Earl is New here

[Jbielak1]

Good afternoon all,
We are new here! I was recommended to contact this page from a favebook group I am apart of. My pup was first diagnosed with IMHA but he ha non-regeneration anemia. Hes on day 11. He went in at 6% RBC and revived a blood transfusion. He was put on prednisone and Azathiaprine, wasn't working. We took him to a higher end ER, he received packed cells and bumped his RBC to 28% to buy him time to try a new medicine. He's currently on mycophenlate and prednisone with plavix and Prilosec. I was told to ask about correct dosage here!!! 🙏🏻

Earl is a 82lb coonhound male
Prednisone : 30mg twice daily
Mycophenlate: 500 mg  3/4 tablets twice daily
Plavix 75mg
Prilosec 20 mg twice daily


Thank you!!!!!

[Jo CIMDA]

Hi and welcome to you and Earl

I am sorry Earl has non-regenerative IMHA.  It is good he has been seen by a higher ER and is now doing well.

You ask about dosage.  82lb of body weight equates to 37.27kg

The recommended starting dose of prednisolone is 1mg/kg/12hrs, so given that Earl is also having added immunosuppression with  mycophenolate this dose is fine.  It is good that he is not on a dose of prednisolone  that is too high because larger dogs don't cope well with the side effects of very high doses of prednisolone.

Mycophenolate is a relatively new drug to veterinary medicine and it is, like so many of the newer immunosuppressive drugs, licenced for humans.  It has had a lot of good reviews over the last few years and it now commonly used as an alternative, or sometimes used as a combination drug to Cyclosporin and of course prednsiolone etc. 

Mycophenolate mofetil ref:  *Plumb's Veterinary Drug Handbook, 8th edition, recommends 10mg/kg every 12 hours.

Earl is having exactly that dose however, this drug is a film coated tablet and that is for good reason.  It is classed as teratogenic drug and therefore

*the manufacturer recommends that the capsules or tablets should not be crushed, split or broken. 

Teratogenic  means it can cause malformation of a foetus and although this is not relevant in Earl's case this rule of not splitting coated tablets can be relevant for various reasons and also to protect the administrator.  So many of the newer immunosuppressive drugs, used initially for  human organ transplant patients, should not be split or broken and they are now film coated.

Earl is having: 3/4 of 500mg tablet  = 375mg MMF twice a day.

As far as I am aware it comes in 500mg tablets or 250 mg capsules, so this doesn't help given the current dose Earl is on, but look at the article below and if you feel inclined, perhaps have a chat with your vet because this article recommends: Mycophenolate:  7- 20 mg/kg twice a day.  A whole 500mg tablet equates to 13.4mg/kg for Earl, and this falls well within the dose of this article and there is no need to split the tablet.  See this link:

https://www.mspca.org/angell_services/mycophenoloate-mofetil-the-latest-in-immunosuppressive-therapies-in-veterinary-medicine/

I did find this link to a specialist compounding veterinary pharmacy in Texas that may be able to produce the exact amount of drug for you.

https://www.svpmeds.com/product/mycophenolate-mofetil-10mg-capsule/

A gastroprotectant is very important when a dog is on prednisolone and Prilosec (omeprazole) is a very good one but taken together with Mycophenolate one might reduce the effectiveness of the other. It might be prudent not to give both tablets at the same time.  If you are giving Prilosec once a day then giving it a night might be better and more convenient for you.
See this link: 

https://www.rxlist.com/drug-interactions/mycophenolate-mofetil-oral-and-omeprazole-oral-interaction.htm

Plavix is to keep the blood from clotting and this is a good precaution.

The above is only for your information and giving you leads where you can do your own research and feel comfortable with the medication.

Earl is doing really well and your specialist seems to have turned this horrible AI disease around. 

Have a look in the files about what to expect when treatment has started, side effects of steroids etc., and the Michael J Day immunosuppressive drug protocol. Steroids are a remarkable drug and lifesavers but it is good to familiarise yourself with the acceptable/unacceptable side effects. As the preds are lowered the side effects will all gradually subside and Earl will hopefully return to being a normal boy again.,

Jo

[Jbielak1]

Thank you so much for your reply!!!! I will ask his vet about all the points you mentioned. I am wondering. He gets Prilosec twice a day, and you mentioned it taking it with mycophenlate. Do you recommend a time to wait to take it to reduce negative interactions?

[Jo CIMDA]

Hi

It is best to ask your vet if the Prilosec and mycophenolate should be given at different times?  Ask him, if by doing this,  might it limit the interaction and any reduction in the effect of the drugs? He may be very experienced in using these drugs and he may think this is not necessary. Often, experience is better than any text book.

The dose of Prilosec (omeprazole) for a dog is 0.5 - 1mg/kg once daily Ref:  Plumb's Veterinary Drug Handbook, 8th Edition. It is usually given once a day but I have known other dogs to have the dose split and given twice a day.

The duration of action of omeprazole is longer than 24 hours so it doesn't really matter when to give the tablet/s, however,  when several drugs are given at different times throughout a day it can be a bit mind blowing and if one can arrange the timings of drugs to fit into your own schedule then it makes life easier.   Some 'human'  references say Omeprazole should be given once a day, half an hour before breakfast.   In practice, if it is only prescribed once a day then administering it at night to your dog still gives protection for the next 24 hours and you have one less drug to juggle during the daytime, but always check with your vet.

You will see that the information below is from human references (Veterinary information is also taken from human references). 

Prilosec (omeprazole)

https://www.drugbank.ca/drugs/DB00338

The delayed-release capsule are enteric-coated (as omeprazole is acid-labile) so the absorption of omprazole begins once the granules leave the stomach. Absorption is rapid. Peak plasma levels occur within 0.5 - 3.5 hours. The absolute bioavailability (compared with intravenous administration) of the delayed-release capsule is 30-40% at doses of 20 - 40 mg, due to presystemic metabolism. This value increases slightly when given repeatedly. Based on a relative bioavailability study, the AUC and Cmax of PRILOSEC (omeprazole magnesium) for Delayed-Release Oral Suspension were 87% and 88% of those for PRILOSEC Delayed-Release Capsules, respectively. Interestingly, when the 40 mg delayed release capsule is given with or without applesauce, it is bioequivalent. However, when the 20 mg delayed release capsule is given with the same conditions, it is not bioequivalent. When the same capsule is given to the elderly, bioavailability increases. Omeprazole was 76% bioavailable.

This reference may be useful:

https://vcahospitals.com/know-your-pet/omeprazole

Jo