Weaning: Atopica (cyclosporine) and Prednisone

[Vally]

Hi Angela

I’m sorry to hear about your girl. I’m not sure what you mean by she would be on medication for a lifetime, but you are ready to get her off all her meds.

The drugs do do a number on them and it’s heartbreaking to see, but when they come down off the drugs or are only on the smallest amount to keep them safe, the side effects go away, and quality of life returns. Bingo is now 11 years (he was 7 when diagnosed) and he’s now doing great. Yes the cost is horrendous.

Bingo had AIHA and auto immune polyarthritis rather than Thrombocytopenia so I’m not sure the reduction of drugs is quite the same. I’m sure someone here will know more.

In Bingo’s case with reductions, cyclosporine was actually the easier to wean compared to prednisone in that there was never a reaction to weaning. We reduced cyclosporine by 50% each time, doing it by going from twice a day, to once a day to every second day, then every third day. At that point, I was told I could stop, but I double checked with Dr Jean Dodds, who said do once a week for 2 weeks and then stop it.

Prednisone was a bit different in that he’s still on a small dose and that was reduced MUCH slower. Initially we were doing 50% reductions, but as soon as we went to every second day, we had a problem, no matter the dose, but his problem was more a case of his auto immune arthritis returning more than the anaemia returning, although the first time we reduced to every second day, his PCV dropped by a lot.

I don’t know if I answered anything really.

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

[admin]

Hi Angela

Vally is absolutely right – prednisone is the “tricky” one & you should follow the guidelines here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
Normally, the prednisone is reduced first SLOWLY down to nil OR the bare minimum dose needed, then reduce the cyclosporine. I would follow Dr Jeans Dodds method that Vally mentioned to be on the safe side. There is no reason why most dogs cannot be drug-free, but some dogs will always need a small dose of prednisone to keep them healthy & happy! You will see a huge improvement in their body condition & well being when you lower the drugs – it’s amazing how they perk up & return to their old selves. And it’s a lot cheaper without the drugs too!

Sheena, Worzel (in remission) & Ollie xxxxx

[Robin Vhal]

For anyone who has their dog on Cyclosporine and “developes ” soft runny stools you need to give them Metronidazole with the Cyclosporine. This will return the stools back to normal. I had to use Metronidazole with 25 and up to 100 mgs of Cyclosporine per day for my 16lb Poodle/Terrier cross and she is doing fine now.

[Michelle]

Hi All – I’m new here and just found this forum. I have an 8 year old Doberman Pinscher who was diagnosed with Immune Mediated Thrombocytopenia. She spent 1 week at our local UC Veterinary Hospital requiring platelet and blood transfusions. She no platelets when diagnosed. She has been home now for 2 weeks. On her last check she was still a little anemic (29) but her platelet count was about 900,000. My poor girl is on Cyclosporine, prednisone, prednisolone eye drops (she bled into her eye) and Omeprazole. If there is a side effect to the meds, she has it, almost all of them. The Cyclosporine has also caused pyoderma so on top of everything, she has to bathe every other day with Chlorhexidine shampoo until that is under control. The worst is the muscle wasting. She was energetic, happy, playful and loved her daily walks. Now she can barely walk around the block. So very long winded way to ask a question…how long did you keep your dogs (with IMP) on the prescribed levels of the prednisone and Cyclosporine prior to beginning the weaning process? Also, it seems like prednisone can be brought down to a therapeutic level (if the dog can’t be taken off) and possibly manage the immune issue as well as the anemia issue while the dog can taken off the Cyclosporine altogether or am I thinking about this incorrectly? We want our girl back and know that she’s still got years left in her if we can get the IMP to stay under control/go away completely. Thank you in advance for your time and expertise.

[Vally]

Hi Michelle,

I know your girl looks a mess right now, and that is the drugs, as you’ve said, but they are saving her life. She sounds as though she has improved though and that’s great.

I probably wouldn’t be doing the walks right now, or if she really wants to go out, maybe do really short trips. Also, her immune system is being kept in check with the drugs right now, so it could leave her at risk of picking up any sort of infection.

In most cases, prednisone is lowered first, as it has the most side effects. Reducing the dose doesn’t normally happen until the PCV has reached 35 and has stabilised there. This has some information that might help:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone

It’s important to reduce the dosage slowly and a reduction of no more than 25-35% at a time with checks before and after.

Yes, it does happen sometimes that a dog will need to stay on a small dose of prednisone. My boy Bingo was one of them. However it was a very low dose.

Ask anything, happy to help.

[Michelle]

Thank you so much for your response, Vally. Once she started improving (this last week we got a wagging tail, barking when someone is at the door, greeting when we walk in the door, etc. Total turn around from the week prior) she started asking, more like demanding, that she go for her nightly walk again. It sounds terrible but because we were worried about her picking up something, we make her walk on the outside part of the side walk and only take her on a loop around our court (that’s what I meant by block, sorry for any confusion) . No sniffing allowed, just walking. That one loop makes her so tired. Do you think that is okay or should I just deny her of her walk and let her “velcro” nature of following me around the house be enough. I’m not sure how to give her the best quality of life while she is going through this and try to make things as “normal” (yeah right) as they can be.

Thanks again! So glad I found this forum.

[Vally]

To be honest, right now, her staying home is probably safer. However, I totally get quality of life. If it were me, I’d likely do 5 minutes outside for a sniff, rather than a walk. Sniffing takes up a lot of their mental energy. It’s good for dogs that can’t exercise after surgery and the like.

[Judith]

Hi Vally,

When you reduced cyclosporine how long was the duration for each time at : 50% then every second day, and every third.

We are in the same situation and I came across your post – it is golden, thank you!! He’s on his 2nd week at 50% [50 mg. a day from 100 mg a day] right now.

“by 50% each time, doing it by going from twice a day, to once a day to every second day, then every third day. At that point, I was told I could stop, but I double checked with Dr Jean Dodds, who said do once a week for 2 weeks and then stop it.”

Lots of love, Judith H.