sign in sign up
<<
Home , Carbamazepine, Ethosuximide, Imepitoin, Phenobarbital, Seletracetam

Antiepileptic

When to measure Peak Factors that affect Dose MOA Half Life Steady state Therapeutic range levels and monitor Other factors Side effects absorption concentration bloodwork

Phenobarbital MAINTENANCE : Barbituate - Increases 90% (absorbed 4-8 hours 7-20 days 15-35 mg/dL (don't Levels 2 weeks and 6 low protein diet may eliminate Collect blood in a non Common: Sedation (especially with hepatic (1/3 goes 32-89 hours 2.2-4.4 mg/kg PO q12h neuronal responsivity to within 2 hours) (Dog) 8-10 go above 35 mg/dL) weeks after starting or Pb more rapidly; alkalinizing serum separator tube; secondary brain disease), elevation in unchanged in (40-90 in (can be given IV) GABA; prolongs opening days (Cat) dose change and then the urine may result in hypertriglyceridemia enzmyes Rare: , urine) dog; 40-50 Cat:2.2-4.4 mg/kg PO of the channel at every 6 months; general enhanced renal elimination; may falsely elevate Pb cytopenias, superficial necrolytic in cat) q12h (can be given IV ) GABA a receptor health panel every 6 drug is a potent inducer of measurements; will dermatitis, changes in thyroid tests, LOADING: Dog Some anti-glutamate months hepatic enzyme artifically lower T4 and facial pruritis (in cats) and cat 16-20 mg/kg IV effects activity and can induce increase TSH or PO over 24 hours Inhibits calcium uptake toxicity more often at high into doses or when other potential hepatotoxic are used

Binds to synaptic vesicle (1/3 via 2.3-4 hours 5-45 ug/mL (human) Levels not Phenobaribal lowers the half Neuroprotective Rare: Sedation; at doses >400 Levetriacetam MAINTAINENCE: 20- 100% 2 hours 17 hours 40 protein A (SVA2) involved glomerular (dog); 3 (seldom performed recommended; general life to 1.5 hours, therefore use properties that may mg/kg/d see , , filtration) hours (cat) due to expense and health panel every 6 decrease seizure salivation, and restlessness mg/kg PO q8h (can be in modulation of NT higher dose or increased given IV, IM, and SQ); release, reuptake and high safety margin) months frequency in patients already induced brain good for use in recycling on damage; "anti-kindling emergency situation; effect"; Possible LOADING: 20-60 "honeymoon effect"; and mg/kg every 2-8 hours are being evaluted in human medicine

Levetriacetam Binds to synaptic vesicle 100% 3-7 hours 5 hours 28 hours Neuroprotective Rare: Sedation; at doses >400 20-30mg/kg PO q12h 5-45 ug/mL (human) Levels not Phenobaribal lowers the half Extended protein A (SVA2) involved Kidney (1/3 via (dog) properties that may mg/kg/d see ataxia, vomiting, (cannot break tablet); (seldom performed recommended; general life to 1.5 hours, therefore use Release in modulation of NT glomerular decrease seizure salivation, restlessness and "ghost some patients require filtration) due to expense and health panel every 6 higher dose in patients release, reuptake and induced brain damage; capsules" (patient's feces may contain q8h dosing high safety margin) months already on phenobarbital recycling "anti-kindling effect"; part of the outer capsule) Possible "honeymoon effect"; brivaracetam and seletracetam are being evaluted in human medicine

Salt - ion thought minimal, not 60-100% - 15-45 days 80-120 days 100-300 mg/dL Levels at 4-6 weeks and IVF with non physiologic Bromide MAINTENANCE: 20-40 monitor levels q 6mo to Common: (give with food and to hyperpolarize neuronal protein bound; then 12 weeks after sodium content, Na in diet mg/kg PO q24h; DO prevent toxicity; BID), PU, PD, polyphagia, bromidism, membranes after via starting or dose change (increased intake, increases NOT USE IN CATS; pseudo- pancreatitis, megaesophagus, traversing neuronal kidneys and then every 6 the rate of elimination) LOADING: 100mg/kg/d hypercholermia on pneumonitis in cats; Rare: behavioral chloride channels months; general health PO for 5 days laboratory testing changes (i.e. aggression), coughing (competes with chloride), panel every 6 months thereby raising seizure threshold; primarily at GABA receptors

