Neuropsychiatr Dis Treat. Reported type 1 adverse effects include sedation, vomiting, loss of appetite, and ataxia (2, 7, 25, 28). Adverse effects consist of sedation only, but periodic hematologic monitoring is advised, because blood dyscrasia and hepatotoxicity are reported in people. Tapering off Gabapentin though requires patience so you need to be careful to not immediately take your dog off large doses of it. J Vet Intern Med. By 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. Seizure. My doctor mentioned the possibility of some side effects, but both he and the drug literature mentioned that the effects would probably go away within 4-6 weeks. (2010) 75:5138. (2015) 1:CD011241. . Phenobarbital (PB) at 1.5 mg/kg q12h was added at this point concerning these abnormal behavior episodes as an atypical manifestation of sensory epileptic events. doi: 10.1212/01.wnl.0000250236.75053.16, 10. The initial dosage (dogs only) is 515 mg/kg/day in three divided doses, increased over time to a maximum of 35 mg/kg/day. The clinical signs in our cases were similar to PAE in humans, which seriously and negatively affected the caregivers' quality of life. Shiloh's on KBr and while I wish he weren't, it has helped in controlling his seizures. doi: 10.5326/0400285, 31. There are important risks to think about when stopping seizure medications. Post If primidone is switched to phenobarbital, one grain of phenobarbital can be substituted for 250 mg primidone. Zappia M, Albanese A, Bruno E, Colosimo C, Filippini G, Martinelli P, et al. The dosage in cats has varied from 5 mg/kg, PO, bid, to 510 mg/kg/day, PO. Further studies are warranted to provide more insights in behavior change associated with ASDs in animals. Serum concentrations of zonisamide should be measured minimally 1 week after treatment initiation or dosage adjustment to allow steady state concentrations be reached. This dog bit the client on the arm multiple times. The aggression was noted in the absence of precipitating causes or environmental triggers, occurring nightly predominantly toward females in the household. Akman CI, Goodkin HP, Rogers DP, Riviello JJ. Charalambous M, Pakozdy A, Bhatti SFM, Volk HA. 2 In addition to the treatment of several generalized epilepsy syndromes, it may also play a role in managing obesity, migraine, and motor dysfunction in Parkinson disease (PD). by SpencerBhumi Mon Jul 01, 2013 5:09 pm, Post The dose of ZNS was further decreased to 2.3 mg/kg PO q12h without any changes in LEV and glycerine for another 3 days then completely discontinued. doi: 10.1111/cns.12418, 6. An IV formulation can be used in status epilepticus. Psychiatric adverse effect associated with anti-seizure drugs has been well-recognized in human medicine. Levetiracetam (generic for Keppra), gabapentin, and zonisamide are the medications most commonly used in cases of refractory epilepsy. University of Veterinary Medicine Hannover, Germany, University of Veterinary Medicine Vienna, Austria, Cave Veterinary Specialists, United Kingdom. We do not control or have responsibility for the content of any third-party site. Front Vet Sci. by readerofthepack Fri Aug 08, 2014 1:32 pm, Post Pharmacotherapy. Another report described that psychiatric adverse events (PAEs) and cognitive adverse events (CAEs) were the most frequently identified reasons for terminating ZNS therapy in 433 epileptic patients who received ZNS (24). Give her as little as possible until you are sure that she is still not having seizures. Following administration of zonisamide (10 mg/kg/day, 30 mg/kg/day or 60 mg/kg/day) to pregnant dogs during organogenesis, increased . Carbamazepine is not recommended for use in dogs because of a rapid induction of hepatic enzymes that eliminate the drug quickly. This was not the case for me. Bromide, phenobarbital and zonisamide are examples, although phenobarbital and zonisamide half-life may get short enough that timing is important. However, cats not only have a longer half-life (1520 hr) than dogs but also do not develop a tolerance to the anticonvulsant effects. o [ canine influenza] The elimination half-life is extremely long (24 days) in dogs; therefore, it takes ~4 mo to achieve steady state kinetics. Give her 3/4 of the regular dose for a few weeks, then a half dose for a few weeks, then a 1/4 dose for a few weeks. Kubota M, Nishi-Nagase M, Sakakihara Y, Noma S, Nakamoto M, Kawaguchi H, et al. Programs Briefs | Epilepsy Foundation, Discrimination in Federally Funded Programs Briefs, First Responders and Seizure Management Briefs, Resources and Seizure Action Plans for Summer Camp, Explaining Epilepsy to Friends and Family, Epilepsy Foundation Individual and Family Services, About Research and Funding at Epilepsy Foundation, The Epilepsy Learning Healthcare System (ELHS), Access the Rare Epilepsy Network Registry, #AimForZero: Striving Toward a Future Free from Sudden Unexpected Death in Epilepsy, Advocacy: Access Prescription Medications, Advocacy: Affordable Comprehensive Health Coverage, Teens Speak Up! CBC, serum biochemical analysis, and urinalysis were within the reference intervals. Fundam Appl Toxicol. Zonisamide was further increased to 7.5 mg/kg q12h due to a few events of cluster of seizures. Treatment in canine epilepsy - a systematic review. Its metabolism is too rapid in dogs, which reduces its effectiveness, and too slow in cats, which increases the risk of toxicity (salivation, vomiting, weight loss). Neurology. Chronic toxicity of the anticonvulsant zonisamide in beagle dogs. with valproic acid and derivatives, gabapentin, tizanidine, amitriptyline, atenolol, memantine, zonisamide, and pregabalin . Tapering phenobarbital is crucial, because it is addictive and can result in withdrawal seizures if stopped abruptly. by MK's mom Fri Jun 05, 2015 2:01 pm, Return to Treatment & Maintenance Issues for Epileptic Dogs. 