Any one using Zonisamide (Zonegran) with success?

Questions about the influence of diet and metabolism on seizures.

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seebr5640
Posts: 222
Joined: Mon Dec 27, 2010 10:34 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by seebr5640 » Sun May 08, 2011 12:33 pm

These are our experiences and you have to realize that your experience may be different. Hopefully better but not necessarily.[/quote]

I am glad that Zonisamide seems to be working for Rocky. Wish I could say the same thing. :(

My epi-Sampson has been on Zonisamide since December 2010 and it does not seem to be helping. The neuro just upped the dose from 150 mg to 200 mg twice a day. He has already had 2 seizures back to back since the Zonisamide had been increased. I don't think it is helping Sampson and I am going to ask that he be switched to Keppra. Especially, since Zonisamide is metabolize through the liver, like phenobarb.

I hope that the Zonisamide continues to work for Rocky.

Barb & epi-Sampson

OrngTby
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Location: Virginia

Re: Any one using Zonisamide (Zonegran) with success?

Post by OrngTby » Sun May 08, 2011 2:32 pm

Actually Barb, the majority of Zonisamide is excreted via the kidneys into the urine, with only about 20% being metabolized - this fraction is primarily metabolized by the liver, just not the entire drug content. Although Zonisamide is new to veterinary use, there is not nearly the concern about liver enzyme levels and damage with zonisamide as there is with phenobarbital.
Melynda, LVT
Gauge
Possible 1st seizure: 12/24/2010 ?
Last known seizure: 8/27/2011
150 mg Zonisamide BID
375 mg Keppra QID

BostonTerrMom
Posts: 4
Joined: Thu Aug 02, 2012 8:02 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by BostonTerrMom » Thu Aug 02, 2012 10:43 am

My Boston Terrier is on Zonisamide (and Phenobarbital). She started having seizures @ age 3. Within three months she maxed out on phenobarbital but was still having grand-mal break throughs. My vet added Zonisamide & it's been much better! It did change the characteristics of the seizures (will explain) but she just went 3 months without one, which for her is incredible. On phenobarbital she rarely went more than 3 weeks without a cluster. They would last 1.5 to 2 minutes but she would pop right out of them. With the Zonisamide, they are fewer but more intense. She seems to not fully recover from one seizure, then goes right back into another one. The other night she had 9 in 55 minutes, but her temp never went over 103.8. She still releases her bladder & sometimes her bowels but now she holds her breath till her tongue turns blue. Seizures SUX for the poor babies, but you just have to deal with the best you can. For us the Zonisamide has helped! We've reduced her PB in half. Maybe we need to increase the Zonisamide..????
Last edited by BostonTerrMom on Fri Aug 03, 2012 12:42 pm, edited 1 time in total.

seebr5640
Posts: 222
Joined: Mon Dec 27, 2010 10:34 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by seebr5640 » Thu Aug 02, 2012 5:11 pm

Hi BostonTerrMom,

Forgive me, I have to ask and I don't mean to be sarcastic. :?

You are saying with the Zonisamide there was improvement? But yet the other night she had 9 seizures in 55 minutes? Was this after she had already been on Zonisamide awhile? If so, the number of seizures she had in 55 minutes is not good. :( And the tongue turning blue is definitely not a good sign. I would think that this many seizures and tongue turning blue could cause brain/neurological damage. Did you take her to the ER vet? Or at least tell the vet about this.



Barb & epi-Sampson (39 lb Sheltie)
Pb 48.6 BID
KBr 1.2 ml of 250 mg BID
Zonisamide 300 mg BID
Keppra (generic) 500 mg TID
Denamarin QD
Taurine 500 mg BID
Vitamins/Minerals & Vitamin B Complex w/Iron
Wellness Core Reduced Fat TID

“They too, are created by the same loving hand of God which Created us...It is our duty to Protect Them and to promote their well-being.”—Mother Teresa

BostonTerrMom
Posts: 4
Joined: Thu Aug 02, 2012 8:02 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by BostonTerrMom » Fri Aug 03, 2012 12:37 pm

According to my vet, the biggest threat of brain damage is from the spiking temperatures. My little girl's never went over 103.8 over that 55 minute period. Three months WITHOUT a seizure... is control for us. Am I happy about 9 seizures in 55 minutes... NO! My vet said if her temp gets to 104, to go to ER, which luckily is a block from our house.
I am curious about dosing tho... since there is no actual reference available. My little girl is on 1/2gr PB & 150mg Zonisamide twice daily. From postings here, it looks like just about everyone here is dosing more than we are.
PLUS.... From one of her episodes, I rushed her to my vet, got her in on an exam table while a dog on another treatment table was getting a nail trim. She heard that dog barking & whinning & she snapped right out of the seizure. I am going to experiement with recording dogs barking and see if that works at home next time (which I actually hope there isn't a NEXT time!).