5-10 mg/kg PO q12h -like: hepatic 68% 3-4 hours 15-17 h 4-7 days 10-40 ug/mL (human); Levels not typically Do not use in Ataxia, lethargy, KCS, inappetance, phenobarbital decreases (dog); 10-20mg/kg PO blockade of T-type Ca+ metabolism via (dog); 34.5h check trough level performed, though Dobermans or other idiosyncractic hepatotoxicity serum concentration (start at q24h (cat) channels and voltage microsomal (cat) ACVIM consensus patients sensitive to 10mg/kg PO q12h if patient is gated Na+ channels, enzmyes (10% statement recommends sulfonamides on phenobarbital), enhancement of GABA, excreted level at 2 weeks after phenobarbital shortens the modulates other NTs; unchanged in starting and then every 6 half life and less bioavailable may provide kidneys) months; general health neuroprotective effects panel every 6 months

30-40% 20-30 mg/kg PO q8h blockade and preventing 80% 1 hour 3-4 hours 16.5-22 h 4-16 mg/mL (seldom Levels not None Good , not Ataxia and sedation metabolized by synaptogenesis of the performed due to recommended; general typically effective as liver and 60-70% alpha-2-delta subunit of expense and high health panel every 6 an ; no excreted the voltage gated T-type safety margin) months good studies in cats unchanged in the kidney

Pregabalin 2-4 mg/kg PO q8h; may blockade and preventing Unknown, likely 2.8-8.2 ug/mL (seldom Levels not Good analgesic - 6-7 hours 1.5 hours 33-40 h None Sedation (usually transient) be possible to dose synaptogenesis of the same to performed due to recommended; general ; possible q12h; start at low end of alpha-2-delta subunit of gabapentin expense and high health panel every 6 dose and go up the voltage gated T-type safety margin) months calcium channel; decreases glutamate, NE and substance P

Felbamate 30% hepatic 20-100 ug/mL (seldom Levels not Synergistic hepatotoxicity, EXPENSIVE; may offer At high doses: nervousness, - 3-7 hours 4-8 hours 20-30 h 15-20 mg/kg PO q8h enhances sodium metabolism; performed due to recommended; general especially if on other some protection of hyperexcitability, and decreased (can be increased in 15 channel inactivation, Excreted expense and high health panel every 6 potentially hepatotoxic drugs, neurons from appetite; Rare: blood dyscrasias, KCS, mg/kg increments q2 enhances GABA, and unchanged in the safety margin) months so monitor liver values/CBC ischemic or hypoxic hepatotoxicity, generalized tremors (in weeks up to 70mg/kg). reduces glutamate urine q6 month; can damage; toxic dose is small breed ) No information about excitation (via NMDA increase Pb levels (due to 300 mg/kg/day; dosing in cats receptors) P450) Flurofelbamate is being investigated in people and may be a less toxic option in the future

May be more effective Renal 30 minutes - 4 2-3.8 h 11-20 hours - Levels not recommended; None Sedation, ataxia, weight loss Sulphamate-substituted as a TID dose, due to 2-10 mg/kg PO 8-12h. hours general health panel monosaccaride. Enhaces short half life; May be Start at low dose and every 6 months titrate up as needed. No GABAergic activity and helpful as an add-on for information about inhibits voltage-gated refractory epileptics; dosing in cats sodium and calcium exteneded release channels version available in human medicine

in liver to several 0.5 mg/kg IV or IN; 1 Benzodiazepam enhance 90% 30 minutes - 2 2.5-3.2 14-16 h - N/A - ER use only None Can develop tolerance Idiosyncratic hepatopathy in cats; metabolites, mg/kg rectally the activity of GABA intravenously; hours in dogs contradictory CNS excitement glucuronic 50% rectally; conjugation, 80% intranasally highly protein bound

Lorazepram 0.2 mg/kg IV (dog only) Benzodiazepam enhance hepatic - - short - - N/A - ER use only None May be more effective Sedation the activity of GABA than diazepam

Midazolam 0.066-0.22 mg/kg IV, Benzodiazepam enhance hepatic, safer - - short - - N/A - ER use only None May be more effective Sedation IN, or IM the activity of GABA than diazepam than diazepam

Levels not patients may develop a Chlorazepate Hepatic - - 3-6 hours 16.5-33 h - potential for hepatotoxicity initially 0.5-1 mg/kg Benzodiazepam enhance recommended; general Concurrent phenobarbital; tolerance; possible use (can go up to 2-4 the activity of GABA health panel every 3-6 drug may increase Pb for at home use for mg/kg) PO q12h months concentration after 1 month cluster patients

Levels not Can be helpful in 0.5 mg/kg PO q12h Hepatic ------Benzodiazepam enhance recommended; general refractory seizures; Hepatotoxicity if used for more than a the activity of GABA health panel every 3-6 mainly used in few months months hypertonicity diseases

Anticonconvulsants NOT recommended in dogs and cats, due to toxicity and/or short half life: , (Dilantin), , valproic acid, , , , , triagabi ne Anticonconvulsants available in the EU for dogs and cats: Pexion ()