Seizures in dogs are a common manifestation of neurological disorder. They are characterized by a wide spectrum of clinical signs and consequences. Canine epilepsy – idiopathic or symptomatic is the usual cause of seizures in dogs. Most common cause is idiopathic epilepsy, which can be inherited in many breeds.
An accurate diagnosis, where the cause can be identified – even though it is sometimes difficult – is of utmost importance when initiating the treatment. When seizures are triggered by other medical conditions, such as: brain tumors, strokes, meningitis, etc., prompt treatment is crucial for the condition’s prognosis and a better quality of life for the canine patient. Once the diagnosis is made, the focus should be on seizure control in the case of epilepsy and on addressing the underlying cause in the case of other medical conditions.
Managing the seizures, by controlling their frequency, severity and side effects is the purpose of anti-epileptic treatment.
Otis, a 4 year old German Shepherd is brought to the veterinary office by his owner – a retired lady that appears to be healthy and active. The owner reports that Otis lost a few pounds in the last few months, does not have the same appetite, has bouts of diarrhea and vomiting. He is on phenobarbital tablets for almost two years now to manage the canine idiopathic epilepsy he was diagnosed with. Otis came for regular follow up visits to monitor his treatment and its side effects. The medication controlled the seizures and appeared to be well-tolerated with minimal side effects until the last visit.
The veterinarian examines Otis and runs new lab tests, with the focus on liver function.
He concludes that Otis must discontinue Phenobarbital due to liver damage.
The owner is advised on the gradual tapering off phenobarbital and given a chart on how to proceed with the weaning of the medication. Prescriptions are written with precise dosage reductions to be prepared at a veterinary compounding pharmacy. Recommendations for liver cleanse with supplements are also given at this visit. The owner is informed that Otis will start taking Potassium Bromide after tapering off Phenobarbital, to keep the seizures under control.
On the next follow up visit, the owner reports that Otis is successfully off Phenobarbital. No seizure occurred during this interval and the symptoms and side effects caused by liver damage have diminished substantially.
Potassium Bromide is prescribed to be prepared at a veterinary compounding pharmacy. Most commonly, it is prepared as an oral solution. Precise strength/dose is calculated based on the dog’s weight. The owner is counseled both by the veterinarian and the compounding pharmacist about Otis’s new medication – why is it prescribed, how it is administered, what are the potential side effects, etc.
A follow up visit is scheduled in three months.
Case discussion: managing canine idiopathic epilepsy requires the commitment time and money by the owner. Regular follow up visits are a must to measure the concentration of the anticonvulsant drug. The veterinarian may adjust the dose, if needed, based on the findings of the lab work. In all likelihood, Otis will be treated for the rest of his life for this condition. Like many other drugs used in veterinary medicine, the anticonvulsant medications we presented with this case, are not FDA approved for use in dogs. Phenobarbital is approved for humans and used off label in veterinary patients. Officially, from the FDA’s perspective, the use of the medication is considered compounding. When specific dosage forms, flavors or exact strengths are needed, the only obvious solution is compounding. There are currently no FDA approved commercial products of Potassium Bromide for humans or animals. The USP has developed a validated compounded preparation monograph for Potassium Bromide oral solution of 250 mg/ml. It appears clear from this case study that any successful veterinarian must know about and work collaboratively with a good compounding pharmacy that specializes in veterinary compounding.
Selecting the right compounding pharmacy as your long-term trustworthy partner is a major decision you must make for your practice. Let HALDEY Pharmaceutical Compounding be that partner for you and allow one of our experienced compounding pharmacists explain to you why you should choose us.
