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Mojarradi A, De Decker S, Van Meervenne S. Once-a-day oral treatment with phenobarbital in cats with presumptive idiopathic epilepsy. J Feline Med Surg 2023; 25:1098612X231196806. [PMID: 37747329 PMCID: PMC10812035 DOI: 10.1177/1098612x231196806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Phenobarbital (PB) q12h is the most common treatment recommendation for cats with recurrent epileptic seizures. Medicating cats may be challenging and result in decreased quality of life for both cat and owner. The aim of this retrospective study was to evaluate treatment with oral PB q24h in cats with presumptive idiopathic epilepsy. METHODS Nine cats with presumptive idiopathic epilepsy, receiving oral PB q24h, were included in a retrospective descriptive study. RESULTS Seizure remission was achieved in 88% (8/9) of the cats and good seizure control in 12% (1/9) of the cats, treated with a mean dose of oral PB of 2.6 mg/kg q24h (range 1.4-3.8 mg/kg). No cats required an increase of their PB frequency at any time during a mean follow-up period of 3.5 years (range 1.1-8.0 years). No cats displayed side effects or issues with compliance at the last recorded follow-up. CONCLUSIONS AND RELEVANCE Once-a-day administration of PB for feline epilepsy was safe and resulted in satisfactory seizure control for the nine cats included in this study. The results of this study justify exploring this topic further in larger prospective studies.
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Affiliation(s)
- Abtin Mojarradi
- IVC Evidensia Referral Hospital in Helsingborg, Skåne, Sweden
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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2
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Hasegawa D, Kanazono S, Chambers JK, Uchida K. Neurosurgery in feline epilepsy, including clinicopathology of feline epilepsy syndromes. Vet J 2022; 290:105928. [PMID: 36347391 DOI: 10.1016/j.tvjl.2022.105928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/07/2022]
Abstract
Feline epilepsy is treated with antiseizure medications, which achieves fair to good seizure control. However, a small subset of feline patients with drug-resistant epilepsy requires alternative therapies. Furthermore, approximately 50 % of cats with epileptic seizures are diagnosed with structural epilepsy with or without hippocampal abnormality and may respond to surgical intervention. The presence of hippocampal pathology and intracranial tumors is a key point to consider for surgical treatment. This review describes feline epilepsy syndrome and epilepsy-related pathology, and discusses the indications for and availability of neurosurgery, including lesionectomy, temporal lobectomy with hippocampectomy, and corpus callosotomy, for cats with different epilepsy types.
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Affiliation(s)
- Daisuke Hasegawa
- Laboratory of Veterinary Radiology, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan; The Research Center for Animal Life Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan.
| | - Shinichi Kanazono
- Neurology and Neurosurgery Service, Veterinary Specialists and Emergency Center, 815 Ishigami, Kawaguchi, Saitama 333-0823, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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3
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Gómez Álvarez CM, Soler Arias EA. Feline hyperesthesia syndrome: Epilepsy as possible aetiology in two cats. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Elber Alberto Soler Arias
- Hospital Escuela Universidad de Buenos Aires Facultad de Ciencias Veterinarias Buenos Aires Argentina
- Endovett Endocrinologia Veterinaria Buenos Aires Argentina
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Hermans M, Charalambous M, Pakozdy A, Eisl-Glantschnigg U, Neßler J, Van Meervenne SA, Serrano G, Cornelis I, Van Ham L, Paepe D, Broeckx BJ, Bhatti SF. Evaluation of the effect of phenobarbital administration on the biochemistry profile, with a focus on serum liver values, in epileptic cats. J Feline Med Surg 2021; 24:530-538. [PMID: 34387120 DOI: 10.1177/1098612x211037431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Phenobarbital (PB) is the most common antiseizure drug (ASD) used for the management of feline epilepsy. In dogs, PB is known to cause serum liver enzyme induction and hepatotoxicity, especially after administration long term or in high concentrations. In cats, insufficient evidence is available to draw similar conclusions. The aim of this study was to evaluate the effect of PB administration on the serum biochemistry profile of epileptic cats. As an additional objective, other adverse effects arising, related to PB treatment, were recorded. METHODS Medical records of four veterinary centres were retrospectively reviewed for epileptic cats receiving PB treatment. Cats were included if they had a diagnosis of idiopathic epilepsy or structural epilepsy; a normal baseline serum biochemistry profile; at least one follow-up serum biochemistry profile; no concurrent disease or had not received medication that could possibly influence liver function or lead to serum liver enzyme induction. Alkaline phosphatase, alanine aminotransferase (ALT), aspartate transaminase and gamma-glutamyl transferase activities, and total bilirubin, bile acids, glucose, albumin, total protein, urea and creatinine concentrations before and during PB administration were recorded. PB serum concentration was also recorded, when available. RESULTS Thirty-three cats (24 males, nine females) with a median age of 3 years (range 2 months to 12 years) met the inclusion criteria. Idiopathic or structural epilepsy was diagnosed in 25 (76%) and eight (24%) cats, respectively. The follow-up period ranged from 9 to 62 months. This study found an increase in ALT in three cats, possibly related to a PB serum concentration >30 µg/ml. No statistically significant increase in serum liver enzymes or other evaluated biochemistry parameters was found by comparing pre- and post-treatment parameters. CONCLUSIONS AND RELEVANCE PB administration did not result in hepatic enzyme induction or other biochemical abnormalities in cats. This strengthens the safety profile of PB as an ASD in cats.
