This time may increase if your pet has decreased liver or kidney function. Introduction. Zonisamide discontinuation due to psychiatric and cognitive adverse events: a case-control study. Addition of LEV (27 mg/kg PO q8h) and glycerin (5 ml/head PO q8h) did not alter the abnormal behavior and decreased appetite. 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 one report, it was listed as an adjunct AED for dogs, but its effectiveness is not yet known. Certain medications called benzodiazepines have anti-seizure effects. Reported type 1 adverse effects include sedation, vomiting, loss of appetite, and ataxia (2, 7, 25, 28). Antiepileptic drugs' tolerability and safety - a systematic review and meta-analysis of adverse effects in dogs. 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. Severe signs of toxicity are easily treated by IV administration of 0.9% sodium chloride, which promotes renal excretion of the bromide ion. Valproic acid (1060 mg/kg, tid) has been used as an adjunct to phenobarbital and primidone in dogs with refractory seizures. In dogs not on drugs that induce hepatic microsomal enzymes, the dosage is 5 mg/kg, PO, bid. Her prognosis is guarded. (2008) 22:73960. Packer RMA, McGreevy PD, Pergande A, Volk HA. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. BMC Vet Res. Akman CI, Goodkin HP, Rogers DP, Riviello JJ. What Drugs, Substances, or Supplements Interact with Voltaren The owner reported 7 days later that no GTCS was witnessed while the episodic abnormal behavior remained at the same intensity and frequency. If they are not available, follow their directions in contacting an emergency facility. 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. 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. The principle advantage of felbamate is a lack of sedation, and adverse effects are reportedly rare. 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. An abnormal behavior episode of case 1 showing aggressive growling at the family members while resting in the bed. Limited data suggest zonisamide may be beneficial . by readerofthepack Thu Aug 14, 2014 2:40 pm, Post Acta Neurol Scand. 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. 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. by ShilohsMom Mon Aug 11, 2014 9:25 am, Post Zonisamide should not be used in pets that are hypersensitive or allergic to it. (2006) 68:S39. The severity of the episodic aggression was scaled as 100% at the initial appointment and the sequential change in the severity was evaluated by the client and provided at each follow-up appointment in the gross scale of 0100%. While the dog remained herself over the next 3 days during hospitalization after reintroduction of ZNS, the exact same episodes relapsed on the night after discharge. Zonisamide - induced urinary lithiasis in patients with intractable epilepsy. This usually takes one to four days. I don't think I've ever felt more helpless. Last weekend, she had a partial seizure followed by a grand mal seizure, followed by another partial within about a 3-hour time frame. Child Care/Camps/Rec. Neurology. Although the drug appears safe, owners should be warned that because of the sulfonamide base, potential adverse effects (eg, keratoconjunctivitis sicca, bone marrow dyscrasia, hepatopathy, vasculitis, and metabolic acidosis) could occur. Oh wow I just read this post after writing about my Apollo's horrible ataxia. 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). If a medication needs to be stopped abruptly, it is normally done in a hospital where close supervision is available. The effects of this short-acting medication typically last only 24 hours in dogs. Am J Ther. Bromide can be formulated into a solution of various concentrations (100 mg/mL, 200 mg/mL, 250 mg/mL are convenient ones) or into tablets or capsules. Tapering and withdrawing off benzodiazepines can be difficult, particularly after prolonged daily use. In countries where bromide is not available as a pharmaceutical formulation (USA), an analytical grade may be obtained from a chemical supply company, although caution is recommended in handling and packaging. Check with your doctor immediately if any of the following side effects occur: No similar episodic aggression was witnessed in association with dose adjustments or addition of other ASDs including PB, potassium bromide, and LEV. Felbamate is a dicarbamate AED that exerts its anticonvulsant effects through multiple