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  • 8/14/2019 Is Atopica Safe _ - Should I Give Atopica To My Dog _.pdf


    Cyclosporine=Cyclosporin=Ciclosporin=Cyclosporin A

    What is Atopica ?

    How Does Atopica Work ?Will Atopica Stop My Pet From Itching And

    Scratching ?

    Does Atopica Have Less Long Term Side

    Effects Than Corticosteroids Like

    Prednisone ?

    The Potential Immediate Side Effects

    The Potential Long-term Use Side Effects

    Of Atopica

    What Should I Do ?

    Are There Safer Ways To Use Atopica ?

    Can I Use Less Expensive Generic Drugs

    Similar To Atopica ?

    Are There Medicat ions My Dog Should Not

    Take While On Atopica ?

    Are There Certain Dogs In Which Atopica

    Must Be Used With More Caution Than In

    Others ?What Should My Veterinarian Monitor While

    My Pet is Taking Atopica ?

    Is Atopica Safe ? - Should I Give Atopica To My Dog ?

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    i f h ld i i h // d h i f / i h

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    worse. In those cases, your vet m ight suggest blood-based allergy testing o r special

    low-antigen d iets. Occasionally, that approach is successful - often, it is not.

    Your veterinarian m ay then have dispensed an oral cor ticosteroids or given a

    corticosteroids injection to your pet. That probably produced a dramatic improvement.Your dog stopped i tching for a while. But it may have also peed m ore and gained weight.

    Your veterinarian was probably reluctant to repeat the therapy, telling you of the serious

    side effects of pro longed corti costeroid use and you probably already knew that anyway.

    But it i s so terribl y difficult to live with a scratchy, itchy, uncom fortable dog. So you

    probably talked the vet into repeating the steroid treatment now and then.

    Veterinarians all know that the desirable effects of corti costeroids against allergic itchingis very dramatic. These drugs m im ic the effects of the natural corti costeroids produced

    every day in your pets adrenal glands. But they also know that corticosteroids have many

    undesirable side effects when they are given too frequently. Prolonged cor ticosteroid use

    leads to weight gain, decreased strength of the binding proteins (collagen) that hold the

    body together as well as increased blood glucose and ci rculating lip ids (fats) that can affect

    your pets liverand pancreas. And those are only a few of the undesirable results that canoccur. You can see why m ost veterinarians were desperate to of fer their cl ients pets other


    This lack of good options for the long-term control of canine atopy led Novartis

    Pharmaceutical Co. to apply for and receive an FDA permit to m arket cyclospor ine for th isproblem under the trade name, Atopica. Their request was approved in August, 2003. You

    can read the package that Novartis submitted to the FDA here.

    cyclosporine is a compound that naturally occurs in a fungus. It had been used in hum an

    medicine since 1972 when i t was discovered that it helped in p reventing rejection of

    transplanted hum an kidneys. (ref) It has since become useful in treating a wide variety of

    autoimmune diseases in people and in fighting organ rejection through i ts abil ity tocripple the bodies im mune system. (chiefly by inhibiting T-lymphocytes) You can read the

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    I At i S f ? Sh ld I Gi At i T M D ? htt // 2 d h i f / t i ht

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    product insert furnished with the drug here.

    The bodys allergic process is extremely com plicated. It involves many di fferent cells,

    transmitter chemicals and processes. But here is my simpli fied explanation:

    Al lergies are caused by unnecessary antibodies - antibodies your dog produces against

    compounds in its environm ent (like mold, house, dust mites or pollen) that would ordinarily be

    ignored. Your dog itches because those antibodies cause mast cells in its skin to release

    histamines. Those histamines produce inflamm ation that irr itates the nerve endings in

    your dogs skin. Mild ly i rri tated nerve endings i tch - severely ir ritated nerve endings are

    painful. It does not cause the skin damage, hair loss and skin infections that you observe

    the dog does that to itself.

