I am pleased to hear that you have gotten through this - both recovering from pancreatitis and successfully switching the medications. Diazepam is not suitable for oral maintenance therapy in dogs, because it is absorbed poorly, has a short half-life of 2.53.2 hr, and tolerance to its anticonvulsant effects develops rapidly. by MK's mom Sat Aug 09, 2014 7:24 pm, Post . doi: 10.1007/s00415-012-6628-x, 12. Epilepsy Res. (2014) 10:257. doi: 10.1186/s12917-014-0257-9, 33. We've had her blood tested and the PB is at the proper levels in her system. doi: 10.1111/j.1748-5827.2006.00290.x, 26. Looking for a convenient way to access your pets health records, refill prescriptions, view upcoming appointments and more? Approximately 25%50% of cats administered bromide developed signs of bronchial disease characterized by a cough and marked pulmonary infiltrates seen on radiographs. Chung J, Hwang C, Chae J, Ahn J, Kim T, Seo K, et al. She's been on it so briefly, but who knows, the KBR may have caused it. doi: 10.1111/j.1939-1676.2011.00783.x, 16. Studies suggest that 60% of dogs respond initially; however, after 48 mo, there is a loss of effect in of previous responders because of development of tolerance. If its better than your original medication, you and your healthcare provider may decide to wean off and eliminate your original medication. In dogs not on drugs that induce hepatic microsomal enzymes, the dosage is 5 mg/kg, PO, bid. by seebr5640 Tue Jul 02, 2013 9:08 am, Post ALT, serum alkaline phosphatase, and/or bile acids should be monitored. Weaning a Litter of Puppies. Make a gruel of canned or dry puppy food mixed with puppy milk replacer or water. A nonfatal hepatopathy in a dog was attributed to zonisamide. Phenobarbital is used to treat your dog if they have epilepsy or other seizures. Zonisamide was first used in Japan in 1972 to treat psychiatric diseases, and it has been widely used to treat epilepsy in Japan and Korea since at least 1990. Doing this may increase your risk of having more frequent and/or severe seizures. Zonisamide - induced urinary lithiasis in patients with intractable epilepsy. (2014) 21:889. A 6-year-old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic aggression. All authors contributed to the article and approved the submitted version. For some of us, it takes . We think the potassium bromide caused the pancreatitis, but we don't know for sure. Our cases showed clinical apparent direct association with ZNS and correlation with dose adjustment in case 1 and case 2. by ShilohsMom Mon Aug 11, 2014 9:25 am, Post When the owner called him during the abnormal behavior episode, the dog was able to come out of it and went back to himself. If azotemia is present, a different AED can be used, or the initial bromide dose can be reduced by half and serum concentrations monitored. Abnormal behavior episodes included sudden rage and aggression to the family members, insomnia, restlessness, and/or constant attention-seeking behavior. Primidone may be more likely to cause hepatotoxicity than phenobarbital, and it has been associated with hepatic necrosis and lipidosis and bile canaliculi obstruction. Already have a myVCA account? Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Buchsbaum R, et al. The elimination half-life is extremely long (24 days) in dogs; therefore, it takes ~4 mo to achieve steady state kinetics. This may also support the possible dose-dependent nature of the aggressive episodes, given the reported elimination half-life of ZNS in dogs being approximately 15 h (6, 26). b. Faught E. Review of United States and European clinical trials of zonisamide in the treatment of refractory partial-onset seizures. The aggressive behavior resolved almost completely within 5 days after the abrupt cessation of ZNS in our cases. Seven days later, the owner reported episodic aggression was improved by 40% compared with that prior to dose reduction. Use of valproic acid in dogs is limited because of rapid metabolism. Carbamazepine has been used to treat aggressive behavior problems in cats ( see Psychotropic Agents Psychotropic Agents Anxiolytics, antipsychotics, antidepressants, and mood stabilizers used to treat human behavioral disorders are being used more commonly in veterinary medicine as adjuncts to behavioral modification read more ). by SpencerBhumi Wed Aug 13, 2014 5:20 pm, Post Brodie MJ, Ben-Menachem E, Chouette I, Giorgi L. Zonisamide: its pharmacology, efficacy and safety in clinical trials. Read More has anyone heard of Zonisamide? For this reason, for anticonvulsants, we always recommend a trough (just before the next dose) sample so you can assess the lowest concentrations that occur during a dosing interval. The likelihood of future seizures in children with epilepsy is based on specific factors like the underlying cause, epilepsy syndrome, and seizure type. Bromide toxicity can be seen at any concentration in an unusually