Has anybody had their dog put on phenobarbital for seizures on an "as needed" basis?
October 24, 2010 8:22 PM   Subscribe

Has anybody had their dog put on phenobarbital for seizures on an "as needed" basis?

We have a 12 year old pug. We adopted him when he was 10 so we don't know his entire medical history, but last week, for the first time that we know of, he had a seizure. I guess you would call it a grand mal because there was no mistaking it - he was shaking and frothing and the whole bit. And he had another one several hours later. We took him to the vet first thing in the morning and the vet took his blood for testing and gave us a prescription for phenobarbital. He said as long as the seizures weren't happening more than once a month not to worry too much and just give him the meds when it seemed like he might be getting ready to have another one.

That sounded okay to us, but when I called to get the blood test results (nothing but a low thyroid), I talked to another vet at the same practice who told me he should be taking the phenobarbital daily especially considering his age. Which vet am I supposed to believe? Has anybody treated their epileptic dog with phenobarbital only when they think the dog needs it?

All the info I'm reading on the internet suggests that phenobarbital needs to build up in the bloodstream to be effective. But it can also be used to stop a seizure in progress. But it takes 4 hours to start working. It makes no sense.

At any rate, I decided to try the "as needed" plan and switch to the daily plan if he has another one. So far, he hasn't had another one, but I did dose him up twice in the past week, once right after the vet visit and once today (he seemed a little jumpy but I was probably just being a neurotic dog-mom).

Complicating things is the fact that phenobarbital seems to make my dog hyperactive and clumsy, which are also the symptoms he seemed to have in the pre-seizure stage (I remember noting how his eyes were bugged out more than usual). When he is his normal self, he is very chill and drowsy.

Also, ever since we got back from the vet, he seems to lose his balance every several seconds when he's standing still (though he can walk fine) and this is with and without the phenobarbital. I don't know if he injured himself during one of the seizures or if he has brain damage now or what. He doesn't seem to be in any pain.
posted by Jess the Mess to Pets & Animals (16 answers total) 2 users marked this as a favorite
Best answer: As the mommy of an old, sick dog - GET THEE TO AN INTERNAL MEDICINE SPECIALIST.

Normal vets are great at normal vet stuff. This is not normal vet stuff.
posted by k8t at 8:34 PM on October 24, 2010

My folks' poodle had seizures and in his specific case, the phenobarbital was not optional-- we always knew when he started spitting them up and hiding them, because he'd seize again.

You might bring up the loss of balance with your current doc and see if a referral to a bigger vet hospital is in order.
posted by fairytale of los angeles at 8:46 PM on October 24, 2010 [1 favorite]

I had a dog who seized for 10 years - you need a specialist. (My dog took no meds FWIW.)
posted by thatone at 9:00 PM on October 24, 2010

Best answer: k8t is overreacting.
We have a seizure kitty. Both vets we've seen about him have gone with the daily plan. Yes this is a cat, but the second vet, which we've stuck with, has a dog who also has seizures and indicated the overall approach is the same. They started him on the lowest dose, we've tracked recurrence over time and they recently increased it after some more follow-up and blood tests. The phenobarbital apparently likes to build up in the liver and do damage, but he's been okay, and the increased dose has slowed down the recurrence even more.

This is speculation—meaning go back and talk to your vet(s)—but what seems most likely is that the first is just being more conservative, since you said this is the only seizure ever so far. Note in particular that the first vet almost certainly knows more about your specific animal's case than the second one. By the time we got to medication(there was initially suspicion it was a food thing), the cat had been having them every other week, and so we might've skipped a couple of steps back around where you are at the moment.

The secondary seizure is common, sort of an aftershock; expect it.

