SK: conception, design, and writing the draft. doi: 10.1016/j.seizure.2004.04.009, 24. CBC, serum biochemical analysis, and urinalysis were within the reference intervals. Although not all of these side effects may occur, if they do occur they may need medical attention. i will go on this drug once i come off topamax I've been on topamax forever! Serum concentrations of zonisamide should be measured minimally 1 week after treatment initiation or dosage adjustment to allow steady state concentrations be reached. Systemic Pharmacotherapeutics of the Nervous System, Maintenance Antiepileptic Drugs (Anticonvulsants). Child Care/Camps/Rec. Do not stop this medication suddenly or else seizures may occur. For me, the side effects of Zonegran far outweighed the positive. Zonisamide is totally unrelated to any of the other anticonvulsants, but, like Keppra, the full extent of its side effects is not yet known so to some vets, it is somewhat controversial to prescribe it. Most dogs will continue for the rest of their lives to have seizures, it now becomes about control. Therapeutic monitoring is not usually necessary with this drug. 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). by readerofthepack Wed Aug 13, 2014 8:29 am, Post 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. Prior to the referral, this dog had been managed with ZNS starting at 2.5 mg/kg per os (PO) q12h then gradually increased in the dose up to 5 mg/kg q12h with the trough blood concentration at 21.2 g/ml over the 15 months. Zonisamide has very long-lasting activity in cats and can be used once daily, although, use in the cat is still new and the full potential for side effects is still being worked out. Don't really have much to add to what has been said, other than to say welcome and I will keep you all in my prayers. The effects of this short-acting medication typically last only 24 hours in dogs. Charalambous M, Brodbelt D, Volk HA. In general, a maintenance antiepileptic drug (AED) should be considered in animals that have had more than one or two seizures within a 6-mo period (assuming these seizures were not caused by repeated toxin exposure) or in animals that have had more than one seizure of unknown cause on any particular day. They are effective at stopping prolonged seizures or clusters of seizures. Gabapentin has been used in cats at 510 mg/kg, bid-tid. Veterinarians may prescribe Zonisamide to treat seizure disorders such as epilepsy. University of Veterinary Medicine Hannover, Germany, University of Veterinary Medicine Vienna, Austria, Cave Veterinary Specialists, United Kingdom. doi: 10.1016/j.yebeh.2006.08.008, 40. This dog bit the client on the arm requiring the emergency room visit for deep bite wound treatment. An oral loading dosage of 400600 mg/kg of bromide is divided into four doses and given with food over a 1- to 4-day period. J Vet Intern Med. An MRI and cerebrospinal fluid analysis were both unremarkable. (2000) 22:2303. Zonisamide discontinuation due to psychiatric and cognitive adverse events: a case-control study. (2003) 23:936. Seven days later, the owner reported episodic aggression was improved by 40% compared with that prior to dose reduction. Seven days after complete discontinuation of ZNS, abnormal behavior episode completely disappeared, and the appetite was recovered by 80% according to the owner. doi: 10.1111/j.1748-5827.2006.00290.x, 26. If excessive sedation occurs, a lower dose should be used initially and gradually increased. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. Epilepsy centers provide you with a team of specialists to help you diagnose your epilepsy and explore treatment options. This case series reports the occurrence of reversible behavior changes associated with zonisamide in three dogs with no pre-existing behavior problems prior to administration of zonisamide. *Correspondence: Shinichi Kanazono, kanazono@vsec.jp, View all Weigh the pros and cons of staying on this medication with your doctor to see if continuing the medication or trying another treatment is right for you. Neuro advised to wean him off both and put him on Zonisamide. Administration of phenobarbital alters the deposition of clorazepate such that the amount of nordiazepam in circulation during each dose interval is significantly reduced. A 50:50 mixture of milk replacer and water is recommended. Hada M, Tamura K, Orima H, Kanazono S, Komatsu T, Ishimura T, et al. Therefore, the