sensitive dog, but it is rare when bromide is used alone and when serum concentrations are < 1.5 mg/mL (15 mmol/L). Shiloh's on KBr and while I wish he weren't, it has helped in controlling his seizures. Especially since he started with a cluster, and had another cluster when they tried to drop the dose, it sounds like this is a dog that will need to . Rare side effects include liver disease, urinary stones, and aggression. Symptoms of Bromide Toxicity in Dogs Stomach irritation (some sensitive dogs may need the splitting of the daily dose into two lots and given with food) Vomiting There is no clinical information on use of felbamate in cats. Your options may include increasing the dose of your current medication, replacing it with a different medication, or adding a different medication while continuing to take your current medication. An abnormal behavior episode of case 1 showing aggressive growling at the family members while resting in the bed. Zonisamide is available as capsules of 25, 50 and 100 mg . After 12 weeks of treatment, 7 out of 10 dogs were seizure-free. It is very important that your doctor check your progress at regular visits to see if the medicine is working properly. Whether or not youre experiencing side effects from your current medication, How much your medication has lowered the frequency and/or severity of your seizures, What other medications may be right for your kind of epilepsy, How they might interact with your current medication. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. (http://www.medicinenet.com/zonisamide-oral/article.htm). MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. A 50:50 mixture of milk replacer and water is recommended. (2012) 60:3579. I do fear removing a drug completely since things have been "okay" lately -- but with Apollo having such bad ataxia this past week it is certainly making me concerned My boy has done marvelous on the zonisamide with no side effects, but my other epileptic who has passed away didn't get much of a break from seizing with zonisamide, they're all so different. Although some of it is metabolized by the P450 enzyme system, much is excreted unchanged in the urine. Perhaps with the money I save on stopping the Zoni, I could hire a dog nurse to give the Keppra strictly. The dosage in cats has varied from 5 mg/kg, PO, bid, to 510 mg/kg/day, PO. doi: 10.1111/jvim.16205, 42. Negative effects of epilepsy and antiepileptic drugs on the trainability of dogs with naturally occurring idiopathic epilepsy. Limitations of this report reside in the small number of cases, the retrospective nature, and difficulty in proving the direct association of abnormal behavior episodes and ZNS or in ruling out other potentially contributing conditions. doi: 10.2147/NDT.S4063, 5. Contact your veterinarian if these signs are severe. Potassium and sodium bromide are drugs used to control seizures in your dog, but there can be side effects and toxicity in some cases. SK: conception, design, and writing the draft. (2011) 73:15058. Merck & Co., Inc., Rahway, NJ, USA(known as MSD outside of the US and Canada) is dedicated to using the power of leading-edge science to save and improve lives around the world. Serum concentrations of zonisamide should be measured minimally 1 week after treatment initiation or dosage adjustment to allow steady state concentrations be reached. by athomas989 Fri May 29, 2015 1:59 pm, Post Zaccara G, Specchio LM. I told her that when Zonisamide was added he still clustered and continued to cluster on an almost weekly basis until KbR was added -- so to me I feel the Zonisamide hasnt done too much .. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian. The nightly episodic aggression completely disappeared within 5 days after discontinuation of ZNS. Bromide appears to stabilize neuronal cell membranes by interfering with chloride transport across cell membranes and by potentiating the effect of GABA via hyperpolarizing membranes. Weaning off Gabapentin requires you to do so slowly. Reported adverse effects of ZNS in dogs in the clinical setting include sedation, generalized ataxia, vomiting, inappetence, and a few idiosyncratic reactions such as cutaneous reactions (13, 14), acute hepatopathy (15, 16), and renal tubular acidosis (17). The episode typically lasted for ~1 min. A maintenance AED should also be considered if the first seizure episode is protracted or severe, or during an episode of status epilepticus (as a followup to emergency treatment, see Antiepileptic Drugs Used to Stop Ongoing Seizure Activity Antiepileptic Drugs Used to Stop Ongoing Seizure Activity In status epilepticus, treatment is essential to prevent death from hyperthermia, acidosis, hypoperfusion, and hypoxia. If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. o [ canine influenza] Apparent acute idiosyncratic hepatic necrosis associated with zonisamide administration in a dog. The therapeutic range for bromide is 12 mg/mL (1020 mmol/L) with concurrent phenobarbital treatment, or 13 mg/mL (1030 mmol/L) for bromide as a monotherapy. If they are not available, follow their directions in contacting an emergency facility. Rob Daniel for his prompt advice on the manuscript preparation. (2003) 28:1849. Neurology. 