# ATOPICA: Please advise!



## RachelsaurusRexU

Long story short, one of my rescue dogs, a 6 year old altered male pit bull mix, has been to several vets and specialists for skin issues. Nobody could ever come up with a diagnosis. He's been misdiagnosed with everything from mange to immune disorders (which PISSES ME OFF, but that's neither here nor there). Well, we finally have a diagnosis: environmental allergies. He saw a vet yesterday who gave him a supposedly low-level steroid injection (I wasn't there) and he responded to it. He has not responded to antihistamines at all and he's on grain free food. (I'd love to get him on raw, but again, neither here nor there.) Anywho, of course the vet wants to put him on prednisone, which I will not agree to. 

His foster mom's roommate has severe allergic reactions to this dog in particular, we're assuming because of his poor skin condition and the amount of dander he's shedding. It's become so much of an issue that she will no longer be able to foster if his condition doesn't improve. I made it very clear that I don't want him on steroids, so she spoke with that vet again this morning and he suggested Atopica. I have no experience with this drug, so I just googled it. Sounds peaches and cream til you get to this part: 

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"Does Atopica Have Less Long Term Side Effects Than Corticosteroids Like Prednisone ?

No.

Although there are dogs, like people, who handle one medication better than another, the potential long-term side effects of Atopica are at least as severe as those of corticosteroids. They are just different side effects, they may take longer to occur and they may not be as readily apparent to you at first. You can read about some of those serious side effects when they occur in humans 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 of intermittent corticosteroid (prednisone, etc.) use combined with less severe options that include topical products, nutritional management and physical intervention. (ref)

What Are These “Dangers” You Mentioned ?

The Potential Immediate Side Effects

Most dogs do not experience immediate side effects from Atopica. But about 30% do experience vomiting, 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. These immediate side effects often lessen or disappear after the pet has been on the medication a week or two.

Since most dogs seem to handle the drug just fine, owners are usually quite satisfied with their pet’s lack of itching and the lack of weight gain and frequent urination that can accompany corticosteroid use.

Atopica can cause inflammation of skin and oral surfaces. So some dogs develop thickened, swollen gums (epulis, gingival hyperplasia). Others develop reddened or tender ear flaps and some develop thickened foot pads (calluses, epidermal hyperplasia, hyperkeratosis).

Some appear to shed more 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 might be. That is because it is very difficult to prove that any new health issue your pet experiences is do to the cyclosporine 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 humans since 1983. So there is a large body of information on its long-term side effects in people. There is no reason to believe that these side effects would be any different in dogs. So many of my reference links and warnings are based on human, not dog, studies.

I explained earlier that Atopica works by disrupting the activity of your pet’s immune system. This, unfortunately, is a double-edged sword. The same helper T-cell policemen that I told you about earlier – the ones whose activities were disrupted by Atopica, are the officers that patrol your pet’s body for invading bacteria, and other pathogens. More concerning to me, they are the same cells that look for abnormal body cells – the ones that later give rise to cancer. Atopica is not at all selective as to which helper T-cell activity it blocks.

Potential Effects On Your Pet’s Kidneys

A second problem with Atopica is that the calcineurin messenger compounds that it blocks are also found in your pet’s kidneys. So Atopica has the potential to damage those organs as well. You can read about that here, here , here and here. 

Potential Effects On Your Pet’s Liver

Cyclosporine appears to also have the potential to injure the liver. 
The liver is a very vascular (blood-filled) organ and cyclosporine damages microcirculation 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 sort 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 pet’s 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 cells throughout their bodies – we all do. We all rely on those policemen cells to locate them, and destroy them through a process called apoptosis. (ref) Dogs and humans receiving cyclosporine are not as effective in doing that. (ref)

Novartis acknowledges that dogs on Atopica run a greater risk of developing cancers. They explain that as the drugs ability to “exacerbate sub-clinical neoplastic conditions". But they give no explanation as to how they came to the convenient conclusion that no really new tumors were formed.