    Cyclospor ine (= Atopica) interferes with this extremely complex process. It prevents a

    certain specific group of lym phocytes (immune system cells) the helper T- lymphocytes, from

    transmitting chemical messages (calcineurin/ interleukins) that result in histamine releasefrom your dog's skin m ast cells. Without released histamine, your pet does not i tch. You

    can think of helper T-lym phocytes as the pol icemen of the body always looking for

    intruders and blowing their whistle when they find them.


    Atopica is usually just as effect ive as corticosteroids in reducing infl ammation and

    stopping itch.

    Atopica is so ld in four-size capsu les that should be given on an empty stomach.

    Veterinarians generally dispense the medication for daily use unti l substantial

    improvement in itching is noticed (about 3-6 weeks). When that happens, the dose is g ivenonly every second day. If that is sufficient in stabili zing your pet, your veterinarian may try

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    Is Atopica Safe ? Should I Give Atopica To My Dog ? http://www 2ndchance info/atopica htm

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    to g ive Atopica even less frequently perhaps every 3-4 days.

    Not all dogs absorb Atop ica or maintain b lood levels of the drug equally well. Som e

    veterinarians will fol low these levels with periodic blood tests and adjust their dose

    schedule accord ingly (ref) Others vets do not believe that blood levels accurately predictconcentration of the medication in the skin and m ake their adjustments based on the

    positive response they see.


    Al though there are dogs, l ike people, who handle one medicat ion better than another, the

    potential long-term side effects of Atopica are at least as severe as those of

    corti costeroids. They are just di fferent side effects, they may take longer to occur and they

    may not be as readily apparent to you at fi rst. You can read about som e of those serious

    side effects when they occur in hum ans here.

    It is not at all clear that you pet will do better long-term on Atopic than it would on a

    wisely- thought out program o f intermi ttent corticosteroid (prednisone, etc.) use combined

    with less severe options that include topical products, nutrit ional m anagement and

    physical intervention. (ref)

    The Potential Immediate Side Effects

    Most dogs do not experience imm ediate side effects from Atopica. But about 30% do

    experience vom iting, loss of appetite, GI upsets or diarrhea. When your pet begins the

    drug, start lower and less frequently than your anticipated dose to try to avoid that. Theseim mediate side effects of ten lessen or d isappear after the pet has been on the medication

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    a week or two.

    Since most dogs seem to handle the drug just fine, owners are usually qu ite satisfied with

    their pets lack of itching and the lack of weight gain and frequent urination that can

    accompany corticosteroid use.

    Atopica can cause inflammation of sk in and oral surfaces. So some dogs develop

    thickened, swol len gums (epulis, gingival hyperplasia). (ref) Others develop reddened or tender

    ear fl aps and some develop thickened foot pads (calluses, epidermal hyperplasia, hyperkeratosis).

    Som e appear to shed m ore while on the medication.

    The Potential Long-term Use Side Effects Of Atopica

    Veterinarians have no problem telling you what the immediate side effects of Atopic are.

    They are quite obvious. It is harder for them to tell you what the long-term consequences

    of keeping your pet on this drug m ight be. That is because it is very di fficul t to prove that

    any new health issue your pet experiences is do to the cyclospor ine and because the drug

    has only been used extensively in dogs since 2003.

    But the same cyclosporine (Neoral), produced by Novartis (Sandoz) has been used in

    hum ans since 1983. So there is a large body of information on i ts long-term side effects in

    people. There is no reason to believe that these side effects would be any di fferent in

    dogs. So many of m y reference links and warnings are based on hum an, not dog, studies.

    I explained earlier that Atopica works by disrupting the activity o f your pets immunesystem. This, unfor tunately, is a double-edged sword. The same helper T-cell po licemen

    that I told you about earlier the ones whose activi ties were disrupted by Atopica, are the

    officers that patrol your pets body for invading bacteria, and o ther pathogens. More

    concerning to m e, they are the same cells that look for abnorm al body cells the ones

    that later gi ve rise to cancer. Atopica is not at all selective as to which helper T-cell activity

    it blocks.

