Antipruritic treatments 3 Flashcards
what are cyclosporines? use?
- Cyclosporines are drugs initially developed to prevent organ transplant rejection.
- Atopica is a cyclosporine licensed for the treatment of atopic dermatitis in the dog.
- Effective treatment for environmental allergies in dogs and cats as long as other factors are ruled out
- brand name generally better than generic
most common side effects of cyclosporines in dogs
intestinal upset, gingival hyperplasia and hypertrichosis.
- Papillomatosis is the next most common side effect that I see
- also, Plasmacytoma
petients where caution is necessary with cyclosporine
do not recommend the use of cyclosporine in patients with a history of tumours, and I use it with caution in the geriatric patient
contraindication for cyclosporine
contraindicated in the presence of neoplasia, patients with history of tumours
cyclosporine vs steroid treatment speed of response to therapy
It is important that the caregiver is advised that the rapid response to therapy obtained following initiation of steroid therapy is not seen with this drug.
- 4-6 wk minimum delayed response
cyclosporine dose, absorption, vomiting prevention, GI upset prevention
- in dogs at 5 mg/Kg per day
- Absorption is slightly better when administered on an empty stomach
- given with maripotant for first 4 days of treatment to prevent vomiting
- freezing the capsule before administration seems to reduce the incidence of GI upset
co-administration of cyclosporine with what other drug increases blood levels?
- Co-administration of ketoconazole increases the Atopica blood levels and the dose should be decreased accordingly
- This is a useful way of decreasing cost in the large dog
assessing the efficacy of cyclosporine over time? dose frequency?
- If there is a 50% or greater response at 4-6 weeks, there is a good chance that the patient will continue to improve and that the treatment frequency or dose can be decreased.
- Dose or frequency reduction is particularly important as the drug is quite expensive
> Once there is a significant response, the frequency can be slowly decreased
what should cats have before starting cyclosporine? what cats should not receive this drug? diet considerations?
- Cats should have a CBC done and be screened for FIV and FeLV prior to starting cyclosporine.
- Cats should not be fed raw diets when on Atopica.
- Cats at risk of contracting toxoplasma (outdoor cats, cats on a raw meat diet) should not be treated with this drug.
cyclosporine dose in cats
Syringe is dosed at 7 mg/Kg of cat
cyclosporine is approved for what conditions in cats
Approved for allergic dermatitis manifested by excoriations, eosinophilic plaques, miliary dermatitis and self-induced alopecia
possible issue of cyclosporine in young animals
Safety of the treatment in dogs less than 6 months of age has not been established. As gingival hyperplasia is a potential side effect, the use of the drug in patients with immature dentition can lead to problems.
cyclosporine mechanism of action
- Calcineurin inhibitor:
- By inhibition of calcineurin, cyclosporine specifically inhibits T-cell function, and thus cell-mediated immunity, but has little immediate impact on humoral immunity
- blocks transcription of T cell cytokines, such as IL-2, important in the activation and proliferation of T-lymphocytes
- also affected are interleukin 4, TNF-alpha, and interferon gamma
when to discontinue cyclosporine use in cats
The owner should be advised to discontinue if there is anorexia and/or weight loss as hepatic lipidosis has been reported in cats on Atopica Cat
tacrolimus - what is this drug? use? pros and cons?
- Like cyclosporine, tacrolimus is a calcineurin inhibitor, but with better tissue penetration
- alternative to steroids
- applied twice daily for the first week and then in reduced frequency.
- slow onset, not for flares
- initially application may lead to a burning sensation
- The patient should not be allowed to lick the area of administration for at least 20-30 minutes and small pets in particular should be watched to avoid ingestion as toxicity can occur.
- wear gloves when applying
- May not be cost effective unless there is clear evidence of thinning of the skin with steroid
treatment.