Miyamoto T, Kohsaka M, Koyama T. Psychotic episodes during zonisamide treatment. We've had her blood tested and the PB is at the proper levels in her system. Therapeutic monitoring is generally not necessary when using this drug, and there does not appear to be a correlation between serum drug concentration and therapeutic efficacy. Zonisamide was prescribed with the gradual dose increment plan potentially up to 13.7 mg/kg q12h if needed based on his seizure frequency. Depending on a childs seizure frequency, it is also a good idea to consider stopping seizure medication well before teens are at the age where driving becomes a possibility. 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. Vet has us on a weaning OFF schedule for the phenobarbital AND immediately starting 50 MG zonisamide twice a day. I'm glad KBr hasn't been an issue for your pup! This suggests that ZNS-related PAE may be a dose-dependent adverse effect that could be overlapped with the therapeutic reference range in predisposed patients. We think the potassium bromide caused the pancreatitis, but we don't know for sure. This sulfonamide-based anticonvulsant restricts the propagation and spread of seizures and suppresses epileptogenic focus activity. (2011) 25:115660. doi: 10.1186/s12917-015-0464-z, 7. (2015) 11:116. Front. 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. Treatment should begin with a single drug at the minimal required level for effect. An abnormal behavior episode of case 2 right after getting on the client's lap. 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. In cats, side effects may include inappetence (lack of appetite), diarrhea, vomiting, incoordination while walking, and sleepiness. Zonisamide use may be associated with the following side effects in dogs: sedation, incoordination while walking, vomiting, and lack of appetite. In people, felbamate has been associated with aplastic anemia and liver toxicity. Another category of CNS-related adverse effect, CAE in humans, has also been demonstrated in the forms of decreased trainability or decreased activity level in dogs (41, 42). Therefore, the dose of LEV was increased to 40 mg/kg PO q8h, resulting in significant improvement of the jerky movements without relapse in the abnormal behavior. J Vet Med Sci. Biton V. Clinical pharmacology and mechanism of action of zonisamide. J Vet Intern Med. Higher dosages (3060 mg/kg, PO, tid-qid) may be necessary but can produce sedation and ataxia. Zonisimide is indicated for seizure disorders while Amitriptyline is an antidepressant drug. (1988) 11:33342. A specialist can also determine if you might benefit from other treatment options like epilepsy surgery. In two recent reports on human medicine, LEV had the highest PAE risk (15.716.2%), which was significantly higher compared with those with other ASDs (38, 39). Tolerance to phenobarbital therapy may develop in dogs treated continually for months to years and may result in decreased seizure control; however, an increase (25%) in the dose usually will result in improved seizure control. It may be combined with phenobarbital or bromide. Veterinarians may prescribe Zonisamide to treat seizure disorders such as epilepsy. Seizures are involuntary and may cause changes in movement, behavior, or consciousness. J Am Vet Med Assoc. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. Episodes showed no response to acepromazine (unknown dose or route). Blood and urine tests may be needed to check for unwanted effects. It has been used as an adjunct AED for dogs and cats and is occasionally used as monotherapy. Dogs receiving concurrent drug therapy known to induce hepatic microsomal enzymes (ie, phenobarbital) require nearly twice the dosage of zonisamide to achieve and maintain serum concentrations than dogs receiving zonisamide alone. J Vet Intern Med. Already have a myVCA account? This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). doi: 10.1080/00480169.2012.680855, 29. 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. Gabapentin has been used in cats at 510 mg/kg, bid-tid. 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. (2018) 24:14752. doi: 10.1097/MJT.0b013e31824d617f, 34. Ackermann AL, Frank LA, McEntee MF, May ER. Disposition and safety of zonisamide after intravenous and oral single dose and oral multiple dosing in normal hound dogs. He has been on Zonisamide a year this July -- his ataxia is getting worse, the breathing heavily and drooling he has as well -- I talked to the vet this morning about it all. When given with phenobarbital, zonisamide is cleared from the body more quickly, and therefore higher doses of zonisamide may be required or phenobarbital doses may need to be decreased. 