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Affiliation(s)
- Michelle Hermans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Ursula Eisl-Glantschnigg
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Jasmin Neßler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart Jg Broeckx
- Laboratory of Animal Genetics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie Fm Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Marsh O, Corsini G, Van Dijk J, Gutierrez-Quintana R, De Risio L. Prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. J Feline Med Surg 2020; 23:59-66. [PMID: 32484071 DOI: 10.1177/1098612x20924925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The study objective was to investigate the prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. METHODS The medical records of two veterinary referral clinics from 2007 to 2017 were searched for cats fulfilling the inclusion criteria of a diagnosis of epilepsy, treatment with phenobarbitone and available follow-up information on the occurrence of adverse effects. Follow-up information was obtained from the medical records of the primary veterinarian and referral institutions and a questionnaire completed by the cats' owners. RESULTS Seventy-seven cats met the inclusion criteria. Fifty-eight were affected by idiopathic epilepsy and 19 by structural epilepsy. One or more of the following adverse effects were reported in 47% of the cats: sedation (89%); ataxia (53%); polyphagia (22%); polydipsia (6%); polyuria (6%); and anorexia (6%). Logistic regression analyses revealed significant associations between adverse effect occurrence and both phenobarbitone starting dosage and administration of a second antiepileptic drug (AED). For each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times. When a second AED was used, the likelihood of adverse effects increased 3.2 times. No association was identified between epilepsy aetiology and adverse effect occurrence. An idiosyncratic adverse effect, characterised by severe neutropenia and granulocytic hypoplasia, was diagnosed in one cat. This resolved following phenobarbitone discontinuation. CONCLUSIONS AND RELEVANCE The prevalence of phenobarbitone-associated adverse effects was 47%. Sedation and ataxia were most common. These are type A adverse effects and are predictable from phenobarbitone's known pharmacological properties. In the majority of cases, adverse effects occurred within the first month of treatment and were transient. Idiosyncratic (type B) adverse effects, which were not anticipated given the known properties of the drug, occurred in one cat. Increased phenobarbitone starting dosage and the addition of a second AED were significantly associated with the occurrence of adverse effects.
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Affiliation(s)
- Oliver Marsh
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Giulia Corsini
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Jan Van Dijk
- Centre for Preventive Medicine, Animal Health Trust, Newmarket, UK
| | | | - Luisa De Risio
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
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Johnson ER, Taylor AR, Boothe DM, Gray-Edwards HL, Winter RL, Martin DR. Pharmacokinetics of a commercially available product and a compounded formulation of extended-release levetiracetam after oral administration of a single dose in cats. Am J Vet Res 2019; 80:950-956. [PMID: 31556719 DOI: 10.2460/ajvr.80.10.950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare pharmacokinetics of levetiracetam in serum and CSF of cats after oral administration of extended-release (ER) levetiracetam. ANIMALS 9 healthy cats. PROCEDURES Cats received 1 dose of a commercially available ER levetiracetam product (500 mg, PO). Thirteen blood and 10 CSF samples were collected over a 24-hour period for pharmacokinetic analysis. After 1 week, cats received 1 dose of a compounded ER levetiracetam formulation (500 mg, PO), and samples were obtained at the same times for analysis. RESULTS CSF concentrations of levetiracetam closely paralleled serum concentrations. There were significant differences between the commercially available product and the compounded formulation for mean ± SD serum maximum concentration (Cmax; 126 ± 33 μg/mL and 169 ± 51 μg/mL, respectively), Cmax corrected for dose (0.83 ± 0.10 μg/mL/mg and 1.10 ± 0.28 μg/mL/mg, respectively), and time to Cmax (5.1 ± 1.6 hours and 3.1 ± 1.5 hours, respectively). Half-life for the commercially available product and compounded formulation of ER levetiracetam was 4.3 ± 2.0 hours and 5.0 ± 1.6 hours, respectively. CONCLUSIONS AND CLINICAL RELEVANCE The commercially available product and compounded formulation of ER levetiracetam both maintained concentrations in healthy cats 12 hours after oral administration that have been found to be therapeutic in humans (ie, 5 μg/mL). Results of this study supported dosing intervals of 12 hours, and potentially 24 hours, for oral administration of ER levetiracetam to cats. Monitoring of serum concentrations of levetiracetam can be used as an accurate representation of levetiracetam concentrations in CSF of cats.