Leukemias and lymphomas are lymphocyte tumors. They increase in frequency in humans receiving cyclosporine. There are articles as well that say that lymphomas increase in frequency in dogs receiving cyclosporine. 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 Atopica for 28 days. Lymph node enlargement (lymphadenopathy) , not related to infection, is often a prelude to lymphoma.

Effect On Blood Capillaries

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 sometimes referred to as its potential for vasculotoxicity.

Increased Susceptibility To Infections In General

Dogs and humans receiving cyclosporine appear to have reduced ability to fight infections of all kinds. That includes bacterial and fungal skin infections and urinary tract infections.

Neurotoxicity

Some dogs receiving Atopica appear weaker than usual – particularly in their hind legs. It is very hard to judge the causes of generalized weakness in pets. Sometimes, just not feeling good can be misinterpreted as weakness. But cyclosporine is known to occasionally produce muscular weakness and nerve dysfunction in human beings. (ref)

Potential Effects On Your Pet’s Pancreas

Cyclosporine also has the capacity to lower your dog’s ability to produce insulin , and so, interfere with its blood sugar metabolism. (ref)

Increased Number Of Warts (papillomas)

Veterinarians have noticed that dogs receiving Atopica may grow more warts. Warts in dogs are a benign skin tumors caused by virus (papilloma virus). (ref) This same virus might even be involved in the other skin thickening and inflammation problems occasionally seen in dogs receiving cyclosporine (ref)"

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Doesn't sound any better than corticosteroids! How can they prescribe this crap to peoples' beloved pets?! Yikes. So what's a girl to do? What's "long term" considered as far as drug usage? Should I take into consideration that this is a six year old dog (not that I think six is old) and just get him on something to make him comfortable even though I'm not comfortable with these friggin side effects? Should I consider corticosteroids to be a "safer" choice?

What else can we do for him and the people in his foster home that will work? They're at their wits end and I don't have another foster for this poor boy.


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## pandaparade

Hey, I had te same problem with my own dog. He was never diagnosed with a certain problem, but I remember using drugs on him like crazy. Prednisone, ugh.. made my dog so lethergic and zoned out. He would just sit there every day.. and he was a puppy! As far as Atopica goes, I tried it and if I can recall it is EXPENSIVE! With all the side effects I returned the medicine. I just hate medicine for dogs. I actually just stopped giving him aeverything and luckily the itching subsided by alot. I think it al comes down to the dog. If the dog is having horrible itching problems, it may be worth it, then again.. 

My doctor told me this, and it made me cringe. You can put him on meds all his life and have a dog who doesn't itch, and lose a couple years on him, or have a dog with irritations all his life. Again though, my dog seems to be much better without the meds now. It basically comes down to that. :/


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## magicre

are you going to end up taking him back?

i'm sorry this is happening.....i wonder if filth's seed mix would help....i know it's not part of prey model, but it worked on bubba and malia's fur...


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## chowder

Chelsy had horrendous skin issues with itching, flaming red skin, oily hair, and booger eyes. It was so bad that the poor little dog couldn't even walk straight, she was always in a "c" shape from trying to turn around and scratch herself, plus she lost all the hair on her face and back. Here is what I learned over the course of 15 years with her (and NONE of it from vets!!):

Antihistamines usually don't work on FOOD allergies. They usually are effective against environmental allergies. If you've tried antihistamines and it didn't work, it's probably a food allergy.

Grain free food is not automatically allergy free. Chelsy had to eat the ones with the fewest ingredients possible. A lot of the grain free had things like tons of fruit, flaxseed, yeast, olive oil, marigolds, and salmon....all of which set her off. Find a food with the fewest exotic ingredients and the most pure meat possible. I had Chelsy on mostly all meat canned food with real meat supplementation. She also could eat EVO dry but there are other grain free dry with not too many ingredients. 