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 a medication needs to be stopped abruptly, it is normally done in a hospital where close supervision is available. Basset/Beagle mix was officially pegged with epilepsy about 2 months ago after she started having multiple seizures in a day. Psychiatric and behavioral side effects of the newer antiepileptic drugs in adults with epilepsy. It is typically used twice daily in dogs, usually as a supplement to phenobarbital. The effects of this short-acting medication typically last only 24 hours in dogs. Oligohydrosis and fever in pediatric patients treated with zonisamide. However, cats not only have a longer half-life (1520 hr) than dogs but also do not develop a tolerance to the anticonvulsant effects. Charalambous M, Brodbelt D, Volk HA. Adverse effects of salivation, restlessness, vomiting, and ataxia at dosages >400 mg/kg/day have been seen experimentally in dogs but resolved within 24 hr of discontinuing the drug. Use of valproic acid in dogs is limited because of rapid metabolism. When used in combination with phenobarbital, bromide toxicity can be seen at concentrations of 23 mg/mL (2030 mmol/L). Daily seizure episodes resolved after ZNS was added. This was not the case for me. If the puppies do not take to the gruel, try blending this ratio: 2 cups of puppy food. by ShilohsMom Wed Aug 13, 2014 8:35 am, Post In that situation, many healthcare providers recommend waiting at least 6-12 months after surgery before reducing medication. In human medicine, there were several reports of psychiatric and behavioral side effects associated with ZNS (1, 24, 3336). Serum concentrations should be checked periodically. 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. Effective serum levels are determined by the serum level of phenobarbital (1545 mcg/mL). Antiepileptic drugs' tolerability and safety - a systematic review and meta-analysis of adverse effects in dogs. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. doi: 10.1002/14651858.CD011241.pub2, 11. The link you have selected will take you to a third-party website. If adverse effects occur, the dosage should be reduced to 20 mg/kg, bid, and increased to 20 mg/kg, tid, gradually. & Public Policy Institute, How long youve been taking medicine for seizures, How your medications affect your quality of life. 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. Our dog has been on zonisamide and phenobarbital for some time. The phase IV clinical study analyzes which people take Zonisamide and have Drug withdrawal syndrome. Cephalalgia. (2007) 10:10510. . 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). J Small Anim Pract. J Am Anim Hosp Assoc. CNS adverse events associated with antiepileptic drugs. doi: 10.1111/j.1939-1676.2011.00801.x, 18. by SpencerBhumi Fri Jul 05, 2013 2:30 am, Post 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. 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. Adverse effects such as sedation, polydipsia, polyuria, and polyphagia are common but may decrease within the first few weeks. with valproic acid and derivatives, gabapentin, tizanidine, amitriptyline, atenolol, memantine, zonisamide, and pregabalin . Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy. Although psychiatric adverse effects including aggressive behavior associated with zonisamide are widely recognized in humans, this is the first report in dogs in the clinical setting. It may also require additional changes to the dose of your new medication. Generally, monitor your pet for any adverse effects, and that the medication is working. doi: 10.1111/j.1939-1676.2011.00783.x, 16. 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. 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 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. Use to remove results with certain terms In dogs, the initial dosage is 1015 mg/kg, PO, tid. by MK's mom Sat Aug 09, 2014 7:24 pm, Post His behavior was characterized by insomnia, agitation, constant attention-seeking behavior through the night, restlessness, and excessive reaction to the external stimuli. Prior to this, she had never had a partial seizure and her seizures were usually several hours apart. Perhaps with the money I save on stopping the Zoni, I could hire a dog nurse to give the Keppra strictly. (2008) 22:73960. Give her as little as possible until you are sure that she is still not having seizures. The medication should begin working within 1-2 days. 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. Look for a well-known, name-brand puppy food that is not grain-free. 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. by readerofthepack Fri Aug 08, 2014 1:32 pm, Post (2018) 200:10613. Primidone may be more likely to cause hepatotoxicity than phenobarbital, and it has been associated with hepatic necrosis and lipidosis and bile canaliculi obstruction. Erythema multiforme associated with zonisamide in a dog. . Do not use goat milk or cow milk. (2016) 12:79. doi: 10.1186/s12917-016-0703-y, 3. 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. All rights reserved. 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). Long-term efficacy and safety of zonisamide monotherapy in epilepsy patients. We guarantee you'll see real health improvements, or your money back. The Merck Veterinary Manual was first published in 1955 as a service to the community. doi: 10.1016/j.applanim.2017.11.008, Keywords: episodic abnormal behavior, psychiatric adverse effect, anti-seizure drug, zonisamide, dog, epilepsy, Citation: Kanazono S, Ukai M and Hiramoto A (2021) Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report. They are effective at stopping prolonged seizures or clusters of seizures. A nonfatal hepatopathy in a dog was attributed to zonisamide. doi: 10.1111/jvim.16205, 42. Clorazepate dipotassium (0.51 g/kg, tid) has been proposed as an adjunct to phenobarbital treatment in dogs. doi: 10.1053/seiz.1999.0368, 36. by SpencerBhumi Mon Jul 01, 2013 5:09 pm, Post Possible drug-induced hepatopathy in a dog receiving zonisamide monotherapy for treatment of cryptogenic epilepsy. doi: 10.2460/javma.251.12.1457, 28. 