Zonisamide + Phenobarbital + KBr

This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian.

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ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Zonisamide + Phenobarbital + KBr

Post by ectorino » Fri Jul 19, 2013 1:29 pm

Hello from Italy, we have a Golden Retriever named Boss who started seizing since he was 1 and a half year
We tried Keppra + PB at first, after 9 months Keppra stopped working, therefore we moved to KBr + PB, but no that much improvement
We moved then to Zonegran + KBr + PB (400 mg Zonegran BID + 115mg x 2 PB + 1050 mg of KBr)......no fits for 5 months, but the dog was very weak, and he was sleeping almost the whole day!!!! The vet decided then to reduce PB to 50 mg x 2, but suddenly after three days the fits reappeared.......this is leading all of my family into a big frustration because we really believed to be close to a partial solution.....maybe it's just a question of adjustment of the dosage....but nowadays I'm very sad because I made a lot of efforts and it seems that the fight against epilepsy is still far to be solved......
Has anyone had something similar experience??
Many thanks
Ettore
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

Kipsmom
Posts: 61
Joined: Tue Mar 26, 2013 8:59 pm

Re: Zonisamide + Phenobarbital + KBr

Post by Kipsmom » Fri Jul 19, 2013 7:32 pm

Hi Ettore -

Could it just be that the phenobarb was reduced too quickly? You didn't say if Boss's dosage was reduced over time, so that's what makes me think that might be what caused the seizures. That's a pretty big reduction. When my dog had to stop phenobarb abruptly due to a life-threatening reaction, he had multiple withdrawal seizures and had to be hospitalized, even though another drug (Keppra) was added for several days immediately before the phenobarb was stopped. Hopefully, Boss will be OK within a few days.
Don't lose hope!
Ellen and Kip
Corgi/Lab/Shepherd mix - 50 lb
750 mg KBr QD
200 mg Zonisamide BID
1250 mg Levetiracetam (Keppra) TID
1st seizure 11/15/2012
In doggie heaven 8/20/13 :-(

ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Re: Zonisamide + Phenobarbital + KBr

Post by ectorino » Fri Jul 19, 2013 11:50 pm

Hi,
Yes, to be honest I had the same feeling....it was the first time that we have tried reducing PB because the dog was always too sleepy and it has been chosen the most toxic drug of the cocktail and this has been done in one day....starting from 115 mg X 2 to 50 mg X 2 in a day....I'm not a vet and I haven't any experience on how is the normal procedure to partially reduce the dosage of an epileptic drug, like PB especially, but yes maybe from 115 mg X 2 to 50 mg X 2 in one day was too quick....luckily Boss didn't have any cluster, so far.....now I immediately went back to the previous dosage.....I was happy because in only three days he recovered a lot of energy, so definitely what he is assuming now is too much to pretend he could move and walk like he did when he was an happy dog....
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

Kipsmom
Posts: 61
Joined: Tue Mar 26, 2013 8:59 pm

Re: Zonisamide + Phenobarbital + KBr

Post by Kipsmom » Sat Jul 20, 2013 7:06 am

Well, maybe you can give it another try (reducing the phenobarb), but in a very slow manner. I agree, it's the worst drug as far as side effects go, but it's so effective for seizure control in many dogs that it's no wonder the vets keep prescribing it. I'm no expert, but from what I understand, you would want to go about reducing Boss's dosage over a matter of weeks, a tiny bit at a time.
Best of luck to you, and I hope your boy bounces back to being a happy dog!
Ellen and Kip
Corgi/Lab/Shepherd mix - 50 lb
750 mg KBr QD
200 mg Zonisamide BID
1250 mg Levetiracetam (Keppra) TID
1st seizure 11/15/2012
In doggie heaven 8/20/13 :-(

SpencerBhumi
Posts: 228
Joined: Sat Feb 11, 2012 9:25 am
Location: South Australia

Re: Zonisamide + Phenobarbital + KBr

Post by SpencerBhumi » Sat Jul 20, 2013 4:40 pm

Hello Ettore, and welcome to the forum.

It is so often shown here that there is no single answer to canine epilepsy management – so much trial and error for each individual dog, for which I wish you good luck.

We are in the process of weaning drugs but are choosing the keep the pheno above all others. We have tried most common anti epilepsy medications and Spencer still has serious clusters, too often. So our thought is ‘why give drugs that are not apparently working’.

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. Both pheno levels and liver enzymes are at the high end of acceptable.

Other drugs have been added/removed over time, each one having significant side effects beyond those of the pheno. These side effects on Spencer’s personality, mobility, coordination, thirst/hunger, behaviour - subsequently our lifestyle & $budget have taken their toll. So, with still having a healthy liver we are keeping the pheno & KBrom. Notably within two weeks with a slightly lower dose of Zonisamide Spencer is more alert and coordinated (becoming the ol’ dog we once knew), and no fits or twitches so far.

