Fast pred taper

[Pam]

Our dog was diagnosed with IMHA February 5, 2015. She’s currently taking prednisone and cyclosporine. Her IMHA is in remission.

Her liver is extremely distressed due to the prednisone. She’s jaundiced and her liver enzymes are off the chart.

Vet is having us taper prednisone from 30 mg per day down to zero prednisone per day over four weeks time. Vet said our priority has to be relieving the liver stress even though we know doing such a fast taper might put our dog into an IMHA relapse.

Has anyone else done such a fast taper? Has the IMHA returned?

Should we increase the cyclosporine as we decrease the prednisone in hopes of preventing a relapse?

Thank you for any thoughts you have about this.

Pam & Ella

[Patrice]

Pam,
Try reading this and see if it helps you some.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
My best
Patrice

[Brigitte]

Hi Pam,
reducing prednisone fast is always a red flag for me. The danger of a relapse is quite high if the reductions are not done slowly. I understand that in certain cases it is necessary to do it if the side effects are too severe. Is your dog taking any supplements to reduce the stress on the liver, such as Sam-E and milk thistle? This would be something I would discuss with my vet, it could make a big difference.
From what I understand an increase in cyclosporin will not help while reducing the prednisone. The body can only absorb a certain amount of the cyclosporin, giving more will not be beneficial. I would ask your vet to consider a 33% reduction and see if the liver values will go down. If that is the case, and I think it will be, I would wait for at least 2 weeks before doing an other reduction, again not more than 33%. After that I would consider doing smaller reductions because that is when the adrenal glands will have to “wake up” and start to work again. You have to remember that the liver is an amazing organ, being able to heal itself. Most of our dogs have had these high, off the chart liver values that can look very scary. With a slow reduction of the prednisone, supplementing with Sam-E and milk thistle and possibly Dr. Dodds liver sparing diet I am confident that your dogs liver values will come down. A fast reduction over only 4 weeks from a high dose is risking a relapse for sure. It would also be good to know how long your dog has been on the 30mg, has there been any reductions before and what is the weight of the dog. When was the last PCV done and where is it at. As I said the liver is quite capable of healing itself, however a relapse will make you go back to the beginning and be hard on your dogs whole body.
I would also consider an on line consultation with Dr. Dodds.
Best wishes,
Brigitte

[admin]

Hello Pam & Ella

Firstly, I’m sorry you’ve had to contend with this horrible disease – I’m so glad you’ve found us.

I could not agree with Brigitte more – fast reductions are asking for trouble. I would only agree to a fast reduction if there was a major clinical reason for doing it. Vets reduce prednisone quickly for other illnesses, maybe skin problems or similar – but AIHA is far more serious & we always recommend the slowly, slowly approach.

I know that Ella is having side effects (as ALL our dogs do) which are affecting her liver – if you can get some Denamarin (contains Sam-E & Milk Thistle & is a high quality product) immediately, this will help her. Many of our dogs have had raised liver enzymes – off the scale in some cases – and the Denamarin has helped us all. Here is a link to the site:
http://www.nutramaxlabs.com/dog/dog-liver-health/denamarin-for-dogs
My dog’s levels were back into the normal after a few weeks of using Milk Thistle & Sam-E. Also, you can use Dr Dodd’s liver cleansing diet, as Brigitte suggested.

Many, many times, (too many) we have seen relapses when the dose has been reduced too fast – please don’t take that risk if it’s only the liver enzymes that are making your vet want to do this. You will end up lengthening the treatment time because you have to put the dose right back up again – starting all over again is not what you want. It’s not worth the risk. If it were me, I would stick to the reduction Patrice has mentioned:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

We all love to help everyone get their pets better – please keep in touch & let us know how you get on at the vets.

Sheena, Worzel (diagnosed Dec 2012, in remission) & Ollie too

[Vally]

Hi Pam

I’m glad to hear that Ella is in remission. I’m assuming Ella is your dog. Sorry if that’s wrong.

She’s on 30mg a day. What is Ella’s weight and do you know what her liver enzymes levels are at the moment? Is she taking Denamarin or milk thistle to help the liver cope?

I totally agree with the others, this reduction terrifies me. Bingo did 50% reductions in the early days and relapsed twice, which meant the pred had to go back up to the dose he was previously on. So should the prednisone be brought down too rapidly, and the disease starts up again, there is absolutely no benefit because the dosage will only have to go up again.

Bingo’s specialist in the early days told me not to worry about the liver – it was swollen and the enzymes higher than they should be, however, he said it would heal and do what it normally does when the prednisone dosage came down. However, Bingo’s liver enzymes went too high. At that point we knew the liver needed help and started using Denosyl (similar to Denamarin). That worked pretty much instantly in bringing the levels steadily back down again.

Depending on the weight, I know they can do 50% reductions when on high dose and it may all be fine. As the dosage is lowered though, as Brigitte said, it gets to the stage where the adrenal glands have to be woken up. To go to fast, Ella’s body can go into crisis if the glands can’t cope.

I agree too cyclosporine can’t go above a certain level. In fact if too much is given, it becomes toxic, so no, you can’t up the cyclosporine to compensate.

Please come back with more information.

My very best,
Vally & Bingo (diag Nov 2011, in remission)

[Pam]

Thank you all for such informative comments. I, too, am very worried about this fast prednisone taper.
Ella (my dog) was sent to a Critical Care Specialist this past weekend because our family vet was closed and Ella stopped eating. It’s the CC Specialist who is recommending this fast pred taper.
We return to our family vet in two days for a physical and to check Ella’s PCV. I’m going to push for a slower taper. Her current PCV is 36.
Ella weighs 70 pounds. She started on 40 mg of prednisone and has been slowly tapered to 30 mg.
Ella gets daily Denamarin and has been started on Ursodiol, both for liver support.
Her liver values (I’m throwing out numbers here because I don’t know which ones you want) are: ALT 708, ALP 6,757 Bilirubin 2.9,
Bile Acids 350.9
Pam & Ella

[admin]

Hi Pam & Ella

Good to read Ella is getting the denamarin & ursodiol too – how long have you been using them? Those enzymes are indeed high – but we’ve seen this quite a few times & they WILL come down. Please have a look at Beth & Heathy’s story/topic
https://www.secondchanceaihadogs.com/forums/topic/liver-enzymes/
I hope this will cheer you up a little as Heathcliffe is doing much better, but it did take time for his enzymes to come down as his were also pretty high. I know it’s not exactly the same scenario for Ella – it’s more a case of being on the pred a long time – it really is amazing how well the liver recovers. To me, a relapse is far worse than raised liver enzymes for a few more weeks – please take it steady. And I wouldn’t increase the cyclosporine either – not safe.

I’m sure your vet will be happy to discuss a compromise – maybe 30% reduction every 2 weeks, which is about the fastest you want to do really. Please let us know how things go.

Love Sheena & the boys

[Pam]

Thanks, Sheena!

Ella has been on Denamarin for 1 1/2 months and her liver enzymes continue to climb. It hasn’t been a miracle supplement for Ella but I figure it can’t hurt to continue giving it.

The Ursodiol was started only 5 days ago so we will have to see at Ella’s next liver enzyme test if it seems to be helping.

Ella sees our family vet in two days and I’m going to propose slowing down the tapering schedule. Instead of stepping down every 7 days, I’m more comfortable stepping down every 14 days. I’m just so worried about an IMHA relapse.

I will read Heathcliffe’s story. Thank you for your suggestions, Sheena!

Pam & Ella