Imuran and Pancreatitis

[dom]

Piper has IMPA (under control currently) and IBD (not really under control) and is in liver failure (currently stable on a load of meds). She hasn't been well for the last few weeks (more than normal) so had bloods last week which showed that she is anaemic, thyroid level is low and her pancreatic levels were high. The blood was re-sent off for more intensive testing and her free T4 is normal so her thyroid is low de to ill health. Her pancreatic levels are coming back at 600 (normal is 0-200). My vet is currently off, so one of the younger newly qualified vets rang to give me the results. She has suggested that there has been occasions where Imuran has caused pancreatitis in a dog and has recommended reducing the dose slightly. Has anyone experienced this? I know that we need to get the levels lower but she is already on a low fat diet, is fed small meals, etc.

[Penel CIMDA moderator]

Yes it happened to Saffy Dom - from the Imuran/aza.     sorry to hear little Piper is having such a hard time at the mo.

[dom]

Was Saffy's dose reduced successfully Penel? I am nervous about reducing the dose as we don't know for definite that it is the cause. The vet said that the inflammation from the IBD could be a factor or the poorly liver. It's so hard to know what step to take next

[Catherine]

Sometimes when a dog has something like a bad stomach upset or infection it can throw the blood result levels into disarray! Perhaps another blood test when she is better will give a better indication.

What is causing her liver to fail? How anaemic is she?

If the FT4 result is normal but just inside of the low normal range there can be "borderline Hypot".

My dog was okay on Azathioprine (Imuran), no pancreatitis.

[Penel CIMDA moderator]

It was reduced successfully a few times, but not the last time unfortunately.  Piper is a really really complicated difficult case to work out I know 

[dom]

Thanks Penel, I have lowered the dose today from 18mg down to 12.5mg so hopefully it will make  difference without too much going wrong.

Sometimes when a dog has something like a bad stomach upset or infection it can throw the blood result levels into disarray! Perhaps another blood test when she is better will give a better indication.

What is causing her liver to fail? How anaemic is she?

If the FT4 result is normal but just inside of the low normal range there can be "borderline Hypot".

My dog was okay on Azathioprine (Imuran), no pancreatitis.

We aren't sure of the reason for the liver issues. On ultra sound her liver looks okay (the pancreas and gall bladder look patchy though) and I considered a biopsy, but at the time when the liver results originally came back so high, it wasn't felt that she would survive an anesthetic so we started her on denamarin and ursodeoxycholic acid and her levels stablised at about 1500 (should be below 500 I think, but its been a while!) I'm not sure how anaemic she is, she is visually very pale, particularly her gums. She's been having trouble with constant eye ulcers since September, which I think has been making her feel down as well.

[Penel CIMDA moderator]

What are you treating the corneal ulcers with Dom? you know Lola had one recently - we treated it with Remend and it worked really well.