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Switching epilepsy medications - advice, opinions, experiences welcomed!

8K views 36 replies 10 participants last post by  GatorBytes 
#1 · (Edited)
Hi everyone,

Riley was diagnosed with idiopathic epilepsy just over a year ago. Given his seizure history, he will likely need to be medicated for the duration of his life. As such, I have decided to switch him from Phenobarbital to Zonisamide.

I do so with a bit of trepidation. But, as Zonisamide is believed (at this point) to be safer for dogs long-term, I am going to go forward with making the switch.

When I say, “believed to be,” I mean, that there really is not much known about the long-term effects on canines. To my knowledge, there have not been any peer-reviewed longitudinal studies of epileptic dogs being treated with Zonisamede. If anyone knows of a study of this type, please let me know.

The transition protocol will be as follows:
  • Initial dose Zonisamede – 350milligrams 2x a day
  • First week, continue Pheno as currently dosed – 97.2 mg 2x a day.
  • After the first week, begin tapering Pheno dose by 25% each month.
  • After the first month of Pheno reduction, reduce the dose of Zonisamide to 300mg 2x a day.
Anyone have any thoughts, comments or experiences with a similar transition protocol?

Riley is 80lbs and 4.5 years old.
 
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#2 ·
When my girl was diagnosed she was put directly on Zonisamide. So no personal experience with a switch over. But that protocol is basically what we do for patients at my vet clinic that are switching.

Good luck. My girl is doing amazing on Zonisamide. She has been (I think) seizure free for well over a year. I say, I think, cause someone wet the bed about a month ago. It may have been her having a seizure when I was asleep, or my other dog who had a UTI. I don't know. But either way. Pretty good control.


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#3 ·
@gsdsar - thank you for your input. Good to know that the transition protocol is similar to what you have seen at your clinic. I have to admit that I found it a bit odd to start with a higher dose of Zonisamide and then reduce that dosage alongside reduction in the Pheno.
 
#5 ·
Phenobarbital is very very toxic to the liver. It requires a lot of monitoring. Zonisamide is supposed to be less toxic, less monitoring, and has fewer side effects. Generally, after 4-6 weeks in Zonisamide alone, you test the levels, then that's it. As long as you are in the therapeutic range there is no more monitoring necessary.

My girl is supposed to be on 200mg twice a day. Which is very low dosing. But seeing as how she is doing so well, I give 100mg in the AM and 200mg in PM. It's working. But she is only 53 lbs.

I don't truly understand why you taper down the Zonisamide during the switch, but that how the neurologist has us do it. It's weird.


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#7 ·
Okay, I picked up the new medication from the pharmacy but I am getting cold feet about starting them.

I was surprised that the highest per pill dose is 100mg... so to achieve his 350mg dose I will have to give four pills (3 100mg, 1 50mg) 2x a day on top of the Pheno he will need to take 2x a day until he is weaned off of that drug.

I think my trepidation about administering that many meds per day is mostly psychological... but, on top of that, I do think I will have to switch up my medication administration technique -which has been to insert the pill in a piece of hot dog. With one pill 2x a day, that made sense... but, with 5 pills 2x a day, I think that might be too much hot dog for the dog.

Need re-assurance that making the switch is the best path forward! My vet is for the switch, the neurologist believes that we would be fine sticking with Pheno... ughh!
 
#8 ·
Yeah it's a lot of pills. Luckily my dog just gobbles them up in her food.

We have lots of dogs at my practice with epilepsy. They are on a mix of meds. You need to do what you feel comfortable with. If the Pheno was not giving the control you want, then a change may be in order. If it was, and you are comfortable with monitoring, then stuck with it.

In the end you need to be happy with the protocol and the results. Have you looked into Keppra? It's a bit costlier, but it would be less pills and us still low maintenance.

I am lucky that my girl is controlled at a dose that is under the recommended amount. She is on less than 5mg/kg a day, and doing great. Maybe you would be able to wean down once your pup is controlled.


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#14 ·
Kiya has been on pb since she was 18months old she will be 10 in May. I recently had the zoni discussion with my vet whom consulted with a neurologist for the dosage. I would have had to give her about 10 pills on top of the pb till we switched. Since the zoni is processed thru the liver I decided not to change. Her last liver values were in the 600's range and after 8 years that's not horrible. Milkthistle and her part home cooked diet is helping keep her liver values at bay.
Kiya was only having a few seizures a year sometimes up to 7 but 2013 she had 11 that I am aware of. She was on 60mg bid (twice a day) and 1200mg of kbr. We increased the pm dosage to 90mg last month. Ataxia is a problem but it has been since the beginning.
Sometimes if it ain't broke don't fix it.
 
