. When used in combination with phenobarbital, bromide toxicity can be seen at concentrations of 23 mg/mL (2030 mmol/L). Reports of hindlimb weakness should be investigated as potential bromide toxicosis by measuring serum bromide concentration and discontinuing bromide for several days to see whether the weakness improves. It may also require additional changes to the dose of your new medication. In human medicine, there were several reports of psychiatric and behavioral side effects associated with ZNS (1, 24, 3336). It has also been used to treat aggressive behavior problems ( see Psychotropic Agents Psychotropic Agents Anxiolytics, antipsychotics, antidepressants, and mood stabilizers used to treat human behavioral disorders are being used more commonly in veterinary medicine as adjuncts to behavioral modification read more ). doi: 10.1111/jvim.16205, 42. Oligohydrosis and fever in pediatric patients treated with zonisamide. This synthetic analogue of the inhibitory neurotransmitter -amino butyric acid (GABA) inhibits seizure activity via multiple mechanisms, including inhibition of neuronal sodium channels and potentiation of the release and action of GABA. 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. 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. ALT, serum alkaline phosphatase, and/or bile acids should be monitored. I told her that when Zonisamide was added he still clustered and continued to cluster on an almost weekly basis until KbR was added -- so to me I feel the Zonisamide hasnt done too much .. 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. Contact your veterinarian immediately if your pet stops eating, becomes dramatically lethargic, or develops a yellow color of the skin, gums, or whites of the eyes. doi: 10.3988/jcn.2007.3.4.175, 4. 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). For longterm maintenance in cats and dogs, phenobarbital may be given at 24 mg/kg/day, PO, bid. by SpencerBhumi Fri Aug 08, 2014 2:50 pm, Post Our low carb, nutrient-dense recipes are the easiest way to feed your dog fresh homemade food on the budget you choose. Zonisamide may be given in combination with other . Because it does not undergo hepatic metabolism, bromide is useful in dogs with liver disease. No use, distribution or reproduction is permitted which does not comply with these terms. (2020) 7:169. doi: 10.3389/fvets.2020.00169, 41. White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK. 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. Please confirm that you are a health care professional. 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 . Miyamoto T, Kohsaka M, Koyama T. Psychotic episodes during zonisamide treatment. An abnormal behavior episode of case 1 showing aggressive growling at the family members while resting in the bed. An MRI and cerebrospinal fluid analysis were both unremarkable. Log in 24/7 to access your pets health care information. Dewey CW, Guiliano R, Boothe DM, Berg JM, Kortz GD, Joseph RJ, et al. 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. All rights reserved. Give the missed dose and then wait the recommended interval before giving the next dose (continue giving it regularly at that new time). Vet. 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. Sci. However, clorazepate may increase phenobarbital concentrations, resulting in adverse effects. Zonisamide - Zonisamide is a broad-spectrum antiseizure medication that blocks voltage-dependent sodium and T-type calcium channels. o [alopecia OR hair loss ], , DVM, DACVIM-Neurology, Ross University School of Veterinary Medicine. Colleen, Rylie, Sophie & angels Izzie & Shiloh. 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 is available as capsules of 25, 50 and 100 mg . It is created by eHealthMe based on reports of 8,997 people who have side . His behavior was characterized by insomnia, agitation, constant attention-seeking behavior through the night, restlessness, and excessive reaction to the external stimuli. Our consideration for keeping the pheno are 1) it is still the necessary drug to re-load Spencer with to control bad clusters, 2) its main side effect (hunger) is manageable and 3) liver damage (enzymes) is being monitored & is acceptable for the moment " with Milk Thistle supplement. This may suggest that PAE or CAE are not necessarily associated with higher serum concentration of ZNS than the reference range. 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). At that point the docs added Phenobarbital. Our initial plan was to gradually increase ZNS dosage as needed and to maintain LEV at the same dose. (2018) 200:10613. If they are not available, follow their directions in contacting an emergency facility. doi: 10.1016/j.yebeh.2006.08.008, 40. Zonisamide (ZNS) is an antiepileptic drug (AED) approved for adjunct treatment of partial seizures in adults. Topiramate is a newer AED that is well tolerated by people and increasingly used for neuropathic pain. Critical differences are that 1) the dog's body adapts to zonisamide pretty quickly -- maybe 2 weeks -- and the ataxia goes away, and 2) the dose of zonisamide doesn't have to increase continually. But, taking them daily may cause drowsiness, dizziness and loss of balance, and other side effects. Doses may be doubled in early stages and increased by 25%50% in later stages. Mephenytoin, although related to phenytoin, has been effective in dogs (10 mg/kg, tid) because of a slower rate of elimination. She's on a low-fat diet for a few weeks to help her pancreas return to normal. Primidone is not recommended for use in cats because of toxicity concerns. Adverse effects consist of sedation only, but periodic hematologic monitoring is advised, because blood dyscrasia and hepatotoxicity are reported in people. Zonisamide-induced psychosis in a patient with bipolar disorder and narcolepsy. Copyright 2021 Kanazono, Ukai and Hiramoto. This dog had an episode of cluster seizures. Because diazepam has a rapid onset of action that prevents the spread read 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 dog bit the client on the arm multiple times. Use to remove results with certain terms If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. Nevertheless, one report indicated that dogs with seizures that are not well controlled with phenobarbital may respond better to primidone (eg, psychomotor seizures). (2008) 10:41821. Weaning a Litter of Puppies. In dogs, the initial dosage is 1015 mg/kg, PO, tid. by readerofthepack Thu Aug 14, 2014 2:40 pm, Post doi: 10.5326/0400285, 31. Bromide is an effective maintenance AED in cats, but the incidence of adverse effects does not warrant its routine use unless there is no other choice. 