Gentle Jacob's mom
Posts: 925
Joined: Thu Mar 04, 2010 10:52 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by Gentle Jacob's mom » Sat Aug 04, 2012 5:48 am

You didn't mention if you'd tried rectal Valium or Clorazepate to break the clusters. I have to agree with Barb. Nine seizures in 55 minutes is a lot! I'm not a vet, but from what I've been told the intensity and duration also has a negative effect. I know it's mainly because of their temperature. I understand that you've made it three months, and if your pup is anything like Jake I'd be grateful for that too, but that many seizures would have me very worried about status. Also, I'd approach the dog barking carefully. I know every dog is different when it comes to this, but barking dogs have sometime caused seizures with Jake.

Take Care,
Lynne

BostonTerrMom
Posts: 4
Joined: Thu Aug 02, 2012 8:02 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by BostonTerrMom » Sat Aug 04, 2012 9:30 am

Thank you for your thoughts & recommendations. Sometimes it is difficult to see the whole picture when standing so close....

Agreed.... 9 seizures in 55 minutes is TOO MUCH!... even if it was after three months of none. I've discussed my concerns with my vet and with a little research, we've decided my little girl needs her Zonisamide dose increased, effective immediately.

I also have a kit set up to give her diazapam rectally should we find ourselves in another situation like that. It was so awful for her.

thanks again!
a worried Boston Terrier Mom

seebr5640
Posts: 222
Joined: Mon Dec 27, 2010 10:34 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by seebr5640 » Sat Aug 04, 2012 11:31 am

Hi BostonTerrMom,

Here is a link that gives the starting dose recommended. It may be used by most veterinarians. I really don‘t know.

http://www.merckvetmanual.com/mvm/htm/bc/tphm18.htm

Keep in mind each dog is different. Dosage can vary by weight, what the therapeutic range shows for the drug and clinical signs that the dog is having. Some dogs can take more, some can’t.

Back to your first post regarding that the Pb has been decreased and asking if you should increase the Zonisamide. I hope that decreasing the Pb did not create the seizures to occur when she had nine of them in 55 minutes. Is that possible? :(

Please keep in mind, the more seizures that occur, the more it causes a kindling effect. The brain learns how to have seizures and it continues them. That’s why it is so important to get the seizures under control.

I’m so glad that you have discussed this with your vet and have decided to increased the Zonisamide and have gotten some diazepam as well.

Another suggestion, if the diazepam doesn’t seem to work or your dog can’t tolerate it, is the ice pack on the mid back. This has helped me numerous times when I have seen Sampson about ready to go into a seizure. I was able to stop the seizure. And even if I can’t, the ice pack still gets applied and it decreases the post-cal stage down to nothing. This might be something worth trying. I wonder if this helps keep the temperature down as well?

Someone previously had mentioned that they were able to stop their dogs seizure by saying something to them in a loud voice, not screaming. For example, with Sampson, I see him going down about to have a seizure and I will say “Sampson want a carrot!” This will pop him right out of it and he will follow to me the kitchen. I will say this because he loves baby carrots. Maybe something being said that your dog likes to hear would work?

I hope the increased dosage of Zonisamide works and keeps the seizures at bay for a long time. :)

Keep us posted and good luck!

Barb & epi-Sampson (39 lb Sheltie)
Pb 48.6 BID
KBr 1.2 ml of 250 mg BID
Zonisamide 300 mg BID
Keppra (generic) 500 mg TID
Denamarin QD
Taurine 500 mg BID
Vitamins/Minerals & Vitamin B Complex w/Iron
Wellness Core Reduced Fat TID

“They too, are created by the same loving hand of God which Created us...It is our duty to Protect Them and to promote their well-being.”—Mother Teresa

featheredwyngs
Posts: 17
Joined: Fri Mar 09, 2012 9:03 am
Location: Florida

Re: Any one using Zonisamide (Zonegran) with success?

Post by featheredwyngs » Tue Aug 14, 2012 8:58 pm

Figured I would add to this thread for anyone looking for information on Zonisamide.

