Azathioprine

[Guest tigger]

if your greyhound has been on....or is currently on this medication. And how long until its affects(good and/or bad) were seen.

 

Specificly for my greyhound it is being recommended as a 2nd medication for severe IBD/PLE/secondary Lymphangiectasia.

 

Thanks in advance,

Kathy and Stevie

[2hounds]

My Mia is still on 25mg every other day along with 10mg pred every other day for long term immune mediated polyarthritis associated with Erlichea. She was on the pred first (40mg/day at first) and we put her on the Azathiaprine hoping to get her weaned off of the pred faster because Aza has less side effects. It didn't work out like we had hoped, she is still on both meds, but she has been stable for about 6 months now.

[tbhounds]

Well, first I would like to tell you that I can sympathize with you. A true case of IBD/PLE is a serious disease-so much more than just diarrhea and a sensitive tummy. Sounds like your dog had a complete work-up.

My dog was given Azathioprine in hopes that we could reduce the Pred dose he was on. Well, in my boy's case it just didn't work. His protein levels just kept going down along with his attitude and weight--I was losing him. While he was being treated by some very talented Drs it was time to seek out a Internist. I was so lucky to find a very wonderful GI Doc. Long story short he changed his drug protocol. He was put on (for life) a steroid called Budesonide. That drug turned my boy around---proteins up-attitude up and weight is up too (okay so he's a little chubby now). The wonderful thing about this drug is it doesn't have the same side-effects that the pred does (drinking and peeing) as it pretty much stays in the GI tract with very little of it metabolized through the liver. I still need to be careful not to alter his diet (rabbit works well for him--NO FAT)

So, I would give your med protocol a try--repeat bloods per your Dr but, if you are not happy with his progression don't hesitate to find a second, third opinion. If your Dr truly cares about the health of your pet he/she should gladly give you a reference.

Good luck--keep us informed--feel free to PM me if I can answer any other questions you might have.

[Guest LynnM]

It's one of the standard meds for autoimmune conditions in people, and more recently, animals. It is used when corticosteroids can't be used, aren't effective, or to reduce the amount of corticosteroid required.

 

Right now, my oldest is being treated for IBD (we dealt with it about 5 years ago and it's been a pretty long remission) and he is on- and responding to- budesonide/Entocort. Fortunately, we don't have to deal with PLE. Last time his gut got bad, Entocort wasn't around. This time, we're trying it and he's responding to it with very few side effects.

 

Lynn

[dmswartzfager]

I did a quick search for it and found this old thread: azathioprine. I do remember we tried it with Blitz for a couple of weeks for his IBD, but his appetite went down and his stools actually got worse, so I stopped using it. My sympathies - Blitz is stable with no medications and the raw diet now, but when we were going through all that right after we adopted him last year, it truly sucked. I was so tired and frustrated because just about everything we tried didn't work. Best of luck to you.

[ShantisMom]

Shanti was on it for a little over 3 months for IMPA. Her blood work was staying good, we had other issues not related to the medicine. It was hard to get her to eat on this medicine. It made her pretty sick to her stomach. I had to give pepcid with it. She got the runs with it quite a bit.

 

If you are going to be on it a while, check with Costco. I got Shanti's Imuran for about $45 for 100 tablets. It would have been almost $400 at the vets.

 

You are actually not suppose to touch the medicine yourself. They gave me gloves with it which was a pain. I just carefully dumped it into the meat of the day and washed my hands thoroughly.

[Guest tigger]

Hi,

 

A big thank you to everyone that replied. All input...information and experiences...is very helpful when trying to decide what to do next.

 

I decided to try the Budesonide first...so he is weaning down on Pred and started his first Budesonide dose today. Working on food choices as I am sure there will be many attempts until we find one that works. Also, have decided to seek a 2nd opinion from another internal meds specialist.

 

Stevie's albumin is 2.1...down a bit from 2.3 a few weeks ago. The pred effects were severe and it seemed that was becoming as big of a battle as the protein losing issue, thus the change in meds. Which in retrospect probably should have happened sooner anyways.

 

He feels okay...normally his happy head self...but not the past 2 days...his tummy seems upset and a little bloated...not from fluid...just things aren't moving through normally.

 

His current meds are 2mg Budesonide a day, 30mg pred BID(weaning down to 20mg or 10mg BID), 20mg Pepcid AC BID, 1/4 baby aspirin once a day, B12 injection once a week for 6 weeks(then every other week for 6 injections, then once a month).

 

We see the 2nd specialist tomorrow. All paws crossed for helpful news.

 

thanks again,

kathy and stevie

 

 

[duncan41]

Look forward to hearing what the 2nd specialist has to offer. Hand in there! Prayers and healing light going out to you!