    Potential Effects On Your Pets Kidneys

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    A second problem with Atopica is that the calcineurin messenger compounds that it

    blocks are also found in your pets kidneys. So Atopica has the potential to damage those

    organs as well. You can read about that here, here, hereand here.

    Potential Effects On Your Pets Liver

    Cyclospor ine appears to also have the potential to injure the liver.

    The liver is a very vascular (blood-filled) organ and cyclosporine damages m icrocirculation in

    many organs. (ref 1, ref 2)

    Ear Infections

    An increase in the number of ear infections (otitis externa) appears to occur in dogs receiving

    cyclosporine. It is hard to sor t out the cause. Most dogs with chronic skin allergies already

    have ear problems. It could be that rather than causing the problem, cyclosporine only

    weakens the pets natural defenses that keep those infections at bay. Whether the swollen

    ear flaps sometimes seen with Atopic use are due it its affect on skin or reactivated ear

    infections and increased scratching is unknown.

    Increased Number Of Tumors

    Cyclosporine is known to increase the incidence of cancer. You can read the NIH

    statement to that effect here.

    As dogs age, they all develop abnormal, pre-cancerous cel ls th roughout their bodies we

    all do. We all rely on those policemen cells to locate them, and destroy them th rough a

    process called apoptosis. (ref) Dogs and humans receiving cyclosporine are not as effective

    in do ing that. (ref)

    Novartis acknowledges that dogs on Atopica run a greater r isk o f develop ing cancers.

    They explain that as the drugs abil ity to exacerbate sub-clinical neoplastic condit ions". But

    they give no explanation as to how they came to the convenient conclusion that no reallynew tumors were form ed.

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    Leukemias and lymphom as are lymphocytetumors. They increase in frequency in humans

    receiving cyclospor ine. There are artic les as well that say that lymphom as increase in

    frequency in dogs receiving cyclospor ine. But as far as I know, they are based on only a

    single case (ref)

    Novartis reported to the FDA that the lymph nodes of dogs receiving Atopica became

    enlarged in 2.3% of the dogs receiving Atop ica for 28 days. Lymph node enlargement

    (lymphadenopathy) , not related to infection, is often a prelude to lymphom a.

    Effect On Blood Capil laries

    Many of the potential side effects of cyclosporine are due to its potential to cause injury to

    the lining of small blood vessels found throughout your pet's body. (ref) That is

    som etim es referred to as its potential for vasculotoxicity.

    Increased Susceptib il ity To Infections In General

    Dogs and humans receiving cyclospor ine appear to have reduced ability to fight infections

    of all kinds. That includes bacterial and fungal skin infections and urinary tract infections.

    Pets can have infections and parasites that you are not aware of but that are being kept in

    control by i ts healthy immune system. If you weaken that system with m edications like

    cyclosporine (Atopica) the anim als body can loose control of them. Toxoplasmais one of

    those parasites, you can read about what happend to two cats that were given

    cyclosporine here. You can read another 2011 repor t of the worrisom e num ber of side

    effects associated wi th the use of this drug in cats here.

    p p y g p p

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    Som e dogs receiving Atop ica appear weaker than usual particularly in their h ind legs. It

    is very hard to judge the causes of generalized weakness in pets. Sometimes, just notfeeling good can be misinterpreted as weakness. But cyclospor ine is known to

    occasionally produce muscular weakness and nerve dysfunction in human beings. (ref)

    Potential Effects On Your Pets Pancreas

    Cyclospor ine also has the capacity to lower your dogs abil ity to produce insul in , and so,

    interfere with its blood sugar metabolism . (ref)

    Increased Number Of Warts (papi llom as)

    Veterinarians have noticed that dogs receiving Atop ica may grow m ore warts. Warts in

    dogs are a benign skin tumors caused by virus (papilloma virus). (ref) This same virus might

    even be invo lved in the other skin thickening and inflammation problems occasionally

    seen in dogs receiving cyclospor ine (ref)


    Novartis subm itted a list of the side effects of Atop ica when they applied for FDA

    perm ission to m arket the drug. That study was based on the 52-week experience of

    thir ty-two 8-10 month old laboratory beagles not the pet population that would be

    receiving the drug. Nine-month-old dogs are no m ore representative of the pet dog

    population that this drug was to be marketed to than 15-year-olds are representative of the

    hum an popu lation that takes cyclosporine. How many of us wouldn't wish to have the

    stamina and resistance we had at 15 ? I gave that link before hereit is again.

