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Old 01-10-2014, 10:35 PM   #1 (permalink)
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Default Switching epilepsy medications - advice, opinions, experiences welcomed!

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.

Last edited by LifeofRiley; 01-10-2014 at 10:40 PM.
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Old 01-10-2014, 10:51 PM   #2 (permalink)
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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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Old 01-10-2014, 11:25 PM   #3 (permalink)
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@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.
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Old 01-10-2014, 11:51 PM   #4 (permalink)
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why switch from the phenobarb if you were having success with it ?
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Old 01-11-2014, 12:00 AM   #5 (permalink)
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Quote:
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why switch from the phenobarb if you were having success with it ?
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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Old 01-11-2014, 12:27 AM   #6 (permalink)
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Quote:
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why switch from the phenobarb if you were having success with it ?
That is the exact same mindset I had until Christmas Eve. On that day, Riley had 3 grand mal seizures - 2 very minor ones that had an ictal phase of less than 1 minute and 1 that was a little over 2 minutes.

I did not want to raise his Pheno dosage - for reasons gsdsar mentioned - so, it seemed like a good time to try something new.

If the new medication doesn't work out on its own, we can add back in a lower-dose of Pheno.

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Old 01-13-2014, 11:13 PM   #7 (permalink)
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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!
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Old 01-14-2014, 12:03 AM   #8 (permalink)
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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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Old 01-14-2014, 12:49 AM   #9 (permalink)
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Quote:
Originally Posted by gsdsar View Post
Have you looked into Keppra?
First of all, thank you, again, for your input on this thread : )

Yes, I did ask my vet about Keppra. The main barrier for us is the need to administer Keppra 3x a day vs. 2x a day.
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Old 01-14-2014, 12:57 AM   #10 (permalink)
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i had a great pyr, 130 lbs, was on pheno from the time he was about 16 months until we had him pts for a bone cancer. no effects from the pheno. we only checked his levels at his yearly physical.
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