The general point here is that you really just need to talk to your vet some more before trying to go over his/her head. Bring up the conflicting instructions to get clarification, and mention those side-effects, though I'd personally guess they're temporary while the medication is being introduced.
posted by Su at 9:00 PM on October 24, 2010 [1 favorite]

Just so as not to seem like I'm dismissing k8t's comment off-handedly, the vet who started us on the regimen was at a specialist clinic. She then sent us back to the "normal" vet to work with until such time as anything more interesting came up. Continuing a path with her would've involved MRIs and several thousand dollars to probably find out nothing. And we'd already had a record of seizures by that point; a single one is probably not going to be terribly alarming to them if the dog's otherwise been perfectly healthy.
posted by Su at 9:17 PM on October 24, 2010

K8t's not overreacting- go see an internal medicine specialist please.
posted by TheBones at 9:23 PM on October 24, 2010

Also be aware that the drug you've been prescribed is not the only seizure med available for dogs. Ask your vet about Keppra -- if your vet doesn't know what that is, find a vet that actually keeps their knowledge on seizure meds current.

My vet prescribed it for my 4 year old lab -- it has all but stopped the seizures and came with no side-effects that I've seen whatsoever.
posted by toomuchpete at 9:39 PM on October 24, 2010

Best answer: My dog was on phenobarbital for seizures his whole life. I've never heard of taking it on an as-needed basis; we could never predict when a seizure would happen. If he received his medication on time, he would still sometimes have 1 or 2 seizures a month. On the very few occasions when we forgot to give him his meds he was practically guaranteed to have a seizure within a day or two.

Make sure your dog is receiving the correct dosage. I once had a vet prescribe nearly 2x the recommended loading dose of potassium bromide (another seizure medication). I only caught the error (thankfully before giving it to my dog), because I was thorough in researching the medication. The correct dosage of phenobarbital is 3-5 mg / kg administered twice daily (that's 3-5 mg of phenobarbital, per kilogram of your dog). You can find some veterinary neurology textbooks on books.google.com, for example, in A Practical Guide to Canine and Feline Neurology by Curtis W. Dewey, pg 243 and Neurology for the smaall animal practitioner by Cheryl L. Chrisman, p. 106. After a couple of weeks on phenobarbital, the dog's serum levels should be checked to make sure that the correct (therapeutic) amount of phenobarbital is actually in his system.

An alternative medication is potassium bromide. Unlike phenobarbital, it does not potentially damage the liver. Though you may not be as concerned about possible long term effects on an older dog. We tried switching to potassium bromide, but it was difficult to administer since our two options were having it compounded in a capsule or a liquid, both of which my dog refused to take.

If I were you, I'd cross reference your dog's prescription with the dosage recommended in one of the neurology texts and bring any questions or concerns up with your vet, or get a second opinion.

Best of luck to you. I know how hard it is watching your best friend have a seizure, and not be able to help them or help them understand what happened.
posted by ellenaim at 9:42 PM on October 24, 2010

i am also part owner of Su's seizure cat (who actually does have central nervous system damage from his days as a lost kitten, possibly birth).

please be careful when getting a second opinion from any sort of specialist. i did and it didn't work. frankly, it resulted in me being taken advantage of. the specialist prescribed us the same phenobarb the vet did—but from a pharmacy in a different state who insisted it needed to be refrigerated and shipped, basically doubling the cost. if you trust your vet, use their advice. pay close attention to the bloodwork to make sure his liver's okay.

given your dog's age, a deeper look might be worth it, but if he's only had a single seizure, i've never heard anyone call that cause for a daily dosage.

his new clumsiness does point to something new happening in his noggin from what my vet's told me, but be careful taking medical advice from the internet. everyone's body operates very differently.
posted by patricking at 9:54 PM on October 24, 2010

Best answer: I've worked with dogs taking phenobarbital everyday, and with a few that take it as needed.
The dogs that took it as needed showed obvious signs (though they were different for each dog) and would get a pill as soon as the signs were noticed. I've never seen these dogs have a seizure.
These are dogs that go to dog day care and have somebody watching and interacting with them almost all the time. If a dog is going to be home alone for 8+ hours a day, I don't know that I'd want to go that route.
Talk to your vet about your concerns.
posted by gally99 at 10:01 PM on October 24, 2010