Importantly, those drugs that we have & are weaning, we do very slowly to prevent any rebound/withdrawal seizures. Our Zonisamide cessation is a four month plan.

I am sorry I do not have an absolute answer for you or anyone else here but I thought I’d share our experience.

Again I wish you good management and good health for Boss.

Trevor & Spencer
Grateful for the good days, weeks (months).

Pauly the BC
Posts: 5
Joined: Thu Aug 29, 2013 4:21 pm
Location: Canada

Re: Zonisamide + Phenobarbital + KBr

Post by Pauly the BC » Fri Aug 30, 2013 12:38 pm

Hello!

Wondering if you have had any improvement with Boss?

We are thinking of putting Pauly back on KBr, and the combo of Zonisamide and phenobarbital is not working as hoped!
I am worried that he will not have the energy to play and do agility, which he loves!
Pauly
DOB: October 1st, 2010
First Seizure: December 6th, 2012
Last seizure: October 25 (only 10days between)
Longest between seizures: 25 days! Longest yet!
Medications:
Phenobarbitol 90mg BID
Zonisamide 225mg BID
KBr 2.3ml once daily

tiredgranny
Posts: 15
Joined: Mon Sep 03, 2012 3:47 am
Location: Northern California

Re: Zonisamide + Phenobarbital + KBr

Post by tiredgranny » Mon Sep 23, 2013 2:05 pm

As we try to work with vet on solution to Wally's recent culster episode, I'm again intrigued by the number of pets who are being given Keppra, Zonisamide, plus Potassium Bromide. Our vet has never suggested the latter. Wally did have PB when first going on meds years ago but he was so hungry/ravenous all the time and that is when Keppra was being introduced for canines.

Any thoughts on current issue? 18 cluster seizers 6 days ago, hospitalized for 30 hours where they gave hime IV phenobarbitol as well as valium. He has not come back to normal behavior. Pacing, trembling, staring now, after first two days unable to stand/walk.

We read that the phenobarb can cause problems like this for weeks after. Our vet didn't say this and told us to increase his Zonisamide to 300mg BID from 200mg -- and he only weighs 20lbs.

Any ideas?

Many thanks.


NOTE: WALLY WEIGHS 20lbs but I can't get my signature to update
__________________________________________________
Christine in Northern California
Wallace: Male Bichon, born April 2002
Weight: 30lbs (a BIG Bichon)
200mg Zonisamide BID
500mg Keppra XR BID (since 6/12)
.25mg Xanax in AM for now (started 12/6/12
)

Pauly the BC
Posts: 5
Joined: Thu Aug 29, 2013 4:21 pm
Location: Canada

Re: Zonisamide + Phenobarbital + KBr

Post by Pauly the BC » Thu Oct 17, 2013 7:31 pm

triedgranny:

Pauly has been on this combo for just over a month, with the KBr being his newest med addition.

Since being on this I have seen great improvements!
-Longest time (ever) between seizures
-More mild seizures, and very short seizures
-His personality has come back!

That being said, the first 2 weeks all he did was sleep! He was also very unstable, so much so that we had to support him to walk and use the bathroom. Currently he still has some hind end weakness but he is back up to all his old tricks (some of which I have not seen since this whole journey started!)

The best thing about this combo? His last seizure spell, he did not have your typical grand mal! It was more of a foci seizure (just drool and jaw snapping, no falling). This for us was a huge improvement, as we where having clusters of 4-6 grand mals with 10-15 foci weekly!
Pauly
DOB: October 1st, 2010
First Seizure: December 6th, 2012
Last seizure: October 25 (only 10days between)
Longest between seizures: 25 days! Longest yet!
Medications:
Phenobarbitol 90mg BID
Zonisamide 225mg BID
KBr 2.3ml once daily

ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Re: Zonisamide + Phenobarbital + KBr

Post by ectorino » Tue Oct 29, 2013 3:23 pm

Hello everyone
I've been out for a few months with limited access to my private email box....
Anyhow, as follows a quick update about Boss conditions.....Unfortunately we have cried victory too soon!!
Since it was five months without fits after introducing Zonegran, agreed with our vet we planned to reduce the PB dosage from the initial dosage (115 mg BID), the most toxic drug of the three....
Everything was fine up to 50 mg BID when, three weeks later, when most likely the new dosage reached the blood, the fits started again.... we were so happy because Boss had resumed running, walking and playing all the day with the other dogs, and now I'm concerned to go back to the previous sleeping personality......hoping that what is going on is because PB works even partially and not because Zonegran is not working anymore.......I'm sure the improvements we had since last year was because of Zonegran off course!!!
The additional trouble is that reducing PB we might have reduced Zonegran dosage by half with significant benefits from the economic point of view, since in Italy a box of Zonegran costs 84 euro, and Boss needs 4 boxes a month......an annual costs would be of 2.400 euro....
Any opinion on Zonegran effectiveness in the years??
I wish you all the best for your beloved friends!!
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Re: Zonisamide + Phenobarbital + KBr

