Merck Manual

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Professional Version

Immunosuppressive Drugs in Animals


Nick Whelan

, BVSc, DACVCP, DACVO, Animal Eye Clinic of Waterloo Region

Reviewed/Revised Oct 2021 | Modified Nov 2022

Immune-mediated ocular disease is not uncommon in dogs. This can include keratoconjunctivitis sicca, immune-mediated keratoconjunctivitis (pannus), extraocular muscle myositis, episcleritis, nodular granulomatous episclerokeratitis, and immune-mediated uveitis (uveodermatologic syndrome) associated with an immune reaction to melanin (seen in a number of breeds, more commonly those of Arctic origin). Immune-mediated ocular disease can be managed by topical, systemic, or a combination of both, that may also be in conjunction with topical and systemic corticosteroids. The drugs most commonly used other than glucocorticoids are cyclosporine, tacrolimus, mycophenolate, and azathioprine.

In addition to topical use, cyclosporine can be used systemically. Bioavailability is variable from different oral formulations. Dosage is 5 mg/kg, every 12 hours for 2 weeks, decreasing to every 24 hours if clinical improvement.

Mycophenolate mofetil can be administered at 7–20 mg/kg, every 12 hours for 3–4 weeks, then reducing the dose to 10 mg/kg/day.

Azathioprine can be administered orally (1.5–2 mg/kg/day, reducing the dose after 3–5 days).

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