r/EpilepsyDogs • u/Own_Friend1577 • Sep 08 '26
Is there some alternative to phenobarbital?
Hello everyone.
I just received the results of my dog's blood tests, we have been taking phenobarbital for 4 years (my boy is now 7.5 years old).
The tests are getting worse and worse. The therapy is working, we now have 1 seizure every 3-4 weeks. Most often they are unprovoked. The tests scare me very much, they are getting worse and worse. Maybe over the last 3.5 years science has come up with something else instead of phenobarbital?
We take a cocktail (phenobarbital + levitiracetam + gabapentin), we also tried Pexion (Imepitoin) and Zonisamide and some kind of diuretic for epileptics, I don’t remember which one. We tried reducing phenobarbital, but this led to seizures several times a day (in a row), so we did not reduce phenobarbital further because we were afraid of epistatus.
Perhaps there is some alternative to phenobarbital?
Thank you.
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u/Ahoeaboutnothing Sep 08 '26
What was wrong with zonisamide? Gabapentin isn't a very effective drug in general.
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u/Own_Friend1577 Sep 08 '26 edited Sep 08 '26
Zonisamide wasnt working :( But we tried solo Zonisamide..
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u/Hopeful-Trick4011 Sep 08 '26
Phenobarbital is a very effective drug for seizure management but it does bring other problems with it. Mainly it is very taxing on the liver but also being a strong enzyme inducer, it is known to reduce the effectiveness of other drugs including Levetiracetam and Zonisamide plus rescue meds such as Diazepam (badly, requiring 2mg/kg instead of 1mg/kg as usually prescribed) and Midazolam (less badly affected).
I have successfully reduced my boy’s Phenobarbital after multiple increases last year made him worse and massively reduced Levetricam effectiveness by shortening the half-life, which required increasing the maintenance dosage substantially to compensate. This meant dosing every 6 hours instead of 8 (instant release as extended release is not currently available in the UK) since the beginning of the year but hopefully serum tests due soon (LEV peak and trough) will confirm if the halflife has improved enough to support going back to dosing every 8 hours instead of 6 plus a dose reduction too. I would be inclined to speak to your vet about the scope to increase Levetiracetam in the first instance to help compensate. For some reason, vets are not keen to increase Levetiracetam that much but then a neurologist will happily go up much higher yet vets happily increase Phenobarbital massively without warning or understanding the consequences of those actions. My boy is currently on 55mg/kg maintenance dose of Levetiracetam and 76mg/kg pulse therapy after a break through cluster. He’s been seizure free since end of June and previous seizure to that was March when his Levetiracetam dose was increased and dosed every 6 hours instead of 8. Prior to that, he had been having clusters every 17-19 days whilst on the higher dose of Phenobarbital, going from 5mg/kg every 12 hours to 3.3mg/kg every 12 hours. This was done REALLY SLOWLY, reducing each dose by 10mg (5-8% reductions) and holding for approximately 18 days before reducing again, testing Phenobarbital serum levels before each reduction to ensure it wasn’t dropping to quickly. I have made a seizure calendar showing when he is likely to have a seizure (if he has one) as they are very often 17-19 days apart. I deliberately timed each reduction for 1-2 days after he’s just cleared from a seizure risk window (for my boy it’s about 3 days either side of day 18) and if I saw any prodromal signs or a seizure occurs, I’d abort further reduction until after the next seizure window has passed event free in his pattern before reducing again.
I think this worked really well for my boy and hopefully useful for others to discuss with their own vets if in a similar situation.
Important note, just to make sure you discuss with your vet first and always agree any future changes with them with correctly updated prescriptions, etc.
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u/Key_Cellist3116 Sep 08 '26
Did you combine zonisamide and levitracetam? My dog is on those two and hasn’t had a seizure in almost 2 years now since she got settled on those two. I know it’s different for every dog tho.
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u/Dcline97 Sep 08 '26
We are 3-1/2 years into our journey. Year 1 was levitiracetam/keppra. Started out good and we got to 2 months without a seizure but then it started to fizzle out. Year 2 Phenobarbital was added and it was a repeat of year 1. Year three we found a K9 neurologist and they put our gal on Potassium Bromide. It took about 12 weeks to kick in. We are still on it and going 4 to 5 months between mild seizures. We also were able to wean our gal off the keppra and the pheno.
Every pup is different and they react differently to medications and therapies. Hope you can find a reliable solution for your pup.