#15 ·
If I have one regret about our medications struggle with Jasmine is that I did NOT push for her neurologist to try Zonisamide and instead kept following his advice to keep messing around with Pheno and Keppra, constantly changing dosages hoping to get good seizure control. Things would look good for a few weeks, and then it would seem like all of a sudden the meds would stop working and she'd have multiple clusters over several days, and we'd adjust dosage and try again. We never were able to get good long term seizure control with her and she died at 2.5 years old from a heart attack. I know all dogs are different and so the meds that work for one won't work for all, but having heard a lot of success stories with Zonisamide.. more than I've heard with any other drug or combo of drugs.. I really wish we'd tried it.
 
#16 ·
if you are interested in a homeopathic route I was given Vet Select Seizure formula by my friend who used it on her severely epileptic dog . The dog passed away from age - being over 12 years which was exceptional for a golden retriever . With this formula the dog was normal. She gave it to me to pass on to a needy dog . Unfortunately the product, unopened , has "just" expired -- I don't know if this has a great impact on efficacy . Anyone is welcome to it . If much longer the contents will be put to compost pile . This is the company Dog Seizures Testimonials From AllergicPet.com
 
#17 ·
Thank you to all of you who have shared your experiences and perspectives. I find it very helpful.

It seems like we have all spent a lot of time weighing the pros and cons of different treatment options!

@Carmspack – thank you for your kind offer and the link! For now, I am going to move forward with the Zonisamide switch, but I will do some more research on the product you mentioned as I do like to be informed about all possible options!
 
#18 ·
hate to repeat myself, but i am a firm believer in, "if it is not broke, don't fix it." i understand the weaning off one while building up the level of the new meds, i would just not chance another episode or finding the new med not as effective and have to establish a correct dose of the new med. why chance a seizure where actual physical damage can occur as well as some neuro damage. just my thoughts and i am not a vet.
 
#20 ·
@huntergreen – I hear you. I have wrestled with this decision. But, at the end of the day, the fact that my dog had 3 recent breakthrough seizures (Christmas Eve) means that there was going to be a change no matter what.

We have already had to adjust the Pheno dosage and the most recent bloodwork suggests that if we were to stick with Pheno we would have to up the dosage as his levels are lower than the last test.

Right now, I am thinking I want to switch the primary medication to one that is processed at a far lower level through the liver.
 
#19 ·
My 1yr old started having severe episodes of cluster seizures- 3-4 in a day was common and it would happen several times per week. No cause was ever found. Vet prescribed pheno, I did some homework, and got him off of it. Vet was not happy. :(

I removed all chemicals and known triggers from his lifestyle- well, as best I could in modern day life. That meant raw feeding, no flea/tick repellents, no more vaccines. I did feed oatmeal in his meals, as it's supposed to be neurologically beneficial (or was then...this was over a decade ago) and within a month his seizures reduced to 1-2 every week or so, instead of clusters several times per week. :)

If I remember right, after about 4 months, they were dramatically reduced, maybe 1-2 per month, and then eventually, and for the rest of his life, he would have less than one per year. What I mean is, approx. every 15-18 months or so, he would have one seizure. No more clusters. :D

Now, I do believe his to be a vaccine reaction due to time of onset, so I am not going to say that a GSD w/inherited epilepsy would necessarily fare as well as he did, but what's important to keep in mind is the threshold- figure out triggers and try to eliminate them, rather than just upping and upping dosages to keep them under control. I would strongly recommend a total removal of unnecessary chemicals from his lifestyle- processed food, insect repellents, lawn fertilizers, certain cleaning supplies, etc. I did all that at first, but gradually realized that the main things were processed food and applied chemicals, as well as vaccines.

Zero meds, less than one seizure per year...not bad for the next 12 years. :cool:
 
#23 ·
Hi everyone,

We are on 'Day Two' of the transition protocol. So far, I have observed that Riley seems more tired than usual, but no ataxia. I think that, once we start dropping down the Phenobarbital dosage and he becomes more acclimated to the Zonisamide, he will be back to his normal self.

Fingers crossed that the transition continues to go well.
 