I did use Temaril-P with Chelsy once or twice just to get her past the incredibly itchy stage until I figured out which food set her off. It made her pee everywhere, but totally stopped the itching and gave her incredible relief. I never used any prescription medication long term on her. It was just a temporary thing until I could find out what her food allergy was and remove it. 

Hope you can figure out this poor dog's problem!


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## RachelsaurusRexU

magicre said:


> are you going to end up taking him back?
> 
> i'm sorry this is happening.....i wonder if filth's seed mix would help....i know it's not part of prey model, but it worked on bubba and malia's fur...


OH GOD NO! He's not one of my personal dogs, he's a dog I pulled for my rescue. He's in a foster home. He's not on a raw diet, though I bet one would benefit him. If I could foster him personally, he'd be on one, but I'm at capacity. 

Pandaparade and Chowder, thank you! We'll get to the bottom of this and find some course of treatment that we can all feel comfortable with.


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## MollyWoppy

After reading that prognosis on Atopica, there's no way in hell I'd give it to my dog. To me, it looks like the side affects, or potential health problems it could cause down the road are far, far more dangerous than the allergies he is showing now. It's scary, you can't let a vet or doctor just tell you what to do, you have to do the due diligence, read the small print and understand what exactly these drugs can do to you in the future.
Good on you for checking, seriously, most people wouldn't.
Mollie is five, I am hoping she is only 1/3 of the way through her life. Thats how I would look at it with your pup, if the allergies are that severe, choose the drug with the least side affects, especially long term side affects. 
I really wish I could help you out, feel really bad that there's no where else available that can take him. God, what a hard decision.


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## DaneMama

Atopica is a controversial drug to me...because of all the side effects and the fact that you'll spend a small fortune giving it to a dog (VERY expensive!). Its an immune suppressant drug...suppress the immune system and think of what will happen.

BUT....I have a really good idea of how terrible some dogs can be to environmental allergies and how miserable they are. My first thought for the dog is to have it allergy tested for environmental allergens (cloth, dander, etc). If something comes up (dogs can be allergic to something like cotton) get rid of the irritant if possible. If nothing comes up, feed raw. If that still doesn't help with the issue....Atopica. 

As a last resort I would use Atopica at its LOWEST effective dose. Its not fair to the dog to let them suffer if there is a drug that will help. It might cause side effects...but it may not. Thats a chance that I would take to make a dog comfortable.


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## Chocx2

My dog, Kelsey, lost her hair had all kinds of problems, they put her on Atopica because I wouldn't let them use steroids.Well thats when I researched a raw diet, changed my dog over to raw, took her off Atopica, she does get allergy shots but is almost off of them. This all started three years ago. She is great now!!!
Yes the Atopica suppressed her system and she was good on it but I read up on it and I think its just as dangerous as steroids. I have a hard time trusting these drug companies, yes it may help some dogs that don't have the money for a allergist but the meds are just as expensive and my dog was throwing up and sick on it so that has to tell you something. I think it helped my dog recover and then the raw food made her system healthy again and now since she doesn't have to fight bad food her system can handle anything that comes her way.
Her allergy was to mites and one grass, mites are in everything grain mites dust mites ect... Not food like they told me.


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## MollyWoppy

I have skin cancers. A couple of years ago, they put me on a drug that uses the immune system to attack the cancer cells. It is a cream, you rub it on and have to wash it off after a few hours, you can only go on it for a maximum of 6 weeks. 
After 3 weeks, of feeling quite rotten, I was on my back. God I felt awful. Couldn't get out of bed, no energy whatsoever, couldn't be bothered eating, drinking, just lay there. And, that is the opposite to what I am. I took myself off the drug and it took a good month to recover. Now, that's what an autoimmune drug, tested for years and passed by the FDA can do. Now the Dr wants me to try it again, it a lot smaller dose, but I'm that, well, basically scared $hitless of that drug, can't bring myself to do that to my body again. 
This is why I'm really apprehensive about putting a dog on a drug like that. How awful is the dog going to feel? Basically it comes down to; which is worse, the cause or the cure. A situation where you have to weigh up each side, take a good long hard look at the results and make your decision from there.


