How long should I stick with Atopica for?

[cassiek]

Hello all.

Any suggestions or advice would be welcome. I apologize that this is rather lengthy.

Approx. 3 months ago, I put Furby on the drug Atopica in an effort to relieve his allergy symptoms. For those who don't know, earlier this year I had an allergy panel done on Furby and found out that he is sensitive to several environmental (many native grasses and weeds) and food (beef, chicken, rice, and some other grains) allergens.

Based on the allergy panel, I have been avoiding feeding the known triggers. The panel said he was negative for turkey, but recently I eliminated turkey from his diet as well. He is allergic to chicken... I wonder if he is sensitive to turkey to, given that they are both poultry? Maybe I am grasping at straws here. Currently, he is being fed Orijen 6 Fish (the panel came back negative for fish). I was feeding a raw diet of lamb and rabbit, but it was too expensive and too hard to get on a regular basis.

Approx. a month ago, my vet and I increased Furby's dosage from 25 mg/day to 35 mg/day. The dosage instructions for Atopica are not entirely clear. Their dosage and administration chart says that a dog between 4-7.9 kgs (Furby is 7.5 kgs), should receive a dose of 25 mg. However, in other places it states it should be 5 mg/kg/day. Given the latter calculation, he should receive 37.5 mgs/day, so it is now at 35 mg/day. We decided to up it after he had been on the drug for 2 months and seen no signs of improvement.

I have seen very little improvement in Furby's condition. The manufacturer claims that following the initial treatment period for 30 days, the dose should be reduced to every 2nd day, then every 3rd etc. until a maintenance level is reached. He is coming up a month on the new dosage, and three months on the drug altogether, and he has shown little improvement at all. The company states if little response to the therapy is seen within the first 8 weeks, to discontinue treatment. Should I?

I am wondering with it being summer and all the weeds and grasses lurking around, if I should seasonally treat him with steriods and Atopica? My vet said you can do this, but I started the Atopica in the first place to get away from the steriods, they made him so letheragic, I hate to put him back on them. But, I do take the dogs running almost every day in the summer, usually in the fields.

Should I give the new dosage another four weeks and see how it goes?

To be honest, I can not afford the $150 a month it is costing... I have also thought about trying the injections to desensitize him to his trigger allergens, but I have heard they can take up to a year before you see any results.

I wonder if alot of the licking is simply habitual and if putting a cone on him would help. But, how long would I wait before taking the cone off and would he likely just go back to licking his paws?

Any help would be appreciated. Thanks!

[Dr Lee]

Furby is a cutie!

Allergies is a disorder of the immune system and does not typically go away. As such, therapy is usually life long. This is one of the reasons that we try to avoid steroids, is that while they may initially work, over time there will be problems that occur.

How long does it take Atopica to work? 1-3 months to show effect. The number one mistake of Atopica is that we start tapering the dose too quickly to save money.

It is so darn expensive though, what can I do? First of all, hang in there at a aggressive dose for three months to see how much relief we get. At this point there are many things that we can do: 1) at this point we start to taper and hope that we can reduce to one dose every three days. So 2-3 doses a week versus 7/week is a large financial savings. 2) we can use multimodality therapy - add in antihistamines, omega 3 fatty acids, steroid sprays, etc. this can help reduce the amount of atopica that we need. If possible, avoid oral steroids. 3) use of ketoconazole. This medication helps delay the metabolism of atopica so by adding this inexpensive medication, we can almost half the dose of atopica. Until the initial 3 months is done, I do not recommend starting this medication. and 4) a good compounding pharmacy like Roadrunner pharmacy can properly microemulsify cyclosporine. Do NOT use Sandimmune and if you are going to use a compounding pharmacy other than Roadrunner make sure your vet is comfortable that they can properly microemulsify the cyclosporine.

