Any Dosing Suggestions for Kitty Taking Prednisolone/Chlorambucil?

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Emily Alsip

Emily Alsip

Member Since 2022
Hello!

My Holland started taking Chlorambucil (in addition to her long term pred) on August 5. For two weeks she was taking both nightly. Now since August 19, it alternates... pred one night, Chlorambucil the next. And her BGs have been a little chaotic!

Every morning after her pred nights, she is well high enough to need her tiny insulin dose of 0.1U Lantus.

But every morning after her Chlorambucil nights, it's much lower. It's been below 100 several times. I'm gone for 10-11 hours during the day and don't feel comfortable giving her any insulin if she's that low and I'm not there.

I know Lantus likes consistency with doses, so I've been trying to give 0.1U all the time, but just can't. It's so clearly tied to the pred, I'm going to ask her doctor about weaning off and trying just the Chlorambucil.

Any other suggestions from personal experience? I need a guideline (like "shoot 1.0U AM when over 125") instead of guessing what's best every AM.

Thanks!
Emily
 
Not what you asked, but what dose of chlorambucil is she getting? Giving that every day is WAAAAY too frequently. I've seen far too many vets misdose it. Even ever other day chlorambucil is an older method and harder on kitties. Can you tell me a bit about why she's getting it? I read a bit in this previous post: https://felinediabetes.com/FDMB/threads/skin-fur-issue.266172/ but it sounds like you don't have a definitive answer as to whether you are dealing with IBD or SCL? I definitely would not give chlorambucil unless you know you are dealing with SCL. It's a carcinogen and can cause inappetance. With proper dosing, it's great for treating SCL if that's what she has. Your kitty should also be on ondansetron for nausea too. Any chance your cat is eating less on days she gets chlorambucil?

To answer the question, I never found the chlorambucil impacted Neko's BG numbers. It did impact her appetite, which improved a lot when we switched from every other day dosing to the more modern every two weeks dosing. Neko was also on budesonide, which would be an alternative to prednisolone. It didn't impact Neko's BG numbers either, though I have seen the one cat that does see a bump, but less than for prednisolone. What + time of night does she get the pred?

What is that 3.5 in the +3 cell tonight?
 
Here is a paper on chlorambucil dosing every two weeks.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/
My Mario was dx'd with small cell intestinal lymphoma and was started on chlorambucil dosed three times a week (M-W-F) he did Ok but the chlorambucil took its tole on behavior and eating. His oncologist did not want to also use prednisolone since he was diabetic. His first oncologist then retired and his second one went to a larger dose of chlorambucil every two weeks. He did better overall on the every two week dosing.
 
Holland has been on pred for (I'm guessing) two years. It's not a new one added when the Chlorambucil started.

Her appetite is the same all days, with an off day here or there that I can't link to anything in particular. It's actually better since starting the Chlorambucil, which makes me hopeful that it's starting to do it's work in her intestines. No vomiting.

Her dose is 0.2mL every other day.

The +3.5 was me hoping to get a reading before going to bed, but I couldn't get her. She's from a hoarding situation and before this DM diagnosis did not permit any kind of touch. So I don't test a lot except at shot times unless she's east to get. I will remove it.

Her pred is 5mg every other day and I give it at 6:30 when she gets her insulin so I don't have to stress her by another attempt to pick her up.

Thsnks, everyone for these other thought. My question was really asking about how to dose the Lantus with the variations caused by the pred. I know I'm supposed to stay steady with the Lantus but that's tricky when the eod pred is at play. Was easier to know what she would need insulin-wise when she had pred daily.
 
Emily Alsip said:
Her dose is 0.2mL every other day.
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What is the concentration of this? That just tells me the liquid volume. By the way, giving chlorambucil by liquid is also not recommended as it's much easier to get it on yourself.

Have you talked to the vet about maybe halving the amount of pred but giving it every day? That might help you be more steady on the insulin dose, as long as that keeps her GI symptoms under control. If that doesn't work, maybe try a drop dose consistently for a while and see what that does for her. With the varying doses, it's really hard to suggest what to dose.
 
Thanks. I like your thought of giving half the current dose of pred but daily. That would totally help even things out! I will ask about this when we go in next weekend.

I need to do what's easiest for her since she's a special case. I am cautious.

It is 3.2mg/mL
 
Emily Alsip said:
It is 3.2mg/mL
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That means 0.2 mL is 0.64 mg every other day. That is really odd ball dosing. Have you ever thought of going to an internal medicine vet? They are pretty good at working with multiple conditions, and current with treatments.

Good luck with the 1/2 pred dose daily. We have some other people here doing daily dosing of pred, and even some EOD. But cats seem to react differently to it. You have to find what works for Holland.
 
Wendy&Neko said:
That means 0.2 mL is 0.64 mg every other day.
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That is a low dose of Chlorambucil. When my Mario was on three days a week Chlorambucil each dose was 2mg. That was a long time ago when the 2mg Leukeran (name brand Chlorambucil) were affordable and compounding not readily available. The Leukeran pills could not be cut/crushed so likely the 2mg was higher than need and likely took it toll on Mario. Now only compounded Chlorambucil is affordable.

This study gives results with some different dosing. Note that the dosing is typically in mg per meter squared. The second link is a conversion of mg per meter squared to mg/kg.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/
https://www.aqua-calc.com/convert/s...per-square-meter-to-kilogram-per-square-meter
 
I’d ask about trying budesonide in place of prednisolone. In most cats budesonide has less of an impact on BG (or none at all), which might help even out your insulin dosing.

Prednisolone definitely impacted Charlie’s BG, budesonide did as well but probably less so. I don’t recall chlorambucil having any impact on BG at all. We were dealing with IM specialists and they immediately swapped out the pred when they realized how much it was affecting his BG. He went OTJ for quite awhile once the pred was removed.
 
Larry and Kitties said:
Now only compounded Chlorambucil is affordable.
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Note, this is a comment for the US only. It's quite affordable in other countries. I am currently giving Leukeran to another cat - as it turns out her every two week dose is a nice multiple of 2 mg. Also Leukeran is the name brand, chlorambucil is the drug name.
 
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