dose of LEV was increased to 40 mg/kg PO q8h, resulting in significant improvement of the jerky movements without relapse in the abnormal behavior. Vet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). If your pet stops eating, becomes dramatically lethargic, or develops a yellow color of the skin, gums, or whites of the eyes, contact your veterinarian immediately. doi: 10.5326/0400285, 31. Apparent acute idiosyncratic hepatic necrosis associated with zonisamide administration in a dog. The weaning process should happen gradually, over a few weeks. Among various ASDs, ZNS has been frequently used in veterinary practice with several adverse effects being reported (2, 7, 1317, 2532). A 6-year-old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic aggression. Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. 23 Articles, This article is part of the Research Topic, https://doi.org/10.3389/fvets.2021.763822, https://www.frontiersin.org/articles/10.3389/fvets.2021.763822/full#supplementary-material, Creative Commons Attribution License (CC BY). The severity and frequency of the episodic aggression showed proportional relationship with the dose of ZNS. The plan now will be to wean the Zonisamide. J Small Anim Pract. Zonisamide may be given in combination with other . (2011) 25:14547. The frequency of his GTCS decreased after increment of ZNS up to 13.7 mg/kg q12h while the abnormal behavior episodes increased in its frequency further to over 10 times a day, including abrupt growling at or attempts to bite the family members when they came into his sight while awake (Supplementary Video 1). Miller ML, Center SA, Randolph JF, Lepherd ML, Cautela MA, Dewey CW. Bromide, phenobarbital and zonisamide are examples, although phenobarbital and zonisamide half-life may get short enough that timing is important. (2015) 21:68391. Murata M, Hasegawa K, Kanazawa I. Zonisamide improves motor function in Parkinson disease: a randomized, double-blind study. doi: 10.1186/s12917-015-0464-z, 7. I'm glad to hear that your baby is doing better. The aggressive behavior toward the female child was particularly noteworthy, biting her as she slept. doi: 10.1016/S0387-7604(00)00118-2, 23. The elimination half-life is extremely long (24 days) in dogs; therefore, it takes ~4 mo to achieve steady state kinetics. Figure 1. by ShilohsMom Wed Aug 13, 2014 8:19 am, Post Seizure. Studies suggest that 60% of dogs respond initially; however, after 48 mo, there is a loss of effect in of previous responders because of development of tolerance. Other reported adverse effects include fatigue, headache, psychiatric symptoms, cognitive disturbances, diplopia, weight loss, diarrhea, ataxia, oligohydrosis, urolithiasis, and rash (1924). Rania Gollakner, BS, DVM, MPH, Contributors: Rania Gollakner, BS, DVM, MPH. Drug levels are monitored 2 wk after initiation of therapy, 2 wk after any dosage change, and usually every 612 mo once seizure control is achieved. Changes in brain serotonin and dopamine levels are considered as a mechanism of ZNS-induced PAE (24, 35, 37) and human patients with a history of psychiatric disorder had significantly greater risk of developing PAE associated with ASDs including ZNS (24, 36, 38, 39). This calendar, in conjunction with serum AED levels, can be used as a guide for dosage and drug treatment changes. Zonisamide (ZNS) is a benzisoxazole derivative with a non-arylamine sulfonamide group (1) and is chemically unrelated to other anti-seizure drugs (ASDs) used in veterinary medicine. Pediatr Neurol. Neuropsychiatr Dis Treat. Further studies are warranted to provide more insights in behavior change associated with ASDs in animals. When given with phenobarbital, zonisamide is cleared from the body more quickly, and therefore higher doses of zonisamide may be required or phenobarbital doses may need to be decreased. No seizure episodes were recognized. I don't think I've ever felt more helpless. 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 . The nightly episodic aggression completely disappeared within 5 days after discontinuation of ZNS. 