Post by ectorino » Mon Dec 09, 2013 3:00 pm

Hello from Italy again!
Just a quick update on the Boss current status…..As I informed we have tried to reduce PB from 115 mg to 50 mg progressively, but at 50 mg twice the fits restarted…..we went back to 75 mg but apparently the fits are not yet under control as at the beginning of this year….now I'm afraid that or Zonegran is no longer working or the PB was fundamental to keep out partially the seizures and we have to increase again the dosage….This year we had no clusters :D , and only 8 seizures as of today, but my main concern is if we might fall down again in the previous nightmare…..I would say that the positive results of this year occurred because of Zonegran, and the fact that like Keppra did in the past, the honey moon effect could be finished makes me very worried about the future…..
To be honest I didn't find any information saying how long it should take to consider Zonegran as successful med or not
Let's really keep crossed fingers…..
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

Chris Douglas
Posts: 254
Joined: Tue Aug 27, 2013 8:50 pm

Re: Zonisamide + Phenobarbital + KBr

Post by Chris Douglas » Mon Dec 09, 2013 4:26 pm

Hi Ettore/Elisa,

I too would like to know how long the honeymoon period is with zonisamide ... (or keppra xr for that matter) as my molly just started on the zonisamide but I have the feeling that the honeymoon period is as different for each dog as the epilepsy itself is different for each dog ... I'd say that if boss has only had 8 seizure this year and no cluster's then your on to something really great for control and hope that y'all continue to have this success for a long time to come ... thanks for the update cause all lil' bits of info from everyone helps soooo much and is greatly appreciated ... ♥

Chris and Molly
Chris & Molly
Brittany 27 lbs female DOB Mar.2008,
Pb 32.4 mg(1/2 grain) BID
regular Keppra 2/250mg BID
Valium tab's 5 mg orally/rectally as needed
Melatonin 5mg SID


1st seizure 8/20/12
last seizure 12/14/13

Rainbow Bridge 12/28/13

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Re: Zonisamide + Phenobarbital + KBr

Post by MK's mom » Mon Dec 09, 2013 9:34 pm

My MK was on keppra and then zonisamide and neither of them gave him good protection for long. There is an article online from the Veterinary Congress talking about the honeymoon period for keppra,which on average is four months. Keppra helped my MK for about that long and when he started seizing it seemed like it got worse after the keppra than it was before the keppra. We then tried zonisamide and that didn't seem to help, so it was back to the Pb and the KBr, which was so hard on his body. He sadly passed away from pneumonia at five years old. I will try and find the article and post the link here.
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

Chris Douglas
Posts: 254
Joined: Tue Aug 27, 2013 8:50 pm

Re: Zonisamide + Phenobarbital + KBr

Post by Chris Douglas » Mon Dec 09, 2013 10:06 pm

thnx vivian,

it would be an interesting read if you can find n post a link ... :D

chris and molly
Chris & Molly
Brittany 27 lbs female DOB Mar.2008,
Pb 32.4 mg(1/2 grain) BID
regular Keppra 2/250mg BID
Valium tab's 5 mg orally/rectally as needed
Melatonin 5mg SID


1st seizure 8/20/12
last seizure 12/14/13

Rainbow Bridge 12/28/13

ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Re: Zonisamide + Phenobarbital + KBr

Post by ectorino » Mon Dec 16, 2013 2:44 pm

Hello,
is there anyone who experienced the honey moon effect with Zonisamide?
I know something about Keppra, as Boss started with Keppra and for 8 months he didn't have any seizure, but suddenly the seizures re-started worse than they were before…..
I'm just wondering if this could happen with Zonisamide at the same conditions…..even if now Boss is taking Zonisamide for one year already…
Thanks!!
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

ectorino
Posts: 13
Joined: Wed Mar 06, 2013 1:23 am
Location: Italy

Re: Zonisamide + Phenobarbital + KBr

Post by ectorino » Wed Dec 25, 2013 1:05 am

Hello and happy Christmas everyone at first
Quick update
We are trying to re-adjuste the dosage of PB @ 75 mg BID
on a weekly basis Boss has a partial seizure without grand-mal, he remained "frozen" for 20 minutes shacking his head and producing some saliva…..after that time he re-starts doing normal
It's strange, it never happened so far…..it looks like if the seizure pattern is continuously changing…..sometime I think that if the success we had in 2013 with only 8 seizures is due to Zonisamide, maybe it could work better alone or in combo with KBr rather than in combo with PB, but when we tried to reduce PB the seizures have re-started……I'm so frustrated sometimes…but never mind, I won't give up
If someone has had similar experience please share it with me…..
Last point, I'm reading some of you using Melatonin, is there any proven efficacy with its use, or better you feel it may help to reduce the night seizures?
Thanks a lot and enjoy your Christmas time
Ettore/Elisa
Boss Golden Retriever 40 Kg
PB 75 mg BID
Zonisamide 400 mg BID
KBr 1050 mg

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