Page 799 - Clinical Small Animal Internal Medicine

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Table 70.1 Summary of antiepileptic drug therapy in the dog
Clinical pharmacology

Protein
Vd (L/ binding
Drug T 1/2 (h) Tss (d) kg) (%) Therapeutic range Dosage IV load dose Monitor Guidance advice
Bromide 20–46 100– 0.45 0 Monotherapy: 1000–3000 40–60 mg/ 3 % Sodium At 1 and 3 months and then Synergistic effect with
days 200 mg/L; with phenobarbital at kg orally bromide 800 q6 months or q1 month PB
1500–2500 mg/L q24h mg/kg/24h post dose change No hepatotoxicity
Inexpensive
Clorazepate 5–6 1–2 1.6 85 20–75 μg/mL (nordiazepam) 2–4 mg/kg No NR Longer acting than
PO q12h diazepam
Complex partial
seizure therapy
Inexpensive
Felbamate 5–6 1–2 1.0 25 25–100 mg/L 20 mg/kg No NR Complex partial
PO q8h seizure therapy
Risk of blood dyscrasia
Expensive
Gabapentin 2–4 1 0.2 0 4–16 mg/L 10–20 mg/ No NR For use with liver
kg PO compromised patients
q8–12h
Levetiracetam 4–8 and 2–3 0.5 <10 Variable 10–40 mg/ 30–60 mg/ Only to establish if Very well tolerated
2–4 with kg orally kg/15 min elimination half‐life is very Minimal liver
PB q8–12h short metabolism
Use in older patients
first
Phenobarbital 24–40 10–14 0.8 40 15–35 mg/dL 2.5 mg/kg 16 mg/kg/5 At 14, 45 and 180 days, then Effective and
Optimal level is 20 mg/dL orally q12h min q months or 14 day post predictable all seizure
dose change types
Close monitoring first
3 months is essential
Zonisamide 15–20 3–4 1.5 50 10–40 μg/mL 5–10 mg/kg No At 2 and 6 weeks then q6 Effective and
PO q12h months or 14 day post dose predictable all seizure
change types
Well tolerated Generic
available
Lacosamide ND ND ND ND ND 5 mg/kg 3 mg/kg/15 ND Well tolerated Very
q12h min expensive
Rufinamide 5–14 2–4 ND ND ND 20 mg/kg No At 1 week and q6 months Well tolerated
PO q12h Very expensive
IV, intravenous; ND, not determined; NR, not recommended; PB, phenobarbital; PO, by mouth (per os).