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Hoshino Y, Inden T, Otaka R, Fukui D, Satoh H, Katayama M. Interaction of cyclosporine with phenobarbital in cats: a preliminary study. J Vet Med Sci 2019; 81:1621-1623. [PMID: 31597813 PMCID: PMC6895620 DOI: 10.1292/jvms.19-0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Phenobarbital (PB) decreases the cyclosporine (CsA) blood level in humans. However, the interaction of PB with CsA has not been reported in cats. This study investigated the effects of
multiple doses of PB on the pharmacokinetics of CsA in three healthy cats. The treatments included oral CsA 5 mg/kg alone and oral CsA 5 mg/kg plus PB 5 mg/kg for 4 weeks. Co-administration
of PB with CsA resulted in significant decreases in the oral bioavailability of CsA though both the first pass and elimination phases. These preliminary results suggest that oral
administration of multiple doses of PB increases the required CsA dosage in CsA-based immunosuppressive therapy in cats.
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Affiliation(s)
- Yuki Hoshino
- Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
| | - Takanori Inden
- Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
| | - Riko Otaka
- Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
| | - Daisuke Fukui
- Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
| | - Hiroshi Satoh
- Division of Veterinary Pharmacology and Toxicology, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
| | - Masaaki Katayama
- Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8 Ueda, Morioka, Iwate 020-8550, Japan
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Hazenfratz M, Taylor SM. Recurrent seizures in cats: Diagnostic approach - when is it idiopathic epilepsy? J Feline Med Surg 2019; 20:811-823. [PMID: 30139320 DOI: 10.1177/1098612x18791873] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Practical relevance: Seizures are one of the most common neurologic problems recognized in cats, affecting approximately 1-3% of the general population. Treatment options and prognosis are closely related to the underlying cause, so it is important that veterinarians are familiar with the diagnostic approach to cats with seizures and options for medical management. Series outline: This is the first of a two-part article series that reviews the diagnosis and treatment of seizures in cats. Part 1 outlines the classification and terminology used to describe epilepsy and epileptic seizures in cats, and discusses some of the most common and unique causes of recurrent seizures in cats. The diagnostic approach to cats with recurrent seizures is addressed, as are criteria for the diagnosis of idiopathic epilepsy. AUDIENCE This review of recurrent seizures in cats is intended for all veterinarians who are facing the challenges of seizure diagnosis and management in the feline patient. Evidence base: Recommendations for diagnosis and management of feline seizure disorders have historically been extrapolated from the canine and human literature. The information and guidance provided in this two-part series is based on a review of the recent published literature addressing seizure disorders and antiepileptic treatment in cats, as well as the authors' clinical experience.
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Affiliation(s)
- Michal Hazenfratz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | - Susan M Taylor
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N5B4, Canada
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Hazenfratz M, Taylor SM. Recurrent seizures in cats: Treatment - which antiepileptic drugs are recommended? J Feline Med Surg 2019; 20:825-834. [PMID: 30139319 DOI: 10.1177/1098612x18791874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Practical relevance: Seizures are one of the most common neurological problems recognized in cats, affecting approximately 1-3% of the general population. Treatment options and prognosis are closely related to the underlying cause, so it is important that veterinarians are familiar with the diagnostic approach to cats with seizures and options for medical management. Series outline: This is the second of a two-part article series that reviews the diagnosis and treatment of seizures in cats. Part 2 describes chronic medical treatment options and prognosis for cats with recurrent seizures, and acute treatment of status epilepticus. AUDIENCE This review of recurrent seizures in cats is intended for all veterinarians who are facing the challenges of seizure diagnosis and management in the feline patient. Evidence base: Recommendations for diagnosis and management of feline seizure disorders have historically been extrapolated from the canine and human literature. The information and guidance provided in this two-part series is based on a review of the recent published literature addressing seizure disorders and antiepileptic treatment in cats, as well as the authors' clinical experience.