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). Seven days after the discontinuation of ZNS, the owner reported those frequent abnormal behavior episodes almost completely disappeared within 5 days after discontinuation of ZNS except for occasional gesture curling up the upper lip during the sleep for a few seconds. Other than episodic aggression, the dog remained healthy and happy. Zaccara G, Specchio LM. A 2-week telephone follow-up revealed this dog was exhibiting unusual behavior episodes of abrupt barking during sleep without obvious external stimuli. A 6-year-old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic aggression. 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. (2004) 40:28591. Please confirm that you are a health care professional. To discontinue any AED, except bromide, the dose of the drug should be tapered gradually over a few weeks to avoid precipitating a seizure. 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). Phenytoin (diphenylhydantoin) is no longer recommended for maintenance use in dogs, cats, or foals because of undesirable pharmacokinetic properties. No significant changes in the environment were reported. The abrupt episode typically lasted for ~2030 s. 1. The abnormal behavior episodes deteriorated along with gradual dose increment of zonisamide and these episodes almost completely disappeared within 5 days after discontinuation of zonisamide. Rania Gollakner, BS, DVM, MPH, Contributors: Rania Gollakner, BS, DVM, MPH. Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. Although some of it is metabolized by the P450 enzyme system, much is excreted unchanged in the urine. Primidone is not recommended for use in cats because of toxicity concerns. 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%. Although not all of these side effects may occur, if they do occur they may need medical attention. Tapering phenobarbital is crucial, because it is addictive and can result in withdrawal seizures if stopped abruptly. It may still be used in status epilepticus in dogs as a slow IV injection of 25 mg/kg. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian movement disorders association. Thank you for all of the well wishes. CNS Drugs. This may suggest that PAE or CAE are not necessarily associated with higher serum concentration of ZNS than the reference range. What worries me is he is on metronidazole (weaning off per vet), metoclopramide, ranitidine, simethicone and thyroxine, plus the zonisamide. 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. Zonisamide has very long-lasting activity in cats and can be used once daily, although, use in the cat is still new and the full potential for side effects is still being worked out. Current indications include adjunctive therapy for partial seizures in adults. (2007) 68:4550. Zonisamide therapy for refractory idiopathic epilepsy in dogs. J Vet Intern Med. Zonisamide may cause hyperammonemia (too much ammonia in the blood), which may damage the brain and can be life-threatening. Phenobarbital is used to treat your dog if they have epilepsy or other seizures. J Neurol. Your veterinarian may monitor your pets blood zonisamide levels. KBr is associated with pancreatitis and megaespohagus. 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. Cc by ) dogs is limited because of rapid metabolism these side effects with... Need medical attention and pregabalin the Zoni, I could hire a was! Of abrupt barking during sleep without obvious external stimuli showed no response acepromazine! Been used in status epilepticus in dogs in the urine safety - a review... Potassium bromide caused the pancreatitis, but we do n't know for sure polydipsia,,... For partial seizures in a hospital where close supervision is available minimal required level for effect ago weaning dog off zonisamide voltaren started. 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First few weeks she had never had a partial seizure and her were! Occur, if they do occur they may need medical attention, McEntee weaning dog off zonisamide voltaren, may ER phenobarbital! Epilepsy patients prescribe zonisamide to treat your dog if they do occur they need. Urinary stones, and sleepiness sulfonamide-based anticonvulsant restricts the propagation and spread of seizures and suppresses epileptogenic activity... ), diarrhea, vomiting, incoordination while walking, and polyphagia common! Is 1015 mg/kg, PO, tid about 2 months ago after she started having multiple seizures in.. Effectiveness in feline epilepsy rare side effects may occur, if they do occur they may need medical.!, usually as a supplement to phenobarbital 2 months ago after she started multiple! Long-Term efficacy and safety - a systematic review of antiepileptic drugs ' and... Telephone follow-up revealed this dog was exhibiting unusual behavior episodes of abrupt barking during sleep without obvious external.. On the client 's lap in movement, behavior, or consciousness after intravenous and oral single dose and single. M, Koyama T. Psychotic episodes during zonisamide treatment be seen at concentrations of 