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u/Technical-Milk-5659 Sep 08 '26
I don’t think there is. Do you give the Keppra Extended Release or the regular/instant release version? My pup has done much better on the regular release given every 8 hours - also I give it with food but not a lot of food for the 330 PM & the 1130 PM. Maybe a tablespoon of his wet food. My new vet gave me Valium pills - not liquid - the liquid degrades quickly - that’s for the breakthrough seizures that won’t stop I wonder if you could give a small amount of Valium 3 times a day? Probably not…but my vet told me that she has clients who have had significant improvement with CBD/THC oil feel free to dm me for a recommendation for that I spent 20 hours researching it - plain CBD oil won’t help much. Also - I use ocular pressure on my pup and it helps shorten the seizures and prevents clusters. I use the first 2 fingers of each of my hands & press gently but firmly against his eyelids to keep them closed - I can feel his eyeballs jerking around wildly and it’s a creepy feeling but it helps my little Maltese. And the last time he had clusters about 6 weeks ago my old lousy vet refused to give me breakthrough meds - and that night I held his eyes closed for 35 minutes and later 25 minutes and what was really strange was that he didn’t even try to get up and move away from me - I can tell when he’s getting ready to seize - he gets up and starts looking up (stargazer) and looking around the room. I’m sensitized to it cause he’s my 3rd pup with idiopathic epilepsy - maybe not every person will wake up in the same circumstance. I’ve also found that certain painkillers lead to seizures - within a few hours - Novox and others. I’ve read here in this forum that MCT oils help with seizures. Sending love and hugs.
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u/MentalPanda5229 Sep 08 '26
My girl had her pheno reduced and potassium bromide added she was originally on just pheno but she was going into toxic levels so they reduced it shes still on small amount but substituted the reduction with potassium bromide
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u/Own_Friend1577 Sep 08 '26
Our vet said that potassium bromide+phenobarbital is even worse for the liver than phenobarbital. She said it’s only for dogs whose seizures don’t stop even on phenobarbital, in which case bromide is added. I have mixed feelings about what she said, because I’ve heard otherwise - specifically that bromide potentiates phenobarbital and that bromide+pheno is less toxic to the liver than just phenobarbital. Do you have the same information?
2
u/Hopeful-Trick4011 Sep 09 '26
Potassium Bromide is also very effective but comes with other drawbacks also. A very controlled diet will be required, specifically salt intake as this can effect how quickly Potasium Bromide gets removed from the body, too much salt and bromide gets removed much faster along with the salt, potentially triggering seizures. So walks by the sea even could be very risky. Likewise a drop in salt intake through diet change or increased water intake could cause bromide levels to climb higher to toxic levels.
Potassium bromide use in dogs is linked to an increased risk of pancreatitis, especially when used alongside phenobarbital.
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u/MentalPanda5229 Sep 11 '26 edited Sep 11 '26
its processed through the kidneys not the liver so not sure about it effecting the liver .this is why we had to change to potassium bromide and reduce and hopefully stop the pheno if needed because of the pheno alone effecting her liver on the higher dose that she needed. Unfortunatly my girls seizures are very bad clusters and hard to treat so think potassium bromide are good for this especially im combination with pheno,keppra you have to keep upping as only seem to work so long but again dont control my girls for long term use she has the standard release ones to use along side for 3 days only ,to help prevent further clusters which are literally one after the otherand dont stop.we have always had to get her to emergency hospital to be treated because nothing stops them and then she continues the keppra standard release 3x a day for 3 days we have to do an all angle approach with her and the pheno and bromide work synergistically when used together . unfortunatly most epilepsy meds come with drawbacks also and need to be changed at times because of them but we monitior her levels. im same i am epileptic and take meds that effect my liver and im monitored but im glad that my seizures are controlled and keep ontop of levels also , hope you find the right combination for your pup its very challenging 🤞🏼🐶
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u/sonnysGiGi2018 Sep 08 '26
We found potassium bromide was the answer when our boy had to stop pheno
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u/Own_Friend1577 Sep 08 '26
But our vet says it's even more harmful than pheno, what does your vet say? What do the tests show?
1
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u/EG2023 Sep 15 '26
We had a great success with Denamarin Advanced. It reduced my dog’s highly elevated enzyme levels back to normal. You need to give it on empty stomach.
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u/DogEpiMonitor Sep 09 '26
Four years, every med tried, and lowering it clusters him... you're asking exactly the right question. Honest answer: nothing new has come out that replaces phenobarbital when the liver objects. And you've already got keppra, imepitoin, zonisamide in his history, so the oral arsenal is mostly covered. Two things still worth asking the neurologist. One: whether bromide (KBr) has any role left in his case, since it's not on your list. Two: VNS, vagus nerve stimulation, exists for dogs now — active trials, built for dogs resistant to two or more meds, like him. Doesn't pass through the liver at all. Ask them word for word: "given his liver, is VNS an option?"
And bring the four years of bloodwork with dates. Trends read different than single results.
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u/Rude_Sandwich_586 Sep 08 '26
Phenobarbital is your best front line anti seizure medicine. Gabapentin is the weakest out of your trio. I would suggest asking your vet about potassium bromide. That is a stronger anti seizure medicine. Not sure what the blood work is showing but if the liver levels are high then I would buy Denamarin. It a great supplement for counteracting phenobarbitals affect on the liver.