1 Its mechanisms of action include inhibition of voltage-dependent sodium and T-type calcium channels. Similarly, a case series study described abnormal behavior episodes in dogs receiving LEV (40). The adverse effects are usually mild, such as transient ataxia, loss of appetite, lethargy, and vomiting. This will begin to lessen the puppies' dependence on their mother's milk and presence. Charalambous M, Pakozdy A, Bhatti SFM, Volk HA. Treatment in canine epilepsy - a systematic review. Therapeutic monitoring is not usually necessary with this drug. It turns out that our poor gal has very, very severe pancreatitis. Thus, diazepam can be used as a maintenance treatment in cats, with dosages ranging from 0.250.5 mg/kg, PO, bid-tid. The clinical signs in our cases were similar to PAE in humans, which seriously and negatively affected the caregivers' quality of life. Doses may be doubled in early stages and increased by 25%50% in later stages. For children who have undergone successful epilepsy surgery and are now seizure-free, it is reasonable to try coming off medication. 8:763822. doi: 10.3389/fvets.2021.763822. Adverse effects classified as type 4 have not been reported (7). However, there may be a risk that your seizures will return after weaning off. Collinet A, Sammut V. Suspected zonisamide-related anticonvulsant hypersensitivity syndrome in a cat. Other reported adverse effects include fatigue, headache, psychiatric symptoms, cognitive disturbances, diplopia, weight loss, diarrhea, ataxia, oligohydrosis, urolithiasis, and rash (1924). For the most part, people who continue to have seizures despite taking two or more medications at appropriate doses may not benefit by adding medications without removing others. i will go on this drug once i come off topamax I've been on topamax forever! doi: 10.1111/j.1939-1676.2011.00801.x, 18. Phenytoin (diphenylhydantoin) is no longer recommended for maintenance use in dogs, cats, or foals because of undesirable pharmacokinetic properties. There are important risks to think about when stopping seizure medications. by seebr5640 Sat Jul 13, 2013 8:33 am, Post J Vet Intern Med. Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. Post (2015) 21:68391. The aggressive episodes deteriorated day by day over the next 5 days until ZNS dose was reduced to 5 mg/kg PO in the morning and 2.5 mg/kg PO in the evening. However, aside from a previous report by Walker et al. Our dog has been on zonisamide and phenobarbital for some time. Give the missed dose and then wait the recommended interval before giving the next dose (continue giving it regularly at that new time). Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. doi: 10.1016/j.yebeh.2017.08.039, 39. Enter search terms to find related veterinary topics, multimedia and more. It may be combined with phenobarbital or bromide. Administration of phenobarbital alters the deposition of clorazepate such that the amount of nordiazepam in circulation during each dose interval is significantly reduced. The authors thank the owners of three cases, referring veterinarians and colleagues at Veterinary Specialists & Emergency Center for supporting us for the article preparation. After failing to control daily epileptic episodes with PB, LEV, and potassium bromide over the next 10 days, ZNS at 50% reduced dose (5 mg/kg PO q12h) was resumed to confirm the direct association between ZNS and the aggressive episodes as well as to manage seizure episodes. (2000) 9:6570. This pyrrolidine-based anticonvulsant has an unknown mechanism of action. It is created by eHealthMe based on reports of 8,997 people who have side . This dog was managed well with PB (2 mg/kg q12h) and LEV (20 mg/kg q8h) with no observable epileptic or aggressive behavior episodes for 13 months until this dog died of an unrelated condition. If primidone is switched to phenobarbital, one grain of phenobarbital can be substituted for 250 mg primidone. 2015 ACVIM Small animal consensus statement on seizure management in dogs. by SpencerBhumi Sun Jun 30, 2013 4:03 pm, Post In addition to its anti-seizure potency, ZNS may be efficacious in treating various human neurological and psychiatric diseases including migraine, neuropathic pain, essential tremor, and Parkinson's disease (812). ApplAnim Behav Sci. Levetiracetam is initially administered at 20 mg/kg, PO, tid, in dogs; 1020 mg/kg, PO, tid, in cats. Most people with epilepsy take one or more medicines. Zonisamide is administered by mouth, as an oral capsule, or it may be compounded into an oral liquid. (2017) 251:145761. 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