[packmom]

Leeanna is on this as she is weaned from Pred. She goes for bloodwork at the end of the month to see how well it works. The no touchy thing is a pain. I pour one into the cap and then pour it into her mouth.

[Guest tigger]

It's a new day for Stevie!!!! The 2nd specialist we saw today was phenomenal!!!! He sets the standard and if you don't hear all of the following or your specialist is not receptive to all this information...then move on....quickly move on to someone who will.

 

Dr. Ron Hodges....an exceptional man, extremely knowledgeable, very experienced(20 yrs) and a bonus...very compassionate as if Stevie was his own

 

 

He started with "How is Stevie doing?"......which ilicited a response from me "we are one month out from when all this started(ascites, critically low albumin, scoping, hetastarch infusion) and he is...status quo. He has responded to meds, but has made no strides in his albumin level/total protein.

 

Next we went through his bloodwork results and UA and what were important...hematocrit, platelet count, WBC, no protein in his urine, liver values good, cholesterol increasing so he was okay with that.....

 

Next what isn't a factor....Ca level low, falsely low as it binds to albumin and there is corrected calcium result which accounts for the "loss" so Ca is fine. Lymphocytes...falsely low because of the pred he is on...Eosinophils...not a factor.

 

Next and most important....he went through the pathology report and clearly wanted me to understand this information and in Stevie's case...it's moderate to severe inflamation everywhere and lymphangiectasia in the small intestine. This is the cornerstone for the treatment plan he laid out.

 

Next he went to a dry erase board and listed out the options for medication.....prednisone(initially only)....he couldn't say enough "we have to get him off the pred it's killing him".....next option Budesonide....next Azathioprine...next Chlorambucil....next Cyclosporine. He circled Cyclosporine and said he doesn't like to use this as he has seen little good effect from it..so that got an "x" marked through it.

 

His recommendation for Stevie---due to the severity of Stevie's illness, Budesonide alone is not enough so Azathioprine will be started too.

 

He drew a line and said these are things he has to have...not it could help...would be nice to try....he MUST have.

PROBIOTICS---MUST CONTAIN ACIDOPHILUS, LACTOBACILLUS AND BIDOBACTERIUM.

METRONIDAZOLE

GLUTAMINE--AMINO ACIDS

DENAMARIN-SAMe and MILK THISTLE COMBO FOR LIVER SUPPORT

 

OPTIONAL

FISH OILS--OMEGA 3 HAVE ANTI INFLAMMATORY PROPERTIES...IT CAN HELP..CAN'T HURT...UP TO CLIENT

MCT--MEDIUM CHAIN TRIGLYCERIDES IF HE HAS TROUBLE GAINING WEIGHT...THIS IS A FAT WITH A SHORTER CHAIN AND IS MORE EASILY ABSORBED...FYI---THE OIL BY ITSELF DOESN'T TASTE GOOD...HE DID SAY PORTAGEN(87% MCT'S) BY MEADE JOHNSON IS GREAT TO USE TOO.

 

He welcomed all questions...was thrilled at really good ones!....he wants Stevie to get better and said over and over "we have to help this guy all we can" so his approach is a combination of holistic and western medicine because we want to treat the disease AND support his systen.

 

Next, the foods.....no mention of ZD, ID, DD, HA, and B.S.(oops, sorry that last one is my vented frustration from the week!) ...nothing about prescription diet. He said it needs to be hypoallergenic only(single source protein and single source carb that he has not been exposed to before).

Duck, rabbit, venison, salmon....

 

He was absolutely fine with the current choice of Natural Balance Duck and Potato....he really likes Merrick Salmon because it is all natural, no additives, no preservatives because any dog with this disease does not need to be processing anything extra through his/her system.

 

LOW FAT MYTH OR FACT??.....the main problem is the inflamation triggered by the protein source....but he said it could only HELP him to be on a LOW FAT diet. For Stevie, Low fat(approx 10%) is the only way...he can't handle much above 12% or at least right now he can't.

 

So here is the revised medication list for Stevie

Budesonide 2mg a day(since we already started it...will see if it works for him or not).

NO PRED!!!!---stop ASAP...the Budesonide will pick up immediately and do the good job the pred has been doing to reduce the inflamation.

Azathioprine--50 mg once a day for 10 days, then once every other day for 10 days til next recheck/bloodwork

Zantac 150---helps with upset stomach from meds, but he really likes it for bloating/gas and stevie does have problems with that...in his words "Zantac kind of takes hold of the gas and kicks in the motility of the GI tract to move it on through".

Metronidazole--500mg in AM....250mg in PM.

Glutamine-500 mg once a day

Probiotics--1 tablet daily, must contain acidopholus, lactobacillus, bidobacterium

Denamarin--SAMe and milk thistle combo given on empty stomach one hour before his meal

1/4 baby aspirin once a day

B12 injections as previously directed

 

What to watch for at home......

