Heartworm medicine

[Henrie]

I have a question, Saydee is due her heartworm meds and has IMHA, she is on predisone, antibiotics and Prilosec, I also added Milk Thisle to her daily routine.  My question is should I give her her monthly trivexus?  Saydee was diagnosed with IMHA on 10/27/17, her red blood cell count is slowly improving, she at 42% at the moment.  Thanks for any information you can provide for me, the vet says yes give it, but I'm not sure if it's a good idea.

[Jo CIMDA]

Hi

I can only give you my personal opinion.  I wouldn't give Saydee any unnecessary medications, especially as she is still having treatment and her immune system is compromised.

  A dog with a genetic predisposition to autoimmunity should be kept as natural as possible and that means no more vaccines and unnecessary preventative drugs. 

I once asked Prof Catchpole, of The Royal Vet College, if dogs that have had AI disease should ever be vaccinated or given spot on treatments ever again and he categorically said No, because the risks outweigh the benefits in a genetically predisposed dog.

Her PCV is 42% and I presume she is now on a reducing prednisolone protocol.  Please take a look at the Michael J Day immunosuppressive drug protocol in the files.  It is the best protocol I have come across.

Hopefully she will be weaned down successfully and reach remission.  You can then reassess her meds but I think her liver has enough to cope with at this time and adding more unnecessary chemicals could do her more harm than good.

I have looked up Trivexus and it is made of two chemicals Spinosad and milbemycin.  Milbemycim doesn't have many adverse effects listed but spinosad has quite a few and a number of drug interactions as well.   I don't know how true the reports are but there is some bad press about Trivexux.

https://www.whole-dog-journal.com/blog/Trifexis-Adverse-Effects-20898-1.html

As Saydee has an A disease it is best to keep her away from any unnecessary drugs from now on.  Drugs, chemicals, hormones, stress etc... are all major triggers for AI disease.

Jo

[Henrie]

Thank you for your opinion, my gut feelings also tell me not to give her the heartworm meds since she is on such high dosages of Prednisolone, she takes 40mg in the morning, and 40 at night along with Prilosec and a antibiotic twice daily also.  Our vet says it shouldn't bother her since she's been on it for years, but as you said it's a chemical and that's what is bothering me in her present condition with IMHA.  Her RBC started out at 29% and now after a week and four days she's at 42% but lack energy and it's probably affecting her muscles and hair now.

[Jo CIMDA]

Hi

Saydee's body isn't behaving normally at this time and even though she has had these drugs for years no one can tell if they will be too much for her to cope with, also, these drugs can trigger an AI disease and this is why all drugs in future should be given only when they are needed and preventative medicines are not essential and could do more harm than good if given to a dog like Saydee.

Saydee is on a very high dose of preds - in fact the highest dose recommended for even the largest dog.  Please check out the protocol below and watch that she isn't on too much pred.

Jo



Reducing the Tablets
When significant improvement in the dog's condition is seen, usually between 10-28 days, the initial steroid dose is usually reduced by up to half. The dose is generally given for another 10 - 28 days and depending on the dog's progress and clinical signs the dose is significantly reduced once more for a further 10-28 days; and again in another 10-28 days. Anecdotal evidence has shown that if at this stage the dose is lowered more slowly, or reduced to an every other day dose over a period of months rather than weeks, relapse are less likely to occur.  It is always tempting to get your dog off steroids as soon as possible, but when treating autoimmune disease, as long as the dog is on a low, every other day dose then taking the last stage slowly seems to work best, depending, of course, on the severity of the disease and allowing for the difference in individual response - no two dogs reactions are exactly the same.  With some autoimmune diseases such as SLE, the dog is likely to be on steroids for the rest of his life. Usually an every other day dose can be achieved, but you risk a relapse if you take the dose too low. Below is the best example of a reducing immunosuppressive protocol I have come across. It is an excellent guide and can be adjusted to the individual.

Example: Reduction Protocol for prednisolone:

Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days
Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.

The dose of azathioprine 2mg/kg/24 or 48 hrs, can be reduced initially by giving a lower dose tablet per day, or gradually reducing from daily dosing to every 2nd day, every 3rd day, every 4th day etc.....  Remember, azathioprine tablets should not be broken or handled without gloves.

"Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.