My understanding of pheno (from a foster cat and my MIL's beloved dog) is that once they start it, they need to stay on it all the time -- starting at a very low dose, and upping it by teeny amounts if they have 'breakthrough' seizures. I am also under the belief that it needs to build up and reach a steady state in the bloodstream.
posted by MeiraV at 6:42 AM on October 25, 2010

Best answer: First off, as a veterinary medical professional (but not your veterinary medical professional), I encourage you to take your pet to an experienced internist.

I would also caution you against taking ANY medical advice (including my own) from people who haven't physically examined your pug and who are not veterinary medical professionals.

(You cannot compare, for example, your dog to Su's seizure cat. Different species, different histories, different veterinarians, etc.)

Phenobarbital requires regular dosing over time to reach a steady state in the patient. For treatment of epilepsy, dosage ranges from 1-5 mg/kg given by mouth every 8-12 hours. Sometimes a loading dose of 20mg/kg is given intravenously so that the patient reaches steady state faster.

"Dogs may exhibit increased symptoms of anxiety/agitation or lethargy when initiating therapy. These effects are generally transitory in nature....Sedation and/or ataxia (wobbliness) often become signifcant concerns as serum levels reach the higher ends of the therapeutic range...Increases in liver enzymes are well described for phenobarbital in dogs and are not necessarily indicative of liver dysfunction... Phenobarbital can alter thyroid testing. Decreased total and free T4, normal T3, and either normal or increased TSH have been reported...Compliance with therapy must be stressed to clients for successful epilepsy treatment. Encourage client to give doses at the same time each day."

This is from Plumb's Veterinary Drug handbook, the essential reference at most veterinary practices.

I encourage you to get a second opinion. Make sure that the records from your visit to the first veterinary office are available to your second opinion for review. If it were my pug, I would discontinue phenobarbital and take him down to your local College of Veterinary Medicine.

Good luck!
posted by Seppaku at 6:53 AM on October 25, 2010 [4 favorites]

My parents had two dogs who had problems with seizures (one due to meningitis and one due to a brain tumor). Both had to take it daily for a long period of time (at least several months) after they were treated for the illness that caused the seizures, but they were eventually given lower and lower doses until the vet was confident that they weren't going to have seizures anymore without it.
posted by Kimberly at 9:03 AM on October 25, 2010

I want to add, again, as the owner of a dog with health issues and as an active member of a forum for my dog's condition:

I've been SHOCKED at the lack of up-to-date knowledge from many vets. 2nd opinions are important.
posted by k8t at 9:33 AM on October 25, 2010

Response by poster: Thanks everybody, lots of useful advice. I was unaware there was even such a thing as a veterinary specialist and didn't know you could take your pets to a College of Veterinary Medicine.

I'll be taking him somewhere soon.
posted by Jess the Mess at 5:45 PM on October 25, 2010

Response by poster: Hey everybody, just wanted to update and let you know I took the advice from Seppaku and theBones to take the puglet to a university vet clinic. I'm so glad I did. We saw a great vet there. He was knowledgeable, straightforward, amiable, and clearly more in it to help us than to make money off of us. I feel like I now have a complete handle on what's going on with dog and what our options are.

He'll be going on phenobarb regularly (according to our awesome new vet and as some of you pointed out, the phenobarb "as needed" recommendation is useless since it needs time to build up in the bloodstream) and we're going to have an MRI done on him as the vet thinks he might have a brain tumor. It sounds awful but the vet sounded hopeful that if a tumor was discovered we could do something about it. It's gonna be expensive but damned if we don't love our little goblin and luckily we have some cash in the emergency fund right now.

So just wanted to say thanks again for the great advice from everyone. I feel so much better now.
posted by Jess the Mess at 7:58 AM on December 12, 2010

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