 

it's not all about perfect poop! Stevie's system will never produce that...loose is a good day...watery blowout is not acceptable as he is losing protein at that point.

If his body doesn't accept the Azathioprine it will make him sick and he will vomit. If this happens...stop the Aza and call immediately.

Food trials----again, loose poos are okay...blowout "NO".....move onto another food.

And always, does he feel okay...if not call immediately.

 

This was a 1 hour crash course on IBD and it was everything and more than I expected! I had a list of questions ready....it was not necessary. Everything was talked about and he welcomed questions and it was a 2 way flow of communication.

 

The Azathioprine needs 3 weeks to take effect...we have a follow up appt on Dec 5th for recheck and bloodwork.

 

As he said...and I clearly understand....there is no cure for IBD. The best you can do is treat and hope for remission and that their health improves. I only wanted to help my Stevie....the pred had to go...it was killing him. But I wasn't willing to further deteriorate his system by adding more drugs only(with other side effects) and not supporting his system with the holistic approach of supplements too.

 

We are very lucky and very grateful to have met Dr. Hodges today! Stevie has a chance and that's all I ever wanted for him. I cried I was so happy...hugged Dr. Hodges....and he gave Stevie a big kiss on his head

 

Dr. Sadanaga who did Stevie's scoping is fully credited for referring us to Dr. Hodges. And Dr. Sadanaga even came running out of the building as he saw us leaving tonight to ask if Stevie was going to be okay. You meet people whom you feel are one in million because they have made such an impact on your life....we have been fortunate to realize that two fold today

 

Stevie is snoozing now...it's been a long day. We will keep you posted on his progress. Thanks again to everyone....when we were truly at a low point this week you guys came through to lift our spirits and give us hope

Edited November 8, 2008 by tigger

[tbhounds]

[Guest jurygirl]

Sounds like Stevie has a Great Doctor!!!

 

My Jury was diagnosed with PLE a few years back. She also did not do well on Pred I ended up reading a post I think was by tbhounds about Budesonide and that was the best thing ever. She had no side effects and started to keep protein in her body. We also tried Azathioprine but her body rejected it , so we stayed on Budesonide 2mg per day and 15mg asprin per day and B12 injections and low fat single protein diet.

 

Hope Stevie is feeling better today!

[Guest tigger]

Stevie is snoozing like a baby today He is tired. Yesterday was very stressful for him...at this point he hates to see a vet's office because he thinks he is going to get stuck or poked somewhere

 

I can tell the Zantac has already helped. No bloating after he ate last night and today. And he fell into a good sleep...not restless and changing positions as he had been doing.

 

A question back to those of you whose greys/dogs rejected the Azathioprine....did you see that in a few days or did it take a few weeks for it to build before it made them really sick?

 

And Tbhounds and her grey Sly Spin rock!!! Thanks again for your help

[Guest tigger]

Just to add...the referral center called back today and said the 1/4 baby aspirin once a day is not needed.

[greyhndz]

Kathy, Lexi became ill from Azathioprine within 1 week. By the end of that week, she stopped eating, acted sick, became lethargic, febrile, vomited, and had liver function tests through the roof. I believe Dr. Sisson says that if a dog is going to be intolerant, it will happen quickly, usually in the 1st 2 weeks.

 

BTW - Entirelypets.com has good prices on Sam-E (Denosyl) http://www.entirelypets.com/denosylsd4.html

and another brand which is generic for Denosyl, and also contains milk thistle, etc:

http://www.entirelypets.com/sadenosyl2256.html

I also swear by Liver Support Factors, in addition to Sam-E:

(I have a bottle I can send down if you'd like it)

 

J

[greyhounds1234]

You might want to google "Imuran"--it's the brand name of the generic azathioprine. In people, it is used as an immunosuppressant and it sometimes used when a person has had a transplant. It is also recomended by some gastroenterologists as a treatment for Crohn's Disease. In Crohn's, it is supposed to lessen the severity of some aspects of the disease.

I was taking it for awhile and still have a huge surplus if you or anyone else would like to have them...free. They are 50 mg tabs.

[ShantisMom]

Shanti tolerated the medicine well. It made her sick to her stomach within a day or two. Nothing that was bad or untolerable, you just knew she was not feeling good and did not want to eat. Pasta and boiled chicken usually fixed it.

[Guest jurygirl]

Jury was sick within 4 days of taking Azathioprine, she was vomiting. She ended up dehydrated because of it and needed fluids.

[Guest tigger]

Thanks for the input! Stevie is doing well tonight...so day one almost checked off. We will take it daily and hope it does okay on it.

 

He got his probiotic and glutamine tonight so all the new meds and supplements are now in progress.

 

Thanks again