    Pay particular attention to the pathological changes that occur red in dogs receiving higher

    than norm al doses. It is no t unusual for, the side effects of short-term , high dose studies

    to be the same as the effects of long-term lower dose studies. (ref)

    The FDA is considerably more demanding about safety studies when it com es to

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    approving human m edications than it is on pet medications. So you wil l find a lot more

    detail on the possible side effects of Atopica when Novartis markets it for hum ans as


    Some of Novartis promotional inform ation on Atopica is highly m isleading, such as thestatement found on their website that ATOPICA targets on ly the specific cells in the

    im mune system that cause the allergic reaction. (ref) Those cells have other very cr iti cal

    functions that will be affected as well.

    Novartis' advice to veterinarians in general practice to run a few sim plistic screening tests

    and then hurry up getting the dogs onto Atop ica is defini tely not in your pets best interest

    either. Read that promotional pol icy here.

    If you would like to read the most current guidelines as to how veterinarians should

    handle cases of Canine Atopy, go here. These are repeat links to my own brief articles on

    the subject: 1& 2

    You can read a typical cl ient handout vets give to the owners of allergic dogs here, and

    how Japanese veterinarians strugg le with the same problem here.

    If you are reading th is article, I am sure you have heard and read all those suggestions

    before, but they can never be repeated often enough .


    Never begin dogs on any powerful i tch-control medication i f there is the slightest

    teeny-weeny chance that fleas may be part of the problem. Dogs that develop allerg ies to

    flea saliva only requi re a single flea to set of an intense itching cycle. It can be very hard to

    locate a single flea. The flea may not even be present on your dog by the time the itching

    begins. All dogs with itchy skin should be on a topical m onthly flea-control product. Some

    do not work as well as they once did , so ask around in your area and avoid flea-infested

    areas li ke dog parks whenever you can. You can read suggestions for flea control on your

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    pet here.


    It is always wise to determ ine how dietary ingredients m ight be affecting your dog. Eitherput the pet on a 60-day trial o f lim ited food ingredients it has not eaten before or feed it a

    diet that has been processed or m anufactured to be hypoallergenic. Do not believe all the

    claims you read about diets particu larly if the product i s sold on that website. You can

    find suggestions on lim ited ingredient diets here.

    Blood Allergy Tests

    I tell m y clients that these blood-based tests for allergies are a waste of their tim e and

    money. The results just do not cor relate with the Real World (ref) Some vets stil l do have

    the test perform ed by Idexx or Heska. Read one of their promotional brochure here.

    Just because blood allergy tests don t work doesnt m ean you cant tr y to decrease your

    dogs exposure to antigens. Try m aking changes in your home air filtration system,

    cleaning and vacuum ing p rogram and anything else that could possibly decrease thedog s exposure. Its always wor th a try.

    Topical Products

    You should always attempt to m anage itchy dogs with these products fi rst and not stop

    using them even if you go on to use alternative methods. Owners of dogs that do best

    over long periods of tim e tend to use a com bination of approaches to keep their pet's skinin the best condi tion possib le. That generally includes soothing lotions, rinses and

    creams. Most of these products have little if any effect if they just si t on your pet's skin .

    They need to be massaged deep in to the skin where the problem is occurr ing. That is

    because the dog's m ast cells and the processes that liberate histamine from them occur i n

    the deeper skin layers. (ref) (Wear Gloves)

    Many of these products contain corticosteroids. Topical corticosteroid-containing spraysand creams are not as li kely as oral cor ticosteroids to cause unwanted side effects in your

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    pets body when they appl ied in reasonable amounts and according to the product's label.

