Tapering phenobarbital is crucial, because it is addictive and can result in withdrawal seizures if stopped abruptly. by SpencerBhumi Thu Aug 14, 2014 3:08 pm, Return to Treatment & Maintenance Issues for Epileptic Dogs. In most cases, the risk of stopping medication slowly is low. Higher dosages (3060 mg/kg, PO, tid-qid) may be necessary but can produce sedation and ataxia. Think about timing before deciding to wean off an anti-seizure medication. The dosage in cats has varied from 5 mg/kg, PO, bid, to 510 mg/kg/day, PO. doi: 10.2147/NDT.S4063, 5. Blastomycosis is a Systemic Fungal infection Affecting Dogs and Cats Bloat - The Mother of All Emergencies Bloat: First Aid Bloody Nose (Epistaxis) in Dogs and Cats Bones are Unsafe for Your Dog, No Bones about It Brachial Plexus Avulsion in Dogs and Cats Brachycephalic Airway Obstruction Syndrome in Flat-Faced Dogs It appears very safe with no to few adverse effects (ataxia, sedation, vomiting) reported at the routine dosage ranges. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian. Prior to the referral, this dog had been managed with ZNS starting at 2.5 mg/kg per os (PO) q12h then gradually increased in the dose up to 5 mg/kg q12h with the trough blood concentration at 21.2 g/ml over the 15 months. Bermejo PE, Ruiz-Huete C, Anciones B. Zonisamide in managing impulse control disorders in Parkinson's disease. With limited available evidence supporting its efficacy in the veterinary field, this medication has been widely used for anti-seizure purpose in dogs and in humans (27). Long-term safety and effectiveness of zonisamide in the treatment of epilepsy: a review of the literature. Helpful items to consider before changing or withdrawing from your anti-seizure medication: Below are some common situations in which it may be a good time to think about changing or stopping your medication. In this study, CAE was described as cognitive slowing, memory deficits, and language dysfunction, and PAE was described as depression, aggressive behavior, psychosis, irritability, or suicidal ideation (24). . In ruminants, phenobarbital is the first choice; in horses, both bromide and phenobarbital have been used. Sci. Repeat this process two or three times a day until they begin to drink the milk replacer on their own. Clorazepate dipotassium (0.51 g/kg, tid) has been proposed as an adjunct to phenobarbital treatment in dogs. It has also been used to treat aggressive behavior problems ( 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 ). The loading dose regimen can be discontinued if the dog becomes too sedated, or smaller divided daily doses can be tried. Vet. They are usually given to people with epilepsy only when other anti-seizure medications havent helped. The goal is to prevent seizures with as few side effects as possible. Serum therapeutic concentrations are 1545 mcg/mL. Two more months later, levetiracetam (LEV) at 17 mg/kg PO q12h was added on ZNS as the dog experienced another episode of cluster of seizures. (2008) 31:54453. Limited data suggest zonisamide may be beneficial . The decision to start maintenance anticonvulsant or antiepileptic therapy should be based on the frequency and severity of the seizures, the age of onset, the likely cause(s) of the seizures, and the results of diagnostic testing. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Many laboratory assays cannot distinguish between serum bromide and chloride ions, so serum chloride values may be reported as falsely high. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Dose adjustments of other anti-seizure medications in case 2 did not result in significant changes in these behavior episodes. It may still be used in status epilepticus in dogs as a slow IV injection of 25 mg/kg. Japn J Vet Dermatol. The owner reported 7 days later that no GTCS was witnessed while the episodic abnormal behavior remained at the same intensity and frequency. In dogs not on drugs that induce hepatic microsomal enzymes, the dosage is 5 mg/kg, PO, bid. Severe signs of toxicity are easily treated by IV administration of 0.9% sodium chloride, which promotes renal excretion of the bromide ion. We do not control or have responsibility for the content of any third-party site. Charalambous M, Shivapour SK, Brodbelt DC, Volk HA. In cats, phenobarbital is the usual first choice, but levetiracetam and zonisamide are becoming more acceptable; diazepam is an alternative choice. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. by athomas989 Fri May 29, 2015 1:59 pm, Post Read More Dermatol. This synthetic analogue of the inhibitory neurotransmitter -amino butyric acid (GABA) inhibits seizure activity via multiple mechanisms, including inhibition of neuronal sodium channels and potentiation of the release and action of GABA. It may also require additional changes to the dose of your new medication. In addition, aggression has been reported in a research setting investigating chronic toxicity of ZNS in dogs (18). Set up your myVCA account today. Zonisamide, USP is a white to off white crystalline powder, pKa=10.2, and is moderately soluble in water (0.80 mg/mL) and 0.1 N HCl (0.50 mg/mL). If adverse effects occur, the dosage should be reduced to 20 mg/kg, bid, and increased to 20 mg/kg, tid, gradually. in the research setting where three male dogs showed aggression while they received 75 mg/kg/day of ZNS for 52 weeks achieving the serum ZNS level around 80120 g/ml, (18) abnormal behavior episodes as we experienced have not been reported in the clinical veterinary setting to the best of our knowledge. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. The aggressive behavior resolved almost completely within 5 days after the abrupt cessation of ZNS in our cases. ALT, serum alkaline phosphatase, and/or bile acids should be monitored. Pharmacotherapy. BMC Vet Res. Another week later, the owner reported the increasing frequency and the change in the episodic abnormal behavior. Zonisamide - Zonisamide is a broad-spectrum antiseizure medication that blocks voltage-dependent sodium and T-type calcium channels. Given the history and unremarkable clinicopathological analyses results, ZNS dose was reduced to 4.5 mg/kg PO q12h without any changes in LEV and glycerine to avoid multiple variables at one time for assessing the clinical response to the medication adjustment. (2018) 200:10613. To minimize the risk of increased seizures and maximize the benefit, weaning should be done slowly and under the guidance of an epilepsy specialist. Zonisamide use may be associated with the following side effects in dogs: sedation, incoordination while walking, vomiting, and lack of appetite. Negative effects of epilepsy and antiepileptic drugs on the trainability of dogs with naturally occurring idiopathic epilepsy. Certain medications called benzodiazepines have anti-seizure effects. Zonisamide (Oral Route) Side Effects Drug information provided by: Merative, Micromedex Along with its needed effects, a medicine may cause some unwanted effects. Our initial plan was to gradually increase ZNS dosage as needed and to maintain LEV at the same dose. Ten more days later, the owner described that abnormal behavior episodes were deteriorating in the following aspects: increasing in frequency to daily events, not limited to during the sleep, and deteriorating in its severity to bite the owner on her arm severe enough to visit an emergency hospital. Acute hepatic failure has been reported in cats given diazepam for behavioral problems; thus, a pretreatment chemistry profile should be evaluated before using diazepam, and cats should be watched closely during the first 2 wk of use. Make a gruel of canned or dry puppy food mixed with puppy milk replacer or water. The owner reported the same abnormal behavior episodes relapsed within 12 h after re-introduction and gradually deteriorated over the next 3 days. The incidence of PAE severe enough to result in discontinuation of ZNS was 6.9%; the incidence of CAE resulting in discontinuation of ZNS was 5.8%. by seebr5640 Mon Jul 01, 2013 5:12 am, Post But, taking them daily may cause drowsiness, dizziness and loss of balance, and other side effects. Thank you all for the concern. doi: 10.2460/javma.251.12.1457, 28. I'm glad KBr hasn't been an issue for your pup! Zonisamide should not be used in pets that are hypersensitive or allergic to it. Knudsen JF, Thambi LR, Kapcala LP, Racoosin JA. What Drugs, Substances, or Supplements Interact with Voltaren Within another week, the abnormal behavior episodes completely disappeared. Zonisamide was discontinued abruptly and PB was increased to 2 mg/kg q12h. The aggression was noted in the absence of precipitating causes or environmental triggers, occurring nightly predominantly toward females in the household. For maintenance therapy in dogs, it may be used alone at 0.5 mg/kg, tid, but it is best used as an adjunct to phenobarbital at dosages of 0.10.5 mg/kg/day. J Vet Intern Med. Our 5 y.o. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. In our cases 1 and 2, ZNS was discontinued abruptly due to serious impact of the aggressive behavior episodes to the family and human data according to the aforementioned report (38). Of course, consult your healthcare provider before making the decision to stop taking any medication and follow your states driving guidelines for people with epilepsy. Cochrane Database Syst Rev. Use an effective form of birth control to keep from getting pregnant during . Hopefully we are out of the woods with the pancreatitis. Recently, ZNS-related anticonvulsant hypersensitivity syndrome was reported in cats (27). Front. Antidepressants - SSRIs and SNRIs Citalopram (Celexa) Duloxetine (Cymbalta ) Escitalopram (Lexapro) I do hope your progress continues in such a positive manner from here on. doi: 10.1111/j.1939-1676.2011.00801.x, 18. (2004) 40:28591. Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. For the relief of ankylosing spondylitis, the recommended dosage of Voltaren (diclofenac) is 100-125 mg/day, administered as 25 mg four times a day, with an extra 25-mg dose at bedtime if necessary. o [ canine influenza] by Gentle Jacob's mom Wed Aug 13, 2014 9:03 am, Post Visual hallucinations associated with zonisamide. In these instances, follow your veterinarians directions and cautions very carefully as their directions may be significantly different from those on the label. Levetiracetam is initially administered at 20 mg/kg, PO, tid, in dogs; 1020 mg/kg, PO, tid, in cats. A total of 10 dogs were enrolled in the study, and all dogs received levetiracetam at a dose of 20 mg/kg/day. This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. No similar episodic aggression was witnessed in association with dose adjustments or addition of other ASDs including PB, potassium bromide, and LEV. Adverse effects classified as type 4 have not been reported (7). Monotherapy is preferred, but if the drug level is well into the middle or high therapeutic range, it may be necessary to consider the addition of another AED. According to the human literature, PAE associated with ASDs appeared reversible in nature (38). Withdrawal symptoms may include increased seizures, anxiety, and panic attacks if you miss one or more doses. Zonisamide may cause hyperammonemia (too much ammonia in the blood), which may damage the brain and can be life-threatening. Following administration of zonisamide (10 mg/kg/day, 30 mg/kg/day or 60 mg/kg/day) to pregnant dogs during organogenesis, increased . Ideally use the same brand of food that the mother dog eats. The principle advantage of felbamate is a lack of sedation, and adverse effects are reportedly rare. Your veterinarian may monitor your pets blood zonisamide levels. doi: 10.1292/jvms.11-0164, 17. ApplAnim Behav Sci. Capsules should be protected from light and be stored in a dry place. If your pet stops eating, becomes dramatically lethargic, or develops a yellow color of the skin, gums, or whites of the eyes, contact your veterinarian immediately. Weaning off Gabapentin requires you to do so slowly. by seebr5640 Sat Jul 13, 2013 8:33 am, Post The seizure episode was described as sudden running fit with falling and defecation, followed by 12-min duration of opisthotonus, clonic motor activities, and copious amount of ptyalism. Check with your doctor right away if you have nausea or vomiting that continues, an increase in the frequency of seizures, loss of appetite, swelling of the face, tiredness and weakness, or yellow eyes or skin. Zonisamide is totally unrelated to any of the other anticonvulsants, but, like Keppra, the full extent of its side effects is not yet known so to some vets, it is somewhat controversial to prescribe it. If youre taking several anti-seizure medications, its possible that one or more of them can be weaned off and removed. Neuropsychiatr Dis Treat. Bromide has been used in horses as a maintenance AED, but there are no published studies on its clinical efficacy. Potassium and sodium bromide are drugs used to control seizures in your dog, but there can be side effects and toxicity in some cases. doi: 10.1016/j.jfms.2008.01.006, 30. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking. Written informed consent was obtained from the owners for the participation of their animals in this study. In dogs, the initial dosage is 1015 mg/kg, PO, tid. (2005) 46:3141. White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK. Cephalalgia. The plan now will be to wean the Zonisamide. As adjunct therapy with phenobarbital, potassium bromide can be administered at 2040 mg/kg/day, PO, either as one dose or divided into two or more doses; the sodium bromide dosage is slightly lower at 1730 mg/kg/day, PO. Faught E. Review of United States and European clinical trials of zonisamide in the treatment of refractory partial-onset seizures. 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