every 4-6 weeks ask for a mini chem screen for liver values so you can monitor the liver. Once you reach subsuppressive doses of cyclosporine, and your cbc's have been fine you can switch to a simple spun pcv with each dose reduction. You can do these at little cost as often as once a week if it makes you feel better. If you see any rapid drop in pcv in a short period of time, from 60 to say 30, move back up to your original dose and begin weekly monitoring with full cbc's again. I highly doubt you will see this, but this would be your plan of attack. I hope this has helped you, Patrice |
| Patrice NYS |
| Sierra's been on Cyclosporine 5 years. We reduced by 1/3 to 1/2 each reduction ... with more frequent testing (and watching closely of course), but we also spaced out the reductions by 7-8 months. Never weeks. When another auto-immune problem cropped up, seeming to follow a dose reduction, we went back up to the previous dose and have remained there ever since. Sierra's been at 100mg/day dosing for almost 3 years. I worry about her kidneys, so we supplement with fish oil for kidney protective effects. And feed a home prepared diet with some emphasis on green-leafy veggies (per her vet, Dr. Scanlan, green leafies are supportive of kidney funtion - it seems to have worked for Sierra in bringing some mildly elevated values down to normal over time). I won't tell you not to worry, because I think we all do when we reach those points. But I will wish Cranky & you a good response to the reduction. |
| Ronda So Cal |
| Thanks everyone for there wonderful advice. Patrice Cranky is a 5 pd toy poodle. He has been in the 60's PCV for about 4 months before that in the 50's we have had good PCV since diagnosis and transfusion. Teresa and the Crankster. |
| Teresa Smithfield Ky |
This thread was discussed between 03/06/2008 and 04/06/2008
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