Dosing Question for Prednisone and Azathioprine

JLS

Guest

Thanks for the response!

Her name is Gidget :)

Her normal vet who diagnosed her and I typically trust the most left on vacation out of the country a couple days later. Then I took her in for a PCV the next week and to suggest a longer dose because they had things setup more short-term then I had read should be happening. So that Dr agreed and changed the prescription instructions. But then when I noticed her weight and muscle mass going away I made that PCV check for 2 days ago and to discuss lowering the dose a little if it was good. Unfortunately that Dr also went on vacation so I got another Dr. That is when they gave me these pills to begin switching her too.

To be honest I’ve talked to 5 different vets now on this (including a personal friend vet and emergency vet clinic) and none of them seem overly familiar with the ways to handle this. They all know the diagnoses and general idea behind the AIHA but as far as long-term dosage etc it seems like they are scrambling or winging it.

This last Dr had never heard of any muscle loss, weight loss, or being bug eyed from Prednisone. I agreed that the label on the bottle etc didn’t list these things in the side effects but I found TONS of information online from real people that are battling this from the Pred. I’m not sure I can blame that on the Dr’s vs the pill companies listing side effects etc. It’s obviously something people should expect from this med.

They did not give any mention of stomach protection etc.

The point of this new med was to replace the Prednisone with it. After telling me that those side effects aren’t from Prednisone the dr did more research while waiting on the blood test results and then suggested to switch her to this new med just incase it’s the Prednisone causing it. So I think the Dr might have googled a bit a somewhat verified what I was telling her.

So is your suggestion just to keep her on the Predisone (forget the other med) and slowly dial it down in 25% increments a few weeks at a time? If so I’ve still continued to give her the 20 mg twice per day and haven’t started the other med. So as her first taper down should I do a 20mg tablet in the morning and then half a 20mg tablet at night? Or should I use the pill cutter to split up quarters so I can do 3/4 a 20mg pill in the morning and 3/4 a 20mg pill at night?

I look forward to her normal Dr getting back next week. He isn’t perfect but he always listens to me and cares about the dogs. He’ll do good research on anything I present as a concern to him I think and get me on a good path.

Details

Linda

Guest

Hi GLS and Gidget! I would rather have the backing of those here. Plus, we have a great glossary to look things up on this forum. I would imbed the links, but I’m on my iPad and can’t toggle back and forth.

Yes, that is what I am saying, but there are some pre- questions to be answered. But straight across three board, a forever carved in stone rule, don’t rush weaning.

What is the other medication recommended by the last vet? Typically, two auto immune suppressants are used. For instance, my cocker spaniel, Sadie, weighing 32 pounds, is on 40mg of prednisone and 50mg of cyclosporine (Atopica). She was originally put on a ‘loading dose’ higher on both. But when her PCV reached a ‘low normal’ range, both were lowered a bit. But Sadie is a rare bird (dog) in that this is get 3rd relapse and this one was a dilly. Don’t panic – what she’s doing is not common. So, we hit her hard with the medications (she had to have two transfusions this go around, never before).

For Gigits weight, that’s actually a bit low on the pred. It’s usually 1mg per pound. But you are absolutely right, there are some lousy side effects. I am concerned too about liver, tummy and anti-clotting meds for her. These are VERY important.

For tummy: most of us typically use Sucralfate. It is by prescription from your vet. I actually get Sadie’s (as with all her scripts) from Costco. They give canine discounts.

Fir liver: most of us use Denamarin. Pro prescription needed. Depending on weight, I buy it from Amazon. The box of 30 will last 30 days, one daily.

For anti-clotting (much needed, but discuss with vet about blood coagulation first): most of us use either 1/2 an aspirin or Plavix. I use Plavix (1/2 tab) for Sadie.

This is all on the forum, under AIHA TERMS. Please check it out.

We are here for you and Gidget. Please ask any and all questions. You can even scan and download Gidget’s bloodwork. There are several here much brighter and more knowledgable than me that can look it over and help you understand what is going on. Better yet, have your vet send an electronic copy and just forward it to us. You can scratch through names, addresses, etc., if you feel uncomfortable sending that.

I hope this is of some help. Others will reply too. You are certainly doing a great job already. Being here is a big step in the right direction too. Trust me, we have all been right where you are right now. It’s a crazy roller coaster. We’re here for you – don’t feel alone.

Hugs to Gidget – let’s get her well!

Linda and Sadie

Details

Vally

Keymaster

Hey JLS, sorry to be so slow to answer. I’m not sure if I missed your post, but we normally get an email when someone posts and I don’t remember see it, so need to check that that’s working properly. It’s probably me though :)

Absolutely agree with what the others have said. Gidget (and I LOVE that name, I was a real Gidget fan when I was a kid – that’s giving your age away Vally !!!) was not on a super high dose for this disease and the reduction that was mentioned is the usual reduction for injuries or skin conditions where it’s normal to reduce by 50% over a few days until nothing. BUT that’s not the case here. Some of us have been through the relapses (raises hand) and it’s in most every case, because of quick reductions, so don’t rush it.

Yes, prednisone makes them incredibly hungry and yet the weight just keeps dropping off. That’s going to be muscle that’s being lost. The symptoms you’re seeing of bug eyes and loss of muscle tone, big bellies, drinking heaps, peeing heaps, that’s all definitely a side affect of the predisone and it’s scary to see them go through it. Here’s the link to read about prednisone and reducing it so you can find it quickly:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
and
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

As the dose is safely lowered though the side effects all start to go away, so don’t worry too much about them.

Gidget sounds as though she’s doing well though – in fact 38 puts her back into normal again, so yes I’m wondering about why they’re adding in the azathioprine. I guess because they’re talking about reducing the prednisone maybe??? Prednisone is the key drug in dealing with this. Usually a second drug is needed, and the drug of choice is now Cyclosporine (as it has fewer side effects), but it’s used together with prednisone. With Gidget back into normal range though, I’m thinking keep up the PCV tests, and stay with the prednisone.

Yes, do you have a copy of the blood works? It not, ask for a copy. You can attach them to the Urgent Advice link at the top, or here
https://www.secondchanceaihadogs.com/urgent-advice/
and someone can have a look at it for you and explain what seems to be happening. It’s also a good way to check if aspirin, or the like, is needed to stop clotting, as is very common with AIHA, and one of the biggest risks.

I totally agree with Linda, when on high dose prednisone stomach protection is very important. The prednsione can cause ulcers (it did with Bingo) and the best to use is Sucralfate, but that needs to be given 2 hours away from other meds or it stops their absorption.

My local vets didn’t know what was going on, this disease, although we seem to hear more and more about it, is not common at all. My vets suggested I take Bingo to an internal specialist, who had it pinned pretty much immediately. I’ve also since changed my local vets (not the specialist – we love Uncle Phil), because I would see a different vet almost every time I went in. It was very frustrating.

Again, I’m sorry to get here so slowly. Thanks Laurie for jumping in. We never want anyone to be alone with this disease.

Ask anything, someone’s been through it.

Vally & Bingo (diagnosed Nov 2011, in remission)

Details