    They are best for spot treatment of your pets paw-webs, axilla (armpits) and groinareas

    where licking is usually worst. When they are used, they need to be massaged into the the

    skin un til they vanish so your pet doesn't just li ck them off. They include topical

    triamcinolone sprays (Like Genesis Topical Spray), betamethasone-containing sprays and m istsand nystatin/neomycin/thiostrepton/triamcinolone products (Panalog, Anamax,etc.). Walmart

    sells an acceptable alternative. (ref) Dogs m ust not be lathered with these products

    because when licked off and ingested, they have the same effects as oral cor ticostero id


    There are other specific co rticosteroid-containing veterinaryspraysand lotionsthat

    owners of itchy pets rely upon. But in every case, you need to m oni tor your pet closely for

    sensiti vity to the product, increased thi rst and urination or weight gain. Do your best to

    prevent the pet from licking the products off by m asaging them well i nto the skin. The

    previous two links to the inserts that accom pany the products explain those side effects in


    Omega Fatty Acid Supplements And Ceramide-Containing Topical Products

    Oral fatty acid supplements have been m arketed for i tchy dogs for many years. They

    usually con tain a mixture of omega-6 and omega-3 fatty acids - compounds your dog's

    body can not synthesize on its own. These lip id supplemental are occasionally helpful in

    decreasing itching when a dog's diet does not provide them. Increasing the fat (lipid)

    content of the pet's diet is occasionally helpful as well when abnormalities of its digestive

    tract do not allow enough fats to be absorbed.

    Ceramidesare a special class of l ipids or fats. They are found throughout the body. Those

    ceramides present in the skin appear to be depleted in i tchy dogs. Recently, a group of

    topical ceramide-containing sprays and d rops have becom e available for itchy pets. They

    seem to help decrease itching considerably better than the oral l ipid products did . You can

    read about those com pounds hereand here. Add them to your pet's treatment plan if they

    appear helpfu l - but be cautious about exaggerated claims for the products. One of them is


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    Physical Methods

    Keeping your pets toenails cl ipped shor t and ul tra-smoothed wil l greatly reduce the

    amount of damage it does to its skin scratching. Dogs chew and groom themselves mostat night and when they are bored and inactive. Being overweight adds to this prob lem. My

    Labrador retriever, Max, has an atopy problem. When he has flare-ups, he wears a soft

    muzzle at night and I massage a topical triamcino lone/bacitracin cream into any wor ried

    areas unti l the problem passes. This has worked well fo r m any years. If you let the

    problem get out of hand, your dogs skin odor will increase and it will sm ell m usty as

    bacteria (usually staph) work their way into the worried areas. At that point, 10 days of broad

    spectrum antib iotic may becom e necessary.


    Only a few of my clients find benadryl to be of much help in contro lling canine allergic

    itches. When they are, it may be their sedative effects that is m ost helpful . Atarax

    (hydroxyzine)or Tavist (clemastine) (Not Tavist-D) are sometim es a bit more effective. Itching is a

    self-perpetuating phenomenon. Many veterinarians suggest Clemastinebecause itscalm ing effect seems qui te pronounced.

    Acepromazine, a veter inary tranquilizer is sometimes helpfu l during flare-ups. It has both

    calm ing and antihistamine-like properties. (ref)


    Any medication that is effect ive for any health problem is a combination of good effects

    and worr isom e side effects. The only ones that are not a m ixed bag of effects are those

    that have no effect at all. Corticosteroid medications are no dif ferent. You have to ask

    yourself several things before using them: Will you and your pet be happier on the

    medication or without i t ? How severe are the potential side effects and how likely are they

    to occur ? Are there ways to adm inister the medication to lessen the chances of side

    effects ?

