Veterinarians use cyclosporine to treat dogs with eye, skin and autoimmune diseases, the most familiar being dry eye, atopic dermatitis and perianal fistulas. Cyclosporine is generally given or applied once or twice a day, depending on the condition being treated. Cyclosporine is available as an ointment (ophthalmic or skin), tablets (non-modified), capsules (micro-emulsified modified) and compounded oral liquid, and sold under many names, including Optimmune, Atopica, Neoral, Sandimmune, Gengraf, Cyclosporine Modified/Generic, Tacrolimus and Protopic.
Dogs must always be examined by a veterinarian, who will prescribe appropriate medications in correct dosages and formulas for any conditions needing treatment.
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Dry Eye
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Miniature poodles, shih tzus and westies are predisposed to developing "dry eye." Veterinarians started prescribing cyclosporine when it was found to relieve the symptoms and discomfort of dry eye, or KCS (Keratoconjunctivitis Sicca), a problem in small breed dogs when tear production is compromised due to immune-related inflammation or destruction of tear gland tissue. According to veterinarian Mike Richards, DVM, it is ". . . the best medication for the problem of tear deficiency in dogs. ... It is available in an ointment with the brand name Optimmune," and alleviates some symptoms in approximately 80 percent of dogs with KCS. Topical cyclosporine increases secretion of natural tears (as opposed to artificial tears), containing growth factors that regulate corneal-cell healing.
Perianal Fistulas
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German shepherds are the breed most likely to suffer from Perianal Fistulas. Cyclosporine controls inflammation associated with many allergic and immune-mediated skin diseases, such as canine perianal fistulas, which have been effectively treated with cyclosporine capsules. Ontario Veterinary College researchers conducted a study on German shepherds with naturally developing perianal fistulas and concluded that cyclosporine produced an "Overall improvement and change in total surface area of involvement and depth of the deepest fistula . . . All cyclosporine-group dogs, but none of the control-group dogs, were subjectively improved after four weeks." Fistula depth decreased in the cyclosporine-group dogs but increased in the control-group dogs, and after four months of treatment, fistulas had healed in 85 percent of cyclosporine-treated dogs, proving that, even though there were some recurrences of the fistulas, cyclosporine is effective and beneficial for dogs with this chronic condition. Perianal fistulas in German shepherds were once considered surgical conditions, but now, cyclosporine is successfully used in many cases. Some dog owners also apply cyclosporine-based Tacrolimus or Protopic ointment onto the perianal area when fistulas are active.
A micro-emulsified (modified) version of cyclosporine increases the oral bioavailability and consistency of absorption in dogs. Because cyclosporine is very expensive, a pharmacological "trick" is used to maintain a higher blood level with less cyclosporine. Concurrent use of Ketoconazole, an antifungal, disrupts the liver enzymes' removal of cyclosporine from the body, so, with a low dose of Ketoconazole, less cyclosporine is needed.
Atopic Dermatitis
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Atopic animals lick, chew, bite or scratch their paws and rub their noses. Atopica, the veterinary formula of cyclosporine, effectively controls inflammation associated with many allergic and immune-mediated skin diseases and has been used successfully to treat atopic dermatitis, itchy skin due to immunological sensitivity to common environmental substances, such as airborne allergens and house dust mites. In the past, dogs with this type of allergy were prescribed corticosteroids, such as Prednisone, to control the extreme itchiness, but long-term corticosteroid use causes problematic side effects. The critical symptom of canine atopic dermatitis is pruritus, intense itchiness that varies in severity with seasonal changes and often has a negative effect on quality of life and the human-dog bond. Canine atopic dermatitis tends to worsen with age, but early cyclosporine-based treatment may prevent the disease from progressing to the severity of symptoms some dogs experience and should not be reserved for treating suffering dogs when all else has failed. In his article, "Cyclosporine Therapy in Veterinary Dermatology," John D. Plant, DVM, reports that cyclosporine is "more effective than antihistamines, causes fewer side effects than long-term glucocorticoid therapy and has a quicker onset of activity than allergen-specific immunotherapy." It usually takes four to six weeks for atopic dermatitis to respond to cyclosporine treatment.
Side Effects and Warnings
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Cyclosporine's most common side effects are temporary and gastrointestinal, such as upset stomach, appetite loss, vomiting and diarrhea. Some dogs develop a thicker coat and shed more than usual. According to Wendy C. Brooks, DVM, "Other side effects reported include . . . heavy callusing on the footpads; red/swollen ear flaps; and proliferation of the gums. When cyclosporine was discontinued, these findings either resolved or improved."
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