First thing first - price. I live in north Florida and the cheapest place here for sure was Costco... the pricing difference was dramatic - a 3 month supply of 100mg pills (twice daily) - cost me around $30 (compare that to my newest supply of a 1 month 30 pill supply of phenobarb at $28 O_O). I called every pharmacy in the area and got prices quoted (and at some places a one month supply of 75mg of Zonisamide, the dose he first started at, cost around $100). Point of this story, call every place you can and ask them the price.

Second part: Unfortunately Zonisamide did not seem to be working for us. He had at least two break through seizures while on it if I remember correctly. We were trying to get him down to one seizure every 3 months instead of every two months (which is his current average). He simply does not seem to be able to make it more than two months (almost to the day) without a seizure. I just started him on phenobarbital one month ago and have not begun to taper him off the Zonisamide just yet. Unfortunately, he had a break through seizure today (making it one month since his last one)... so I'm not sure what to think about medication effectiveness at this point. :/
Remy, American Eskimo Dog (DOB 02/02/2007)
First Seizure, 10/01/2011
Last Seizure, 03/26/2013
Zonisamide 100mg twice daily
Phenobarbital 32.4mg twice daily

Gentle Jacob's mom
Posts: 925
Joined: Thu Mar 04, 2010 10:52 am

Re: Any one using Zonisamide (Zonegran) with success?

Post by Gentle Jacob's mom » Wed Aug 15, 2012 6:22 am

Can I ask why you're tapering off Zonisamide? Every two months isn't bad. Most vets consider that control. Pb does increase appetite, so you want to keep a very close watch on what you have laying around the house, and what's on the ground outside. Jake's had three emergency surgeries to remove things caught in his intestines. This was a dog that we had to coax to eat before Pb. We wound up getting him a lightweight muzzle. It breaks my heart to put it on him when he's outside, but it's keeping him safe, and he doesn't mind it at all. To my knowledge there's nothing to suppress an epi dogs appetite on Pb. Unfortunately there are side effects with most seizure meds. I can't say about the cost, because I get Jake's meds from a compounding pharmacy and get a cost break, and he's not taking Zonisamide.

Lynne

featheredwyngs
Posts: 17
Joined: Fri Mar 09, 2012 9:03 am
Location: Florida

Re: Any one using Zonisamide (Zonegran) with success?

Post by featheredwyngs » Wed Aug 15, 2012 8:11 am

It's a bit of trial and error work I guess. We started w Zonisamide on my request bc it has fewer side effects - but that does not seem to work alone for him. The vet wanted to find out if phenobarbital alone would be sufficient for him bc she does not like to overmedicate (esp if the zonisamide has no effect for him). The only way to test that would be to taper off the zonisamide once he reached therapeutic dosage levels on the phenobarbital. I'm feeling though that if pheno+zonisamide do not work for him (zonisamide tends to be added for dogs w refractory epilepsy) that pheno alone may not as well. Or on the flip side if pheno alone and zonisamide alone don't work for him, then not sure the combination will. But I guess drugs have different interactions so it's worth trying.

As for effectiveness- I know that once every two months is pretty good given how often other users on this forum report their dogs seizure frequency. So I do feel lucky. However achieving "control" or effectiveness is relative to a dog's individual pattern. So my dog has a seizure about every month to two months (w one or two closer together) without medication management. So for a medication to 'work' it should either decrease severity of seizure or (better) frequency. Hence why the vet was aiming for every three months. I wonder though if we're aiming too high? :/
Remy, American Eskimo Dog (DOB 02/02/2007)
First Seizure, 10/01/2011
Last Seizure, 03/26/2013
Zonisamide 100mg twice daily
Phenobarbital 32.4mg twice daily

featheredwyngs
Posts: 17
Joined: Fri Mar 09, 2012 9:03 am
Location: Florida

Re: Any one using Zonisamide (Zonegran) with success?

Post by featheredwyngs » Wed Aug 15, 2012 9:34 am

Gentle Jacob's mom wrote:Pb does increase appetite, so you want to keep a very close watch on what you have laying around the house, and what's on the ground outside. Jake's had three emergency surgeries to remove things caught in his intestines. This was a dog that we had to coax to eat before Pb.
Also thank you for highlighting this for me. I didn't know the hunger could get this dangerous... But now that I'm reading more of the phenobarbital posts I see it mentioned more than once. I was at the beach last week with my dog and he kept trying to eat the smaller or crunched up sea shells o_o so I'll make sure to keep a close eye on him for safety.
Remy, American Eskimo Dog (DOB 02/02/2007)
First Seizure, 10/01/2011
Last Seizure, 03/26/2013
Zonisamide 100mg twice daily
Phenobarbital 32.4mg twice daily

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