Cyclosporine

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Cyclosporine (brand names Atopica, Gengraf, Neoral) is an immune-modulating, immuno-suppressant drug used for many inflammatory disorders and to prevent organ rejection in humans. It is a very useful drug in the treatment of AIHA/IMHA in dogs as it suppresses T cells but does not suppress the bone marrow, unlike azathioprine & cyclophoshamide. Please note : It may take up to 6 weeks for cyclosporine to have an effect & suppress T-lymphocytes, so owners cannot always expect an immediate response to this drug.

The therapeutic range for cyclosporine is from 300-500 ng/ml (nanogram/milliliter) as a treatment for AIHA/IMHA.. Cyclosporine is usually given every 12 hours, strictly as your vet prescribes. This is extremely important, as cyclosporine has a half life of only about 19 hours. Either ALWAYS give without food (recommended) or ALWAYS give with food (the same amount of food is important too) to be sure that the same amount of the drug always gets absorbed. Depending on the type of cyclosporine used, blood level monitoring (trough test) may sometimes be needed to ensure adequate dosage, as absorption varies from patient to patient. Strict consistency in diet, amount of food, feeding times & dosage times are critical to get maximum benefit from cyclosporine. NEVER change the way you give this drug unless advised to by your veterinarian.

Cyclosporine should not be given at the same time as any other medication, as drug interactions are common.

Cyclosporine should not be given to dogs who have had malignant neoplasia.

Cyclosporine gastro-intestinal side effects when starting the drug include nausea, diarrhea, vomiting & anorexia. These side effects can usually be avoided by starting at a low dose. Metoclopramide can be given 30-60 minutes before dosing if necessary. Dogs are also more susceptible to urinary tract infections & other infections whilst taking cyclosporine, therefore vigilance is necessary to catch & treat any infections as early as possible.

Other side effects (mostly long term) of cyclosporine include raised alkaline phosphatase, alanine aminotransferase activities, cholesterol, hypoalbuminemia, raised blood pressure. Cyclosporine is hepatoxic & nephrotoxic, so liver & kidney damage can occur. Enlarged lymph glands, thickened gums, thickening of feet pads & painful ear flaps have also been reported. There is also an increased risk of cancer.

Cyclosporine weaning or tapering – when your vet is happy that your dog has a good, stable PCV/HCT, a slow reduction of dosage can be started. Blood tests must be taken before & after each drop to check PCV/HCT progress. Gradual reduction is recommended to prevent a relapse of AIHA/IMHA. Most dogs can eventually stop this drug altogether, although some dogs will always need to take cyclosporine to remain stable & prevent a relapse. As the dose is lowered, the side effects should slowly subside.

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