Can I use steroids and Atopica together? Did we not start Atopica to avoid steroids? Yes but it was the high dose of steroids that is a problem. If Atopica does not do the trick by itself, then adding in a small amount of steroids can help. Also, the biggest problem with Atopica is getting through the suppressing phase of the allergies. Once you are one maintenance, you can drop the atopica dose and sometimes at this point, reduce and/or stop the steroids. I often will use steroids for the first 8 weeks of Atopica therapy, just to help the pet through the period. Once the Atopica kicks in, then reducing and hopefully stopping the steroids is great.

Here is a link to my site on cyclosporine: Atopica
Link to Omega 3 Fatty acids: Essential information on Essential Fatty Acids
Med link: Allergies.
Roadrunner: Roadrunner Compounding Pharmacy.

Hope this all helps!

[Dr Lee]

Also for the paw licking.

While most of it is dependent upon treating the underlying allergies, here are a few things you can do to help.

1) White vinegar soaks. Soaking the paw in white vinegar one or twice a day can help. Many times the staining is caused from yeast. White vinegar is a safe, inexpensive way to help treat the yeast. So while salivary protein staining may contribute, inflammatory proteins or yeast infections are a common cause for this rust colored staining. Licking helps promote the yeast infections which is why licking alone is often claimed as the sole cause. But controlling the yeast can help.

2) hydrocortisone cream. For the itchiness adding some cortisone cream can help reduce the inflammation and thus the itchiness.

Hope this helps.

[cassiek]

Thank you so much, Dr. Lee! I was hoping you would read my post, and I knew you would have some wonderful knowledge to contribute!

Just to clarify, you think I should stick with his new dosage of Atopic (at 35 mg/day) for another 2 months? Should I start adding the steriods right away? And if so, at what dose? Before I started weaning him off the steriods, I was giving him 1 pill every day. Should I add the steriods until I start to see a considerable improvement?

Thanks!

[Dr Lee]

Originally Posted by cassiek

...you think I should stick with his new dosage of Atopic (at 35 mg/day) for another 2 months? Should I start adding the steriods right away? And if so, at what dose? Before I started weaning him off the steriods, I was giving him 1 pill every day. Should I add the steriods until I start to see a considerable improvement?

If Furby is doing well with Atopica, then yes I would continue. Furby needs to be on this dose for at least 2 months to evaluate response.

I add steroids for patient comfort. There is a downside to the steroids. The downside is that when you begin to taper, you are tapering two medications. This can make things a little tricky. Just follow your vet's instructions. But yes, I typically will use the standard dose of steroids, add on cyclosporine and then taper at 8-10 weeks.

Usually, if dogs respond well to steroids, most will also respond well to atopica. Long term, most can be supported with just atopica.

Hope that helps.

[Dr Lee]

Final note, depending upon work sometimes I cannot read many of the posts here. Anyone is welcome to PM me here to get my attention to a particular thread. Alternatively, you may reach me through my website as well.

[hazelrunpack]

That's a great tip about the vinegar dips, Dr Lee! I'm going to try that with Macie's itchy paws.

[cassiek]

Originally Posted by Dr Lee

If Furby is doing well with Atopica, then yes I would continue. Furby needs to be on this dose for at least 2 months to evaluate response.

I add steroids for patient comfort. There is a downside to the steroids. The downside is that when you begin to taper, you are tapering two medications. This can make things a little tricky. Just follow your vet's instructions. But yes, I typically will use the standard dose of steroids, add on cyclosporine and then taper at 8-10 weeks.

Usually, if dogs respond well to steroids, most will also respond well to atopica. Long term, most can be supported with just atopica.

Hope that helps.

Hi Dr. Lee,

Technically speaking he has been on Atopica for 3 months, but the 1st two were at the lower dose (25 mg/day). So I figure I should give it another month on this dose to really evaluate how it is working?

Furby never did respond too well to the steriods, but I figured that he had been on them so long ( 5+ years) maybe he had built up a certain resistance to it?