mechanisms, including potentiating GABA-mediated neuronal inhibition, inhibiting voltage-sensitive neuronal calcium and sodium channels, and blocking N-methyl-d-aspartatemediated neuronal excitation. Taper off 2 weeks prior to surgery if possible OK to continue Discontinue at least 10 days prior to surgery if possible Drug interactions (e.g., ephedrine, meperidine, methadone, tramadol), which could cause a hypertensive crisis. (If cost is an issue, however, a sample is best checked in 4 mo when steady-state concentrations have been reached.) In all species, it takes ~2 wk to approach a steady-state plasma concentration, because oral absorption is extremely variable and the half-life is long. doi: 10.2147/NDT.S4063, 5. 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. Zonisamide - Zonisamide is a broad-spectrum antiseizure medication that blocks voltage-dependent sodium and T-type calcium channels. Benefits to weaning off medication include the elimination of side effects, cost, and the annoyance of having to take medication one or more times a day. Voltaren should be taken with food to reduce stomach upset. Most dogs will continue for the rest of their lives to have seizures, it now becomes about control. A 50:50 mixture of milk replacer and water is recommended. Phenobarbital causes physical dependence, and thus abrupt withdrawal may cause "barbiturate withdrawal" seizures. (2016) 30:47790. Clin Neuropharmacol. White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK. This dog had no pre-existing abnormal behavior problems before and no seizure episodes were witnessed in association with these behavior episodes. Due to serious detrimental impact on the family, ZNS was discontinued abruptly as a therapeutic trial with our concern of possible association between the episodic aggression and ZNS. 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. Serum level of ZNS was 47.8 g/ml. If you decide to switch to a different medication, youll need to take both for a while to see how helpful the new medication is and how well you tolerate it. Thank you for all of the well wishes. I do hope your progress continues in such a positive manner from here on. This pyrrolidine-based anticonvulsant has an unknown mechanism of action. This will begin to lessen the puppies' dependence on their mother's milk and presence. Rania Gollakner, BS, DVM, MPH, Contributors: Rania Gollakner, BS, DVM, MPH. I noticed this post and was hoping those who have their pups on Zonisamide might respond back and update us as to how they are all doing on this drug. Dermatol. doi: 10.1111/jvim.13841, 8. Brodie MJ, Ben-Menachem E, Chouette I, Giorgi L. Zonisamide: its pharmacology, efficacy and safety in clinical trials. (2014) 21:889. Multiple dose adjustments resulted in significant changes in the severity of the abnormal behavior episodes in this case. Our cases showed clinical apparent direct association with ZNS and correlation with dose adjustment in case 1 and case 2. Zonisimide is indicated for seizure disorders while Amitriptyline is an antidepressant drug. Bromide, phenobarbital and zonisamide are examples, although phenobarbital and zonisamide half-life may get short enough that timing is important. Other than episodic aggression, the dog remained healthy and happy. (2010) 75:5138. Ashkenazi A, Benlifer A, Korenblit J, Silberstein SD. doi: 10.1016/j.eplepsyres.2005.11.004, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Diarrhea sometimes develops with clonazepam, but this may be avoided by starting with once daily dosing and increasing the frequency to three times daily over a period of several days. Adverse effects consist of sedation only, but periodic hematologic monitoring is advised, because blood dyscrasia and hepatotoxicity are reported in people. The abrupt episode typically lasted for ~2030 s. 1. Faught E. Review of United States and European clinical trials of zonisamide in the treatment of refractory partial-onset seizures. doi: 10.1016/S0387-7604(00)00118-2, 23. An abnormal behavior episode of case 2 right after getting on the client's lap. Because the elimination half-life is short in dogs (24 hr), it is probably not an effective anticonvulsant, but a dosage of 510 mg/kg, bid, has been suggested. It appears very safe with no to few adverse effects (ataxia, sedation, vomiting) reported at the routine dosage ranges. This calendar, in conjunction with serum AED levels, can be used as a guide for dosage and drug treatment changes. A 6-year-old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic aggression. Written informed consent was obtained from the owners for the participation of their animals in this study. Per rectal diazepam: Some epileptic dogs have a tendency to experience "cluster seizures" (two or more seizures in a 24-hour period) even when being treated with Phenobarbital and potassium bromide. doi: 10.1292/jvms.11-0164, 17. University of Veterinary Medicine Hannover, Germany, University of Veterinary Medicine Vienna, Austria, Cave Veterinary Specialists, United Kingdom. Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online. o [alopecia OR hair loss ], , DVM, DACVIM-Neurology, Ross University School of Veterinary Medicine. Kubota M, Nishi-Nagase M, Sakakihara Y, Noma S, Nakamoto M, Kawaguchi H, et al. No other ASDs such as phenobarbital or potassium bromide, listed as first-line ASDs in dogs, were prescribed. 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). Find in-depth information on anti-seizure medications so you know what to ask your doctor. Dose adjustments of other anti-seizure medications in case 2 did not result in significant changes in these behavior episodes. Zonisamide for migraine prophylaxis in refractory patients. This effect from phenobarbital can last up to 10 weeks after phenobarbital use has been discontinued. The likelihood of future seizures in children with epilepsy is based on specific factors like the underlying cause, epilepsy syndrome, and seizure type. doi: 10.2165/00023210-200822090-00003, 37. Bromide is generally well tolerated by dogs, but potential adverse effects include bitter taste, gastric irritation, nausea (particularly with the potassium form), polyuria, polydipsia, polyphagia, sedation, ataxia, and pancreatitis. Download our seizure tracking app, print out seizure action plans, or explore other educational materials. Zonisamide (Oral Route) Side Effects Drug information provided by: Merative, Micromedex Along with its needed effects, a medicine may cause some unwanted effects. The trusted provider of veterinary information since 1955, Overview of Systemic Pharmacotherapeutics of the Nervous System, Antiepileptic Drugs Used to Stop Ongoing Seizure Activity, Maintenance Anticonvulsant or Antiepileptic Therapy, Last review/revision Mar 2015 | Modified Nov 2022. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. . The recommended initial dosage is 15 mg/kg, PO, tid, but the dose can be increased every 1421 days in increments of 15 mg/kg if therapeutic benefit has not been noted. 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. 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 . Boothe DM, Perkins J. Therefore, it is important to discuss with your healthcare provider the expected success or failure of weaning off and eliminating anti-seizure medication. Received: 24 August 2021; Accepted: 27 September 2021; Published: 29 October 2021. Cook AK, Allen AK, Espinosa D, Barr J. Renal tubular acidosis associated with zonisamide therapy 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. Answer: Yes, it is a good idea, just wean your dog off slowly. Feeding. (2007) 68:4550. Charalambous M, Shivapour SK, Brodbelt DC, Volk HA. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian movement disorders association. A total of 10 dogs were enrolled in the study, and all dogs received levetiracetam at a dose of 20 mg/kg/day. doi: 10.1080/00480169.2012.680855, 29. A review article reported the most common adverse effects pertained to the CNS were ataxia, dizziness, somnolence, agitation, and anorexia (36). When used in combination with phenobarbital, bromide toxicity can be seen at concentrations of 23 mg/mL (2030 mmol/L). 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. Park S-P, Kim S-Y, Hwang Y-H, Lee H-W, Suh C-K, Kwon S-H. Epilepsy Behav. She was initially put on Zonisamide but after 2 weeks, she had a couple more seizures. Cardiovascular defects were prominent in both rats and dogs. Episodic aggression deteriorated with minor dose increment of ZNS and improved with minor dose reduction. Zonisamide-induced psychosis in a patient with bipolar disorder and narcolepsy. Using this medicine while you are pregnant can harm your unborn baby. Do not use goat milk or cow milk. Veterinarians may prescribe Zonisamide to treat seizure disorders such as epilepsy. She's on a low-fat diet for a few weeks to help her pancreas return to normal. Recently, ZNS-related anticonvulsant hypersensitivity syndrome was reported in cats (27). Right now we are not sure which has made the severe change in her behavior. 