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. Baulac M. Introduction to zonisamide. Spencers last two clusters have changed. In dogs, the dosage can be increased every 2 wk in increments of 20 mg/kg if therapeutic benefit has not been noted. (2007) 10:10510. The phenobarbital metabolite is likely the major functional one, and there may not be an advantage to using primidone over phenobarbital. The episode typically lasted for ~1 min. Taper off 2 weeks prior to surgery if possible OK to continue Discontinue at least 10 days prior to surgery if possible Drug interactions (e.g., ephedrine, meperidine, methadone, tramadol), which could cause a hypertensive crisis. A 2-week telephone follow-up revealed this dog was exhibiting unusual behavior episodes of abrupt barking during sleep without obvious external stimuli. doi: 10.1111/j.1939-1676.2011.00801.x, 18. The initial dosage (dogs only) is 515 mg/kg/day in three divided doses, increased over time to a maximum of 35 mg/kg/day. Daily seizure episodes resolved after ZNS was added. Because a daily maintenance dose may take 4 mo to reach steady state serum concentration, there are situations (eg, severe seizures, seizures that occur on a monthly basis, the need to rapidly switch from phenobarbital to bromide because of phenobarbital toxicity) when a loading dose of bromide should be administered. I'm so sorry that you had to go through all of this, but so happy to hear that she's coming home! Some of the side effects of Zonisimide include dizziness, headache, nausea, vomiting and trouble sleeping. A graph illustrating the association between the dose of ZNS and the severity of episodic aggression in case 2. Epilepsy is one of the most common neurological disorders in dogs (), characterized by spontaneous recurrent seizures originating in the central nervous system ().The prevalence of canine epilepsy varies in different studies between 0.5% and 5% ().If no underlying cause except of hereditary factors are found for the recurrent seizures in the diagnostic work-up, epilepsy is . Read More has anyone heard of Zonisamide? Although the drug appears safe, owners should be warned that because of the sulfonamide base, potential adverse effects (eg, keratoconjunctivitis sicca, bone marrow dyscrasia, hepatopathy, vasculitis, and metabolic acidosis) could occur. In cats, side effects may include inappetence (lack of appetite), diarrhea, vomiting, incoordination while walking, and sleepiness. doi: 10.1111/jvim.13841, 8. These patients improved shortly after ZNS was discontinued. This usually takes one to four days. The trusted provider of veterinary information since 1955, Overview of Systemic Pharmacotherapeutics of the Nervous System, Antiepileptic Drugs Used to Stop Ongoing Seizure Activity, Maintenance Anticonvulsant or Antiepileptic Therapy, Last review/revision Mar 2015 | Modified Nov 2022. If seizures do recur, it is likely that they will be controlled again with medication. Doing this may increase your risk of having more frequent and/or severe seizures. by SpencerBhumi Wed Aug 13, 2014 5:20 pm, Post doi: 10.2460/javma.251.12.1457, 28. The goal is to prevent seizures with as few side effects as possible. Helpful items to consider before changing or withdrawing from your anti-seizure medication: Below are some common situations in which it may be a good time to think about changing or stopping your medication. J Vet Pharmacol Ther. 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. A review article reported the most common adverse effects pertained to the CNS were ataxia, dizziness, somnolence, agitation, and anorexia (36). Limitations of this report reside in the small number of cases, the retrospective nature, and difficulty in proving the direct association of abnormal behavior episodes and ZNS or in ruling out other potentially contributing conditions. BMC Vet Res. However, clorazepate may increase phenobarbital concentrations, resulting in adverse effects. Zonisamide. Other than episodic aggression, the dog remained healthy and happy. The abnormal behavior episodes deteriorated along with gradual dose increment of zonisamide and these episodes almost completely disappeared within 5 days after discontinuation of zonisamide. Episodic aggression toward the adult female occurred while the dog is being picked up and held (Supplementary Video 2). This medication may be given with or without food, however, if your pet vomits or acts sick after receiving it, give this medication with food or a small treat. by SpencerBhumi Sat Aug 09, 2014 4:27 pm, Post No similar episodic aggression was witnessed in association with dose adjustments or addition of other ASDs including PB, potassium bromide, and LEV. The exact same episodes relapsed within days after re-administration of zonisamide