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## hungrydriver

My 9 YO Rottweiller was taken to the world renown Matthew J Ryan Hospital at the University of Pennsylvania for a condition known as Perianal fistulas. He was prescribed Atopica on September 30, 2013 and on November 12, 2013 he died from Necrotizing Fasiitis ( Also know as the flesh eating bacteria). It was the most horriffic and painful death a dog could suffer. And it was needless. I followed their bad veterinary advise religiously and watched my dog discintigrate to ashes in front of me. Never again will my hand introduce Atopica, the enabler of death to another canine as long as I live.


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## Rvent

Rachel, I have had these same issues with Macy, she has been misdiagnosed time and time again, I even brought her to an allergy specialist. I firmly believe that in addition to environmental & food allergies she also had a systematic yeast problem. I have tried everything, prednisone, several different antihistamines nothing worked. I started rotating her on a homemade kefir probiotic made with coconut milk, colostrum, ACV and fish oil...and nothing that breaks down into sugar, after a visit to a holistic vet in Brookfield I realized that the dosage of fish oils are way to little, He put her on fish oil with 1500mg of EPA and 900mg of DHA. Her itching, dander and yeasty parts have changed dramatically.


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## tkepe194

*atopica did kill my dog!*

I'm going to give you a history of my experiences with an atopic Lab/Shar Pei mix.

I rescued Charlie Dog from the shelter at approximately one year of age. Before he was two, he began exhibiting atopic, skin, symptoms. Charlie Dog was run through a number of food experiments with no luck. During this time, he also had a number of hive breakouts. His primary care veterinarian was not equipped to handle this type of situation and referred us to Michigan State University. As they’re a teaching, not a referral hospital, they wanted him to be as symptomatic as he could be before they would see him. Putting him through that was of little interest to me.

The research began. Living as a sedated Benadryl dog with a lifetime of prednisone is counter indicative of a happy life. I found a local vet who provided blood based antigen testing (sent to a third party) at a fraction of the cost with a high success rate, over 80%.

Immunotherapy began for his specific antibodies, he was moved to Claritin and z/d food.

Immunotherapy was administered from approximately two years of age through four years of age, ramping up to titrating and then back down. During the initial stages of treatment, he was still symptomatic and unable to fulfill a normal dog’s life. Multiple doses of prednisone were administered and finally Atopica was suggested.

For me, the cost wasn’t a concern; my ONLY concern was is this better than prednisone, long term. His primary vet confirmed this. From roughly three to five years of age, he was on Atopica, daily.

The symptoms went away. Magic!

In year five, we stopped Atopica to re-evaluate his original atopic presentation. Gone! He was removed from Atopica.

On his sixth birthday, two days ago, Charlie was diagnosed with Adenocarcinoma, pancreas cancer. He has been given two weeks to two months of quality life.

Is this Atopica’s fault? Maybe.

So, on the eve of this diagnosis and the sad fate that is waiting for us. We choose not to focus on the negative and the shortened life-span. Rather, we are focusing on 4+ years of quality life that was given to us because of this drug.

Would I change anything? Yes.

Knowing what I know now, I would have immediately begun immunotherapy and Atopica. Combined, they have provided the most asymptomatic course of treatment. The ONLY thing I would change would have been not to give as high of a dose of Atopica, and as often.

If your dog is atopic, you have to question his current quality of life — for us it was a furless existence with open sores. That is a quality of life that is unacceptable to me.

Final thoughts.
Atopica has provided a quality of life that is unmatched, in our opinion. Immunotherapy is the real winner, though. Titrating Atopica is where we, the veterinarian and I, missed the mark. Charlie and I both know that this information has made his primary care veterinarian a better practitioner and we hope that this information will also help you and your atopic dog find a higher quality of life, with the time that you have together.


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