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). Among various ASDs, ZNS has been frequently used in veterinary practice with several adverse effects being reported (2, 7, 1317, 2532). Fundam Appl Toxicol. doi: 10.1016/j.jfms.2008.01.006, 30. Set up your myVCA account today. I'm glad to hear that your baby is doing better. Our case 2 did not have MRI or cerebrospinal fluid analysis to rule out other intracranial structural conditions, which was clinically considered relatively unlikely given stable condition through a long follow-up duration of this case. Knudsen JF, Thambi LR, Kapcala LP, Racoosin JA. Zonisamide is used off-label for therapy of migraine headaches, mood disturbances and recently for weight loss. Vet has us on a weaning OFF schedule for the phenobarbital AND immediately starting 50 MG zonisamide twice a day. What If I Have a Seizure While I Exercise? J Neurol. By The adverse effects are usually mild, such as transient ataxia, loss of appetite, lethargy, and vomiting. Severe bromide toxicosis (bromism) is characterized by lethargy, disorientation, delirium, and ataxia progressing to quadriplegia and coma. The loading dose regimen can be discontinued if the dog becomes too sedated, or smaller divided daily doses can be tried. J Small Anim Pract. Platt JE, Opler LA, Platt EM. (2006) 26:1199202. If excessive sedation occurs, a lower dose should be used initially and gradually increased. Our low carb, nutrient-dense recipes are the easiest way to feed your dog fresh homemade food on the budget you choose. The phase IV clinical study analyzes which people take Zonisamide and have Drug withdrawal syndrome. 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. 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. Approximately 25%50% of cats administered bromide developed signs of bronchial disease characterized by a cough and marked pulmonary infiltrates seen on radiographs. The recommended therapeutic range is 1040 mg/mL; trough concentrations can be measured ~710 days after initiating treatment or altering the dosage. Visual hallucinations associated with zonisamide. Never attempt to wean off a medication without the support and supervision of your healthcare provider. The owner reported that significant improvements were recognized within 24 h after the dose reduction and no seizure episodes were witnessed. She's been on it so briefly, but who knows, the KBR may have caused it. Adequate control of seizures in epileptic dogs, therefore, may require higher dosages of clorazepate when coadministered with phenobarbital. The aggressive behavior resolved almost completely within 5 days after the abrupt cessation of ZNS in our cases. Pharmacotherapy. 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! Post Other, less common adverse effects are idiosyncratic hyperexcitability, dermatitis, anemia, neutropenia, thrombocytopenia, gingival hyperplasia, and osteomalacia. Phenobarbital 2.5 mg/kg orally q12h was prescribed without loading. MRI, cerebrospinal fluid analysis, and fasted and postprandial total bile acid analyses were within normal limits. In dogs, phenobarbital and bromide are considered first-line maintenance AEDs, but levetiracetam and zonisamide are often used as well. Pancratitis can be dealt with, I hope your vet comes thru for you and your pup. Use OR to account for alternate terms Use to remove results with certain terms by SpencerBhumi Fri Aug 08, 2014 2:50 pm, Post There are important risks to think about when stopping seizure medications. The Food and Drug Administration (FDA) approved it for use in the United States in March 2000, suggesting that it be used along with other seizure medicines (as adjunctive or . Vet. Zonisamide (ZNS) is an antiepileptic drug (AED) approved for adjunct treatment of partial seizures in adults. 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. doi: 10.1016/j.seizure.2004.04.009, 24. Weaning a Litter of Puppies. This medication should be used with caution in nursing mothers, as it is unknown at this time if zonisamide is excreted in maternal milk. J Am Vet Med Assoc. (http://www.medicinenet.com/zonisamide-oral/article.htm). Pharmacokinetic studies have suggested that a loading dose of potassium bromide of 120 mg/kg/day over 5 days and maintenance dosages of ~90100 mg/kg/day will likely result in effective serum bromide concentrations. 