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. 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). Oligohydrosis and fever in pediatric patients treated with zonisamide. Ackermann AL, Frank LA, McEntee MF, May ER. In dogs not on drugs that induce hepatic microsomal enzymes, the dosage is 5 mg/kg, PO, bid. Nonetheless, the proportional association between ZNS dose and the severity of the clinical signs was shown with multiple dose adjustments in this case. Zonisamide (brand name: Zonegran) is an anticonvulsant (antiseizure) medication that is either used as an initial therapy for epilepsy or as an add-on drug for difficult to control seizures. (2012) 126:1928. Pediatr Neurol. The frequency of his GTCS decreased after increment of ZNS up to 13.7 mg/kg q12h while the abnormal behavior episodes increased in its frequency further to over 10 times a day, including abrupt growling at or attempts to bite the family members when they came into his sight while awake (Supplementary Video 1). Similarly, a case series study described abnormal behavior episodes in dogs receiving LEV (40). Zonisamide is available as capsules of 25, 50 and 100 mg . Clin Neuropharmacol. by SpencerBhumi Thu Aug 14, 2014 3:08 pm, Return to Treatment & Maintenance Issues for Epileptic Dogs. What Drugs, Substances, or Supplements Interact with Voltaren Zonisamide (ZNS) is an antiepileptic drug (AED) approved for adjunct treatment of partial seizures in adults. At that point the docs added Phenobarbital. Summary: Drug withdrawal syndrome is found among people who take Zonisamide, especially for people who are male, 50-59 old, have been taking the drug for 1 - 6 months. Phenytoin (diphenylhydantoin) is no longer recommended for maintenance use in dogs, cats, or foals because of undesirable pharmacokinetic properties. No other ASDs such as phenobarbital or potassium bromide, listed as first-line ASDs in dogs, were prescribed. If the level is not within the middle of the therapeutic range, the dose should be increased before adding or switching to a new drug. Serum level of ZNS was 47.8 g/ml. BMC Vet Res. If excessive sedation occurs, a lower dose should be used initially and gradually increased. BMC Vet Res. Think about timing before deciding to wean off an anti-seizure medication. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. Bermejo PE, Ruiz-Huete C, Anciones B. Zonisamide in managing impulse control disorders in Parkinson's disease. Because diazepam has a rapid onset of action that prevents the spread read more ). . I will talk to the vet this week about the plan. Use for phrases The authors thank the owners of three cases, referring veterinarians and colleagues at Veterinary Specialists & Emergency Center for supporting us for the article preparation. The medication should begin working within 1-2 days. (2016) 30:47790. Primidone is a barbiturate that has three metabolites: phenobarbital, primidone, and phenylethylmalonamide. Give the missed dose and then wait the recommended interval before giving the next dose (continue giving it regularly at that new time). Use OR to account for alternate terms Adequate control of seizures in epileptic dogs, therefore, may require higher dosages of clorazepate when coadministered with phenobarbital. Over the next 6 months, several dose adjustments of ASDs were made. Schwartz M, Muana KR, Olby NJ. Upon the initial visit, the physical and neurological examinations were overall unremarkable other than severe degenerative joint condition in his bilateral elbow, coxofemoral, and stifle joints. She always clusters. Looking for a convenient way to access your pets health records, refill prescriptions, view upcoming appointments and more? Although therapeutic and toxic range of ZNS in dogs has not been well-established yet, serum concentration at 47.8 g/ml in our case 2 could be considered in high end or above the therapeutic range (6, 7, 25, 28). This medication should be used with caution in nursing mothers, as it is unknown at this time if zonisamide is excreted in maternal milk. 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. Most people with epilepsy take one or more medicines. It may also require additional changes to the dose of your new medication. J Feline Med Surg. doi: 10.1016/j.seizure.2004.04.009, 24. This is the first report describing abnormal behavior episodes, similar to PAE in humans, associated with ZNS in dogs in the clinical setting. The owner reported that significant improvements were recognized within 24 h after the dose reduction and no seizure episodes were witnessed. Because it does not undergo hepatic metabolism, bromide is useful in dogs with liver disease.