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. 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. It has been used as an adjunct AED for dogs and cats and is occasionally used as monotherapy. Reported type 2 adverse effects include two cases of acute toxic liver injury, three cases with dermatologic lesions, and one case of renal tubular acidosis (1317). Bromide therapy must be titrated to the individual animal based on careful therapeutic drug monitoring and careful monitoring by the owner for early signs of toxicity. Bromide has been used in horses as a maintenance AED, but there are no published studies on its clinical efficacy. Chronic toxicity of the anticonvulsant zonisamide in beagle dogs. These patients improved shortly after ZNS was discontinued. Use OR to account for alternate terms Cephalalgia. The effects of this short-acting medication typically last only 24 hours in dogs. (2003) 28:1849. Introduction. J Small Anim Pract. Adverse effects classified as type 4 have not been reported (7). Treatment should begin with a single drug at the minimal required level for effect. (2014) 10:257. doi: 10.1186/s12917-014-0257-9, 33. Child Care/Camps/Rec. In foals, phenytoin has erratic plasma concentrations. It was also interesting that the average maximum ZNS serum concentration in patients who discontinued ZNS attributable to PAE or CAE was significantly lower than maximum ZNS concentration of control group in the aforementioned study (24). 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. Blood and urine tests may be needed to check for unwanted effects. by SpencerBhumi Mon Jul 01, 2013 5:09 pm, Post Episodes showed no response to acepromazine (unknown dose or route). Brief exposure to temperatures between 15C (59F) and 30C (86F) is permitted. The owner reported the same abnormal behavior episodes relapsed within 12 h after re-introduction and gradually deteriorated over the next 3 days. Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online. If you miss giving your pet a dose, give the next dose as soon as you remember, but if it is closer than 12 hours before the next scheduled dose, either: Never give your pet two doses at once or give extra doses. Zonisamide was abruptly discontinued 4 days after re-introduction, which resulted in resolution of the abnormal behavior episodes within 24 h. No other modifications in other medications were made during this ZNS re-introduction trial. Here, we report three dogs with abnormal behavior episodes associated with ZNS. The recommended oral starting dose of zonisamide in dogs is 37 mg/kg BID and 710 mg/kg BID in dogs co-administered hepatic microsomal enzymes inducers such as PB [11, 28]. 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. 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. It has been used as first-line AED as well as an adjunct AED in dogs not adequately controlled by phenobarbital and bromide. (2016) 30:47790. Other reported adverse effects include fatigue, headache, psychiatric symptoms, cognitive disturbances, diplopia, weight loss, diarrhea, ataxia, oligohydrosis, urolithiasis, and rash (1924). Withdrawal symptoms may include increased seizures, anxiety, and panic attacks if you miss one or more doses. J Vet Intern Med. Seizure. A 2-week telephone follow-up revealed this dog was exhibiting unusual behavior episodes of abrupt barking during sleep without obvious external stimuli. Schwartz M, Muana KR, Olby NJ. Psychiatric and behavioral side effects of the newer antiepileptic drugs in adults with epilepsy. 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. But, taking them daily may cause drowsiness, dizziness and loss of balance, and other side effects. J Neurol. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fvets.2021.763822/full#supplementary-material. BMC Vet Res. In most cases, the risk of stopping medication slowly is low. Bromide (potassium or sodium salt) can be used as a first-choice AED in dogs with epilepsy, as an adjunctive AED in dogs with refractory seizure disorders, or for dogs that have unacceptable adverse effects related to phenobarbital or other AEDs. 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%. Bromide appears to stabilize neuronal cell membranes by interfering with chloride transport across cell membranes and by potentiating the effect of GABA via hyperpolarizing membranes. Get the personalized nutrition plan your dog needs with non-GMO air dried dog food. As for type 3 adverse effects, the possibility of affecting thyroid function (especially decrease in total T4) and the changes in blood chemistry profile within the reference range, including the elevation of ALP and Ca and the decrease of total protein and albumin compared with those prior to the administration of ZNS, were observed (7). Do not stop this medication suddenly or else seizures may occur. Enter search terms to find related veterinary topics, multimedia and more. Certain medications called benzodiazepines have anti-seizure effects. Zonisamide is administered by mouth, as an oral capsule, or it may be compounded into an oral liquid. Our 5 y.o. Generally, monitor your pet for any adverse effects, and that the medication is working. Ethical review and approval was not required for the animal study because this case report describes a medical condition of client-owned dogs without serious iatrogenic consequence. Some of the side effects of Zonisimide include dizziness, headache, nausea, vomiting and trouble sleeping. I lost a LOT of weight and the more bothersome side effects--memory loss, difficulty . Zonisamide (Oral Route) Side Effects Drug information provided by: Merative, Micromedex Along with its needed effects, a medicine may cause some unwanted effects. The link you have selected will take you to a third-party website. In cats, side effects may include inappetence (lack of appetite), diarrhea, vomiting, incoordination while walking, and sleepiness. Most people with epilepsy take one or more medicines. However, the dosing regimen needs to be tailored for each animal; the upper end of the therapeutic range is only limited by adverse effects of bromide. 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). 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. Negative effects of epilepsy and antiepileptic drugs on the trainability of dogs with naturally occurring idiopathic epilepsy. 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. Complete blood count (CBC), serum biochemical analysis, and urinalysis were within the reference intervals.

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