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    It is possible to control canine atopy over a pets li fetim e by using cort icosteroid

    medications, like prednisone, very carefully and judiciously.

    There is usually a small window between the amount and frequency that oralcorti costeroids li ke prednisone can be given to contro l most of the itching in your pet and

    the dose at which side effects occur. That is particularly true if you use a combination of

    approaches like the ones I already mentioned.

    In doing so, you needs to give only enough of the drugs to elim inate the majori ty of

    symptom s not all of them. One needs to use these medications on ly in term ittently and at

    the absolutely, lowest effective dose. Pulsed, introm ittent doses given only dur ingflare-ups are considerably safer than daily doses. One needs to practice strict weight

    control in these pets as well to avoid the same potential problems that occur in hum ans

    taking corti costeroids over long periods. You can read about long-term management of

    those people here. Different dogs react to these medications differently. Through a

    combination of physical exams and blood chemistryexams, changes can usually be made

    in your pet's diet, lifestyle and m edications to m inim ize those unwanted effects. So it

    should not be attempted other than under the close supervision of your veterinarian.Never consent to periodic " Depo" (methylp rednisolone acetate) injections.

    When a moderate corti costeroid dose is gi ven intermittently, many of its side effects can

    be avoided. (ref) When too m uch is used or when it is used for too long without

    interrup tion, corti costeroids often lead to health problems of their own. Those include

    Cushing'sdisease, obesity, diabetes, ligamental tearsand ruptures li ver and eye issues

    and the possibili ty ofAddisonsdisease when the drug is wi thdrawn or stopped too


    There is probably a place for Atop ica in the treatment of stubborn canine skin allergy

    flare-ups as well. But you need to be aware of the drugs po tential ri sks and moni tor yourdog closely when it receives it. There is no proof that dogs do any better on Atopica long

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    term than they do on corticosteroids long term . The secret of success with either is how

    well the drugs are managed.

    There are conditions where medications l ike cyclosporine may be mandatory, like

    pemphigusor autoimmune anemiasBut it is certainly no t mandatory for itchy dogs.

    To get the full benefits of cyclosporine, your dog must be on a very str ict feeding and

    dosing schedule. The diet should be consistent, without any deviations in amount, type of

    food or feeding time.

    Al though corti costeroids and cyclosporine both control itch ing, they do so in somewhat

    different ways. So, theoretically, your dog m ight be better off on a low dose of both of

    them than a higher dose of one or the other. But veterinarians do not know that for sure. It

    is a technique used by physicians that fight kidney rejection and autoim mune diseases of

    many sor t give multiple drugs at lower doses rather than sing le drugs at high doses. (ref)

    To begin wi th, use the pharmaceutical com panys suggested doses as maximum doses.Base your actual dose on the amount, frequency and duration of medication that keeps

    your pet relatively sym ptom -free. Just do no t exceed the maximum suggested doses.

    Begin m edications s lowly and work up to the suggested dose if you need to. Never begin

    or wi thdraw a medication o f this type abruptly except in a crisis or emergency situation

    upon the advice of your veterinarian.

    Pay close attention to your dogs ears. Many dogs with chronic atopy have chronic ear

    infections. Those infections can go out of control when im munosuppressive medications

    such as cyclosporine or cor ticosteroids are given.

    Always give the medicat ion at the same time each day. You can experiment wi th the

    interval between the dogs last m eal and the medication. Novartis suggests it be given on

    an empty stomach, but som e owners find less nausea and vom iting when the medicationis given with a small meal.

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    Som e veterinarians combine Atopica with ketoconazole adm inistration because Atopica is

    very expensive. Others add i t because they suspect fungal skin infections. Ketoconazoleis

    a drug that is used to treat fungal infections. Cyclosporine is not m etabol ized as quickly

    by your pets liver when ketoconazole is present. Although this lowers the dailycyclosporine dose, the same cyclospor ine blood levels remain. So adding ketoconazole

    probably doesnt alter the risks o f cyclospor ine side effects. Since we know that

    ketoconazole has the potential to lower your pet's adrenal gland cortiso l production wh ich

    is, itself, protective against itch (ref) , I am reluctant to give it long-term to dogs as a

    cost-saving measure unti l I know m ore about what the consequences m ight be.