and disappeared again shortly after discontinuation of zonisamide. Zonisamide (Oral Route) Side Effects Drug information provided by: Merative, Micromedex Along with its needed effects, a medicine may cause some unwanted effects. Psychiatric adverse effect associated with anti-seizure drugs has been well-recognized in human medicine. (2006) 26:1199202. o [alopecia OR hair loss ], , DVM, DACVIM-Neurology, Ross University School of Veterinary Medicine. Whether or not youre experiencing side effects from your current medication, How much your medication has lowered the frequency and/or severity of your seizures, What other medications may be right for your kind of epilepsy, How they might interact with your current medication. Cook AK, Allen AK, Espinosa D, Barr J. Renal tubular acidosis associated with zonisamide therapy in a dog. Bromide toxicity can be seen at any concentration in an unusually sensitive dog, but it is rare when bromide is used alone and when serum concentrations are < 1.5 mg/mL (15 mmol/L). (2007) 3:17580. Common adverse effects include transient GI distress, alopecia, sedation, and vomiting. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. The owner reported the same abnormal behavior episodes relapsed within 12 h after re-introduction and gradually deteriorated over the next 3 days. CNS adverse events associated with antiepileptic drugs. doi: 10.1212/01.wnl.0000250236.75053.16, 10. Keep us posted on how she's doing. Cardiovascular defects were prominent in both rats and dogs. The owner reported that significant improvements were recognized within 24 h after the dose reduction and no seizure episodes were witnessed. MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. Zonisamide was prescribed with the gradual dose increment plan potentially up to 13.7 mg/kg q12h if needed based on his seizure frequency. Clin Neuropharmacol. Zonisamide (brand name: Zonegran) is an anticonvulsant (antiseizure) medication that is either used as an initial therapy for epilepsy or as an add-on drug for difficult to control seizures. Blastomycosis is a Systemic Fungal infection Affecting Dogs and Cats Bloat - The Mother of All Emergencies Bloat: First Aid Bloody Nose (Epistaxis) in Dogs and Cats Bones are Unsafe for Your Dog, No Bones about It Brachial Plexus Avulsion in Dogs and Cats Brachycephalic Airway Obstruction Syndrome in Flat-Faced Dogs Here, we report three dogs with abnormal behavior episodes associated with ZNS. Our 5 y.o. Addition of LEV (27 mg/kg PO q8h) and glycerin (5 ml/head PO q8h) did not alter the abnormal behavior and decreased appetite. J Vet Intern Med. Zonisamide monotherapy for idiopathic epilepsy in dogs. Japn J Vet Dermatol. This dog had no pre-existing abnormal behavior problems before and no seizure episodes were witnessed in association with these behavior episodes. 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. Sci. Post Precautions. Rob Daniel for his prompt advice on the manuscript preparation. Hopefully we are out of the woods with the pancreatitis. Bromide can be formulated into a solution of various concentrations (100 mg/mL, 200 mg/mL, 250 mg/mL are convenient ones) or into tablets or capsules. Long-term efficacy and safety of zonisamide monotherapy in epilepsy patients. Look for a well-known, name-brand puppy food that is not grain-free. Dogs on a high salt diet may require dosages of 5080 mg/kg/day to maintain adequate serum concentrations, because high chloride intake increases bromide loss in the urine and lowers serum bromide concentrations. Adverse effects classified as type 4 have not been reported (7). doi: 10.1002/14651858.CD011241.pub2, 11. Monotherapy is preferred, but if the drug level is well into the middle or high therapeutic range, it may be necessary to consider the addition of another AED. 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. Therefore, it is important to discuss with your healthcare provider the expected success or failure of weaning off and eliminating anti-seizure medication. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Vet. The possible benefits and risks may depend on factors such as: Before making any changes, you should speak with your healthcare provider and think about the possible benefits and risks of stopping your anti-seizure medication (ASM). For some of us, it takes . 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.
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