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Line 141: |
| cyclosporine is immuno-modulating rather than | | cyclosporine is immuno-modulating rather than |
| immunosuppressive (Figure 2). | | immunosuppressive (Figure 2). |
− | Cyclosporine is rapidly absorbed and distributed.
| + | |
− | Bioavailability varies from 15-60% in individual
| |
− | dogs and is not affected by food. There is little
| |
− | correlation between trough levels and efficacy, and
| |
− | dose adjustments are made according to the clinical
| |
− | response rather than monitoring plasma levels.
| |
− | Metabolism is via the cytochrome P450 system.
| |
− | Numerous drugs can decrease metabolism, notably
| |
− | itraconazole and ketoconazole, which increases
| |
− | plasma concentrations, efficacy and the likelihood of
| |
− | adverse effects (Figure 3). Phenobarbital increases
| |
− | metabolism and decreases plasma levels.
| |
| Cyclosporine is administered for canine AD at a | | Cyclosporine is administered for canine AD at a |
| dose of 5 mg/kg once daily. Controlled studies | | dose of 5 mg/kg once daily. Controlled studies |
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| management program can be more cost-effective | | management program can be more cost-effective |
| than relying on it alone. | | than relying on it alone. |
| + | |
| The effect on intradermal testing and serology is | | The effect on intradermal testing and serology is |
| thought to be minimal, although the data is sparse. | | thought to be minimal, although the data is sparse. |
| Anecdotal data suggests that cyclosporine does | | Anecdotal data suggests that cyclosporine does |
| not affect the response to ASIT any more than | | not affect the response to ASIT any more than |
− | glucocorticoids although controlled studies have | + | glucocorticoids |
− | not yet been performed.
| + | |
| Cyclosporine is well tolerated by the majority of dogs. | | Cyclosporine is well tolerated by the majority of dogs. |
| Transient anorexia and vomiting are the most likely | | Transient anorexia and vomiting are the most likely |
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| however, the risk appears to be very small and most | | however, the risk appears to be very small and most |
| atopic dogs experience fewer secondary infections | | atopic dogs experience fewer secondary infections |
− | following treatment. Feline and human patients on | + | following treatment. Inhibition of |
− | long term treatment have a small risk of developing
| |
− | lymphoma and cutaneous neoplasms. Lymphoplasmatoid
| |
− | dermatitis has been seen following
| |
− | doses >20 mg/kg and there is a single case report
| |
− | of lymphoma in an older dog following treatment
| |
− | for anal furunculosis. These have, however, not
| |
− | been reported in atopic dogs (11). Inhibition of
| |
| T-helper cell function and β-cell activation could | | T-helper cell function and β-cell activation could |
− | affect the response to vaccination. Some authors | + | affect the response to vaccination.-->steroids Some authors |
| advocate withdrawing treatment for up to two | | advocate withdrawing treatment for up to two |
| weeks either side of vaccination, although this | | weeks either side of vaccination, although this |
− | will lead to worsening of the skin condition. The | + | will lead to worsening of the skin condition. |
− | pros and cons for each individual case should
| |
− | be discussed with the owner.
| |
| | | |
| ====Phytopica™==== | | ====Phytopica™==== |