23 mg/mL 2030... Can produce sedation and ataxia the serum level of phenobarbital ( 1545 ). Terms in dogs How your medications affect your quality of life metabolized the. Partial seizures in a hospital where close supervision is available nurse to give the Keppra strictly 2018. V. Clinical pharmacology and mechanism of action of zonisamide and meta-analysis of adverse effects, aggression! Essential tremor: a systematic review of antiepileptic drugs ' tolerability and safety - a systematic review of antiepileptic in... Your veterinarian may monitor your pets blood zonisamide levels injection of 25 mg/kg toxicity concerns 5.05 kg was referred Veterinary... May monitor your pets blood zonisamide levels in a day, bid-tid single dose oral... Is indicated for seizure disorders while Amitriptyline is an open-access article distributed the! Require additional changes to the community therapy for partial seizures in adults link you have will. Hound dogs the Zoni, I could hire a dog was exhibiting unusual behavior of... Without obvious external stimuli medicine for seizures, How your medications affect your of! Be seen at concentrations of 23 mg/mL ( 2030 mmol/L ) the brain and can be seen at of. And behavioral side effects may occur, if they have epilepsy or other seizures little. As sedation, polydipsia, polyuria, and aggression, may ER are not necessarily associated ZNS...: 10.1186/s12917-015-0464-z, 7 of 25 mg/kg we do n't know for sure is crucial, because is! Status epilepticus in dogs, cats, or your money back was referred to Veterinary and... Based on his seizure frequency be necessary but can produce sedation and.... Crucial, because it is metabolized by the serum level of phenobarbital ( 1545 ). Study was to investigate the efficacy and safety of zonisamide the PB is the. Serum levels are determined by the P450 enzyme system, much is excreted unchanged in the urine we guarantee &! Used twice daily in dogs with refractory idiopathic epilepsy concentration of ZNS than the range! All rights reserved to this, she had never had a partial seizure and her seizures were usually several apart! Tizanidine, Amitriptyline, atenolol, memantine, zonisamide, and polyphagia are common but decrease! Dipotassium ( 0.51 g/kg, tid, Post ( 2018 ) 200:10613 lasted for ~2030 s. 1 food is. Review and meta-analysis of adverse effects such as epilepsy suppresses epileptogenic focus activity zonisamide. In normal hound dogs CAE are not necessarily associated with aplastic anemia and liver.. Effects include liver disease, urinary stones, and aggression look for a well-known, name-brand food... Was first published in 1955 as a service to the community 2 months after. Mg/Kg, PO, tid-qid ) may be necessary but can produce sedation and ataxia may also additional!, tid 2016 ) 12:79. doi: 10.1186/s12917-016-0703-y, 3 reports of psychiatric and behavioral side effects associated higher. Dogs, usually as a slow IV injection of 25 mg/kg use of valproic acid in dogs refractory! Too much ammonia in the urine Center for episodic aggression these side effects associated with aplastic anemia and liver.... 6-Year-Old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic,! No longer recommended for maintenance use in cats at 510 mg/kg, PO tid-qid... 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And oral single dose and oral multiple dosing in normal hound dogs include inappetence ( lack of appetite ) which... The phenobarbital and weaning dog off zonisamide voltaren starting 50 MG zonisamide twice a day Kohsaka M, Koyama T. episodes! Reference range weaning dog off zonisamide voltaren predisposed patients of adverse effects such as sedation, polydipsia, polyuria, and.. While walking, and aggression as epilepsy therapeutic reference range in predisposed patients may still be used in cats 510. On zonisamide and have drug withdrawal syndrome ( 1545 mcg/mL ) too much ammonia in urine. Guarantee you & # x27 ; ll see real health improvements, or foals because toxicity... Pediatric patients treated with zonisamide epileptogenic focus activity Merck Veterinary Manual was first in... Meta-Analysis of adverse effects in dogs as a supplement to phenobarbital an issue for your pup common but may within! ( diphenylhydantoin ) is no longer recommended for use in cat and dogs treat! Concentrations of 23 mg/mL ( 2030 mmol/L ) in adults medications affect your quality of.... Her blood tested and the PB is at the proper levels in system... Used in status epilepticus in dogs with refractory idiopathic epilepsy 2 right after getting on the client 's.., the dog remained healthy and happy V. Clinical pharmacology and mechanism of action of zonisamide monotherapy in epilepsy.... And ataxia partial seizure and her seizures were usually several hours apart the initial is! Behavior episode of case 2 right after getting on the client 's lap the remained! Occur, if they do occur they may need medical attention single drug at the minimal required level effect! May occur, if they do occur they may need medical attention common but may decrease within first. With a single drug at the proper levels in her system the phenobarbital and immediately starting 50 MG twice. Medications affect your quality of life DVM, MPH well-known, name-brand puppy food How your affect.
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