#24 ·
Glad to hear it's going smoothly so far. I did ask one of my vets about the high dosage to start. And she said it had something to do with the way the two drugs interact in the body. She got more specific, but I am tired and can't remember. But she also had to do research because it is do counterintuitive.

Fingers crossed for you guys!!


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#25 ·
@gsdsar - thanks for asking the vet at your clinic about that!

Quick update - There was a setback today, Riley has had 2 seizures. I doubt it has anything to do with the transition protocol because we haven't even started dropping down his original Pheno dosage. Ughhh. I will be talking with my vet to see if we need to make any modifications to the plan.
 
#26 ·
Is your dog still on HW/flea/tick prevention?

Did you investigate magnesium, amino acids, melatonin, skullcap?

Just wondering as there is a connection between pesticides and seizures.
 
#27 · (Edited)
@gatorbytes -

Flea/tick prevention - no.

Heartworm prevention - yes. Riley came into rescue HW+, the recommendation for any dog that has been treated for heartworm is to administer the HW preventative every month. I have not noticed any correlation between the monthly HW preventative and seizure activity. Riley was fostered and adopted in January 2011. Riley's seizures started on December 26th, 2012 - he has gone through periods of time where 3-5 months pass without any seizures.
 
#28 ·
Was he ever tested for MDR1 mutation. Ivermectin can build up in the brain.
 
#29 ·
Update: The transition failed:(. Riley has been having more seizures in shorter periods of time that at any other point since his initial diagnosis.

We were at the neurologist today and the decision was made to stop the Zonisamide and re-institute full dosage of the Phenobarbital…. actually, a higher dosage.

@gsdsar - The neurologist had an interesting pov on the transition protocol that is being recommended to general practice vets… i.e., he doesn’t like it! He mentioned that the interaction between the two drugs interfere with their respective effectiveness – much like what you said in an earlier post.

While I did not get all the details, he inferred there is a much better way to approach transitioning from Pheno to Zonsi. I did not get all the details because, in our case, based on lots of other information shared during our appointment, he thinks that even with a good transition protocol, my dog is not responding well to the Zonisamide, so we are tapering off of it.
 
#30 ·
I am so sorry to hear that. I hope your boy does well now back on the Pheno. We have to do what is best for each individual dog. And each drug does not work as well on each dog.

Yeah the switch over is weird. I would love to know how your Neuro would prefer to have dogs switched. It's very interesting to me.


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#31 ·
I would love to know how your Neuro would prefer to have dogs switched. It's very interesting to me. Sent from Petguide.com Free App
Yes, I was understandably much more pre-occupied on what the recommendation was for my dog than on asking additional questions about the transition protocol. But, I have to say, I did feel like kicking myself afterwards for not asking more questions about that during the appointment!!! I am also curious and I knew that you would be too!

We have another appt. in 3 weeks, I will be sure to ask at that time and share back :)
 
#33 · (Edited)
My girl was put on a combo of pheno and Keppra. I know that it is also used to treat humans and it is a lot safer on the liver than pheno.
She was having static/cluster seizures and the medication did seem to help for a while.
Good luck, it's so hard to see them through seizures.
 
#34 ·
Sorry, I looked back on the thread and you mentioned that you had looked into Keppra. We did have to administer 3x a day, but it wasn't an issue for us.
Keppra is expensive but you can get it at Costco for a little less money.
 
#36 ·
My first rough Collie was diagnosed with epilepsy when he was 3. He actually had his first seizure when he was 2, but then nothing for a year so at that point the vet thought maybe it was a freak event or maybe he'd eaten some grass on a lawn of a person who had use pesticide (it was June and lots of people are way too lazy to put up lawn signs).

Eventually he was put on phenobarb and I have to be honest, nothing else ever worked for him. He always ended up back on the phenobarb and the dosages increased, then increased. We unfortunately had to put him to sleep when he was almost 8. At that point he'd been on phenobarb for nearly 5 years, he had started showing decreased kidney function and he was having unstoppable seizures every other day so he had no quality of life left to speak of.

However, he did really well on the phenobarb from age 3 to about 7-7.5. By which I mean that he had one seizure maybe every 3-4 months. It was hard to watch and he felt terrified and also very ill for the next 24 hours but otherwise he was doing fine, was happy, active, etc. So while it has side effects for sure, it also has the ability to buy you quite a few really good years with your dog.

I wish you all the best, it's not easy but it sounds like you're really doing everything right for your buddy.
 
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