    Naturally, Novartis does not li ke that idea. You can contrast their statements wi th those of

    the FDA here, and you can read about Tevas generic equivalent here.

    There is no publ ished data that I know of comparing the two products. But m any pet

    owners seem equally satisfied with the results they obtain from the generic and the

    name-brand forms; and m any people who have had kidney transplants trust their lives tothe same generic cyclospor ine.

    There is som e thought that vaccinations g iven to dogs taking Atopica m ight not be as

    effective. This is because Atopica might interfere with the dogs immune response to thevaccine ingredients. You can always go to 3-year duration vaccines and taper off the dose

    for a period before and after vaccination. Most dogs are over-vaccinted anyway. (ref)

    Because Atopica has the potential to injure your pets kidneys, any m edication that also

    has the potential to injure kidneys should be avoided when taking Atop ica as well as any

    that might alter the way cyclospor ine affects the body. Those include certain antibiotics,

    antifungal and anti-seizure medications. Go to the Novartis product insert I linked toearl ier to see them all.

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    Physicians think that cyclosporine injures kidneys by interfering with blood flow through

    the tiny vessels that nourish their filtering apparatuses (nephrons). (ref) Non-steroidal

    anti-inflammatory medications (NSAIDs), like Rimadyland Previcoxare widely d ispensed for

    arthr itic dogs. Many o lder dogs also receive Ace inhibi tors, li ke Enalacard, for heartfailu re. Ace inh ibi tors can also reduce kidney blood flow (ref) I would hesitate to use either

    of those two classes of d rugs and Atopica together.

    Atopica should be used wi th caution in all dogs. But since the drug is removed from your

    pets body by its li ver, dogs with l iver disease should not receive it, nor should

    cyclosporine be used in dogs with the sligh test evidence of kidney disease, heart d isease,

    certain blood disorders or po tentially m alignant cancer.

    (I am, by nature, cautious. Those are my personal feelings; there are veterinarians whose ideas would

    differ from mine.)

    Your veterinarian needs to run blood tests before dispensing Atop ica to be sure your pet

    does not have any h idden kidney, liver or heart p roblems or evidence of early cancer.

    Then your veterinarian needs to m oni tor your pets kidneys, liver and heart whi le it is on

    the medication. You need to understand as well, that the effects of cyclosporine

    som etim es appear in hum ans long after the drug was discontinued. I would suggest that

    blood tests be run a month and two months after the first dose to look for acute problems

    and twice a year thereafter.

    Checking for the potential o f cancer is much harder. Novartis hin ts that when cancer

    occurs in pets taking Atopica, it only speeds the growth o f cancers that are alreadypresent. Of course, that is im possible to really know. Veterinarians do not have any m ore

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    good screening tests to detect early cancer than physicians do. About the best we can do

    is monito r your pets superficial lym ph node size, and check its blood for the presence of

    any abnorm al cells (Pre-leukemic syndrome). That only directly detects tumors of the lymphatic

    system and blood. Periodic x-rays or ul trasound examinations m ight also be helpfu l.

    Since kidney damage is the most frequent serious side effect in hum ans taking

    cyclosporine, your vet needs to periodically evaluate your pets urine to check on the pets

    kidney function. Going by its blood BUNand creatinine levels are not enough. By the time

    those values rise, the pets kidneys are already severely damaged. The tests that pick up

    ongoing kidney damage earliest are the urine protein:creatinine ratio and the urine

    microablinur ia test. You can read about them here. These are the same tests used in

    humans taking cyclosporine.

    Drug companies are sometimes reluctant to inform the public about problems associated with their

    products. I wrote thi s article because I am troubled by the large number of clients who consult me when

    their pets have experienced internal health prob lems after receiving Atopica to treat their topical skin


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