My vet prescribed azathioprine. Is it safe for my dog with liver disease?

I'm sorry Meddy is sick. I am trying to understand exactly what is going on with him. It sounds like your vet is suspicious of an immune mediated disease (where Meddy's own immune system is malfunctioning and destroying her platelets (as well as possibly her red blood cells and/or white blood cells). A blood transfusion may have been required help Meddy survive. Let me briefly review the medications you've listed: *Zip vit- I am not familiar with this, but it seems to be a vitamin supplement. *I suppose "sucroll" may be the drug sucralfate, which is a medication that helps to decrease bleeding in the stomach and intestine. *Livotas is not something used in the US and I cannot find any information on it. *Thrombup is an herbal that may be beneficial when platelets are low (I don't have any experience with this one, and it is not generally used in the US) *Lisybin is a supplement for liver health. *Alamin R Forte is not something I have experience with but appears to be used for a number of different indications in India. *I assume Doxypet is doxycycline, which is an antibiotic commonly used to treat possible underlying infection that results in immune mediated cell destruction. Doxycycline also has some anti-inflammatory properties that can be helpful. *udiliv300 is ursodiol, which helps with bile flow from the gallbladder and through the liver *Venol is not a drug used in dogs in the US, so I am not sure what the purpose of this mediation would be for Meddy. *azathioprine suppressed the immune system and helps treat immune mediated diseases. Azathioprine can have negative side effects on the liver, so the liver protective medications listed may be to help try to minimize these negative effects on the liver. * I do not know what you mean by NS DNA D10. Regarding the pictures you've attached : The first picture is shows small spots of bleeding under the skin, which would commonly be seen with low platelet counts. The second picture looks like what is an amino acid supplement that can be given as an injection. I am not sure of the purpose of this medication for Meddy, but I don't see a reason it would cause harm. The third picture of the lab findings- shows the red cell count a little low (mild anemia), and there is no number for either the platelets or the total white blood cell count. Generally that means those counts are very low--too low for the machine to read. To try to answer your questions: I am not highly suspicious that this is liver cancer, but it is possible. We can see immune mediated cell destruction AS A CONSEQUENCE of cancer, so it may be that liver cancer, or another type of cancer, is the underlying cause. It is possible that the liver value abnormalities on the lab work are a side effect from the medication. You can talk to your vet about potentially having an abdominal ultrasound (sonogram of the belly) performed. This may help identify a tumor in the liver or elsewhere that may be the underlying cause of disease. The picture that you took with the spots on the skin-- this would be seen from low platelets. I suspect that the medications were all started BECAUSE of low platelets. It takes time to get that platelet count up, so bleeding will continue while platelets are low. So more bleeding will occur until the meds are working. I do not think that this is reaction to medications. (Having said that, unfortunately sometimes patients just do not respond well to treatment and we cannot get the platelet count up despite our best efforts). Regarding the jaundice that you've seen after the medication was given-- again I doubt this was a result of the medication. If his red blood cells are being destroyed by his immune system, this will result in jaundice. Additionally, following transfusion (even from a known blood source) jaundice is common. I hope that information helps, I can try to help more with a consult. Thank you for asking Petco Pet Education Center, formerly Petcoach!

The problem I see with these medications is that he is taking a steroid (prednisone) and an a non-steroidal (NSAID) - meloxicam at the same time. It is not recommended those be given together. I suggest you talk to your vet about this issue. ( https://criticalcaredvm.com/a-potentially-lethal-combination/ ) I would be worried about this as this can negatively impact the stomach, kidneys and liver. Your vet needs to decide which one he should be on (the NSAID or the steroid) and stop the other one. Divi should also be given some gastroprotectants to prevent stomach ulceration.

Poor Meddy! I am sure you are very worried about him. I wish i could tell you what is going on with him but from the medications you list it sounds like something is wrong with his liver. If he received a blood transfusion then this means he was anemic (low red count). The pictures you show are of a common intravenous fluid solution to maintain hydration, an antibiotic, and a sugar solution (which is often given if the blood sugar is low). It sounds like your vet is working hard to help him. As all of these are supportive medications the really important thing will be finding out why this is happening. I assume you took him to the vet because he was sick and he was placed on these medications to treat him. If this is not the case and he developed sickness after starting a medication then report this to your vet right away. It sounds like Meddy needs more tests to figure this out. Do you have access to any veterinary specialists in your area, such as an internal medicine specialist? If not, you could talk to your vet about he or she getting a phone consult with a specialist to help with the case. I hope this helps and the Meddy feels better soon! Thank you for using Petco Pet Education Center, formerly Petcoach.

Thanks for using Petco Pet Education Center, formerly Petcoach! It is ok to use them together though these are typically used together temporarily and then some of them will be weaned off to hopefully at some point be off medications. I really hope that everything gets better on this protocol. Good luck and all the best!

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. The medications Cassie is currently on are safe to administer to her. The Amoxicillin Clavulanic acid is an antibiotic and the Destolit will help support her liver function. To help support liver function, I also recommend using Denamarin liver supplement which can be found online quite easily. I would discuss starting Denamarin with your vet first prior to adding any an additional supplement into the mix. I hope this helps guide you in the right direction! Please let me know if you have any other questions or concerns and I would be more than happy to help you further.

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. Blood can definitely be seen with cases of IBD. For IBD, immunosuppression is typically the treatment of choice in severe cases. Azathioprine is an immunosuppressant drug that is commonly used along with changing the diet to something such as Royal Canin Ultamino. I would discuss this with your veterinarian for starting something such as Azathioprine in place of steroids to see if this helps more. Please let me know if you have any other questions or concerns and I would be more than willing to help you further. I would also recommend adding in a probiotic such as Purina Fortiflora, which can be purchased online or at your local pet store quite easily.

Hello, without knowing the reason for the Pred., I cannot comment fully of this particular situation, but yes, Pred. is often associated with the elevation of liver values. I would definitely have Piluko on a liver protectant like Sam-e with milk thistle ( we have Denamarin here in the US ). As for the vomiting, your vet may recommend the metoclopramide or another medication such as Cerenia to control it. You can also try ginger root as it does have anti-nausea properties. The dose is wide, from 15-200 mg/kg every 12 hours, so start low & look to find a ginger root capsule that contains no other ingredients, especially xylitol. Make sure you tell your vet if you decide to try this. Thanks for using Petco Pet Education Center, formerly Petcoach.