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. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Clonazepam, unlike diazepam, can be used in dogs for oral maintenance therapy, because anticonvulsant tolerance develops less rapidly, the saturability of its metabolism reduces the elimination rate at therapeutic concentrations, and because it is more highly absorbed orally (particularly in micronized formulations). 27 ) a dose of 20 mg/kg/day the severe change in her behavior Center episodic..., BS, DVM, MPH concentrations have been reached. patient with bipolar disorder and narcolepsy CI Goodkin! 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Lp, Racoosin JA after the dose reduction and no seizure episodes were witnessed in association with ZNS and with... Horrible ataxia treatment changes safety of levetiracetam in dogs, were prescribed just read this after! Behavior episodes may prescribe zonisamide to treat seizure disorders while Amitriptyline is an issue, however, a sample best.: its pharmacology, efficacy and safety in clinical trials, Allen AK, Espinosa D, J.! 5.05 kg was referred to Veterinary Specialists, United Kingdom what to ask your doctor had couple. Are not available, follow their directions in contacting an emergency facility used. Was initially put on zonisamide but after 2 weeks, she had couple... Is a lack of sedation, and all dogs received levetiracetam at a dose of 20.! And ataxia progressing to quadriplegia and coma October 2021, Kawaguchi H, et al is not known. Gradually increased but its effectiveness is not yet known that timing is important to discuss with healthcare... Investigate the efficacy and safety in clinical trials common adverse effects are usually mild, as! Which promotes renal excretion of the bromide ion and your pup disorder and narcolepsy, I hope your continues. United States and European clinical trials of zonisamide in the study, and progressing... Their directions in contacting an emergency facility your dog fresh homemade food on the budget you choose doing. Excessive sedation occurs, a sample is best checked in 4 mo when concentrations... In her behavior withdrawing off benzodiazepines can be measured ~710 days after the abrupt episode typically for! First-Line ASDs in dogs, were prescribed recently for weight loss are easily by. Packer RMA, McGreevy PD, Pergande a, Benlifer a, J. Analysis, and osteomalacia conjunction with serum AED levels, can be difficult, particularly after prolonged use. Reportedly rare if I have a seizure while I Exercise Shivapour SK, Brodbelt DC, Volk.... Kubota M, Nishi-Nagase M, Nishi-Nagase M, Shivapour SK, Brodbelt DC, Volk HA, Benlifer,. Was listed as first-line ASDs in dogs, therefore, it is a lack sedation. Dogs were enrolled in the bed the drugs clonazepam, clobazam,,... Safe with no to few adverse effects are idiosyncratic hyperexcitability, dermatitis, anemia, neutropenia, thrombocytopenia, hyperplasia! Liver or kidney function concentrations of 23 mg/mL ( 2030 mmol/L ) hospital where close supervision is available q12h. Of this short-acting medication typically last only 24 hours in dogs total of 10 were. Riviello JJ 1060 mg/kg, PO, bid an unknown mechanism of action their lives to have,... Be dealt with, I hope your vet comes thru for you and your pup weighing 5.05 kg was to... Is a lack of sedation, and fasted and postprandial total bile acid analyses were within limits. Loading dose regimen can be discontinued if the dog remained healthy and happy a seizure I... Medications so you know what to ask your doctor ~2030 s. 1 for. Are pregnant can harm your unborn baby, Contributors: rania Gollakner, BS DVM. Be seen at concentrations of 23 mg/mL ( 2030 mmol/L ) readerofthepack Thu Aug 14, 2014 2:40 pm post! No other ASDs such as phenobarbital or potassium bromide, phenobarbital and zonisamide are examples although... Pm, post Acta Neurol Scand, Birnbaum AK dogs, therefore, require! And immediately starting 50 MG zonisamide twice a day bile acid analyses were within normal.. Kim S-Y, Hwang Y-H, Lee H-W, Suh C-K, Kwon S-H. epilepsy.... After the dose reduction sodium chloride, which promotes renal excretion of Creative! 5.05 kg was referred to Veterinary Specialists, United Kingdom hypersensitivity syndrome was reported in cats ( ). First-Line ASDs in dogs with refractory seizures ) is an open-access article distributed under the of... Y-H, Lee H-W, Suh C-K, Kwon S-H. epilepsy Behav,. 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