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Affiliation(s)
- Michal Hazenfratz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | - Susan M Taylor
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N5B4, Canada
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10
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Barnes Heller HL, Trepanier LA, Robertson M, Mei C. Prospective crossover clinical trial comparing transdermal with oral phenobarbital administration in epileptic cats. J Feline Med Surg 2019; 21:1181-1187. [PMID: 30688552 DOI: 10.1177/1098612x18823577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare serum phenobarbital concentrations, adverse events and client satisfaction during 14 weeks of transdermal vs oral phenobarbital administration to epileptic cats. METHODS This was a prospective, fixed-order, crossover pilot study. Nine client-owned cats with presumptive or diagnosed idiopathic epilepsy were enrolled. Oral phenobarbital (PO-PB) was administered for weeks 1-14 (median starting dosage of 3.8 mg/kg [2.0-5.4 mg/kg/day] q12h); transdermal phenobarbital (TD-PB) was administered for weeks 14-28 (median starting dosage 18.8 mg/kg/day [17.6-24.0 mg/kg/day] q12h). Serum phenobarbital concentrations (S-PB) were measured at weeks 2, 14, 16 and 28. Client satisfaction questionnaires and biochemistry were evaluated at 14 and 28 weeks. RESULTS Median S-PB concentrations during oral administration were 21 µg/ml (observed range 11-40 µg/ml) at week 2 and 22 µg/ml (8-35 µg/ml) at week 14, and at the higher TD dosage were 18 µg/ml (0-42 µg/ml) at week 16 and 17 µg/ml (7-50 µg/ml) at week 28. Phenobarbital concentrations were significantly correlated with PO dosage at week 2 (r = 0.75, P = 0.03) but not at weeks 16 and 28. Significantly more dose adjustments were needed during the TD phase (P = 0.03), but 6/9 owners (67%) still preferred TD to PO administration. Adverse effects were mild and comparable in both groups. CONCLUSIONS AND RELEVANCE Therapeutic S-PB concentrations were achievable in some cats using TD-PB at 18 mg/kg/day q12h. Poor correlation between TD dosage and S-PB concentrations was observed and more dosage adjustments were required during TD administration. These findings necessitate close therapeutic drug monitoring if TD-PB is prescribed.
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Affiliation(s)
- Heidi L Barnes Heller
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lauren A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Michelle Robertson
- UW Veterinary Care Pharmacy, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Chaoqun Mei
- Institute for Clinical and Translational Research, and Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Krull DP, Thomovsky SA, Chen AV, Mealey KL, Papich MG. Evaluation of Transdermal Administration of Phenobarbital in Healthy Cats. J Am Anim Hosp Assoc 2018; 55:1-7. [PMID: 30427717 DOI: 10.5326/jaaha-ms-6670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose was to determine the safety and achievable serum concentrations of transdermally administered phenobarbital in healthy cats. The hypothesis was that transdermal phenobarbital would achieve therapeutic serum concentrations (15-45 µg/mL) with minimal short-term adverse effects. Enrolled cats had normal physical and neurologic exams and unremarkable bloodwork. Transdermal phenobarbital in a pluronic lecithin organogel-based vehicle was administered at a dosage of 3.0-3.1 mg/kg per ear pinna (total of 6.0-6.2 mg/kg) every 12 hr for 14 days. Serum phenobarbital concentrations were measured 3-6 hr after dosing at seven different times over 15 days. The mean and median serum concentration of phenobarbital at study completion were 5.57 and 4.08 µg/mL, respectively. Mean peak concentration and mean time to peak concentration were 5.94 µg/mL and 13.3 days, respectively. Mild adverse effects were observed. Potency was analyzed in three replicates of the transdermal phenobarbital gel administered; potencies ranged from 62.98 to 82.02%. Transdermal application of phenobarbital in healthy cats achieves a detectable, but subtherapeutic, serum concentration and appears safe in the short term. The use of therapeutic drug monitoring is recommended when this formulation of phenobarbital is used to ensure therapeutic serum concentrations are achieved.
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Affiliation(s)
- Daniel P Krull
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Stephanie Ann Thomovsky
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Annie Vivian Chen
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Katrina L Mealey
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Mark G Papich
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
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12
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Barnes Heller H, Granick M, Van Hesteren M, Boothe DM. Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats. J Vet Intern Med 2018; 32:1145-1148. [PMID: 29671898 PMCID: PMC5980453 DOI: 10.1111/jvim.15129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/19/2018] [Accepted: 03/07/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Multiple dose administration of antiepileptic drugs to cats presents a challenge for owners. Extended release levetiracetam (XRL) has once daily recommended dosing interval, but multiple dose administration of XRL has not been evaluated in cats. OBJECTIVE Evaluate serum levetiracetam concentrations and adverse clinical effects after 11 days of once daily XRL administration to healthy cats. ANIMALS Nine healthy privately owned cats, body weight ≥ 5 kg METHODS: Extended release levetiracetam (500 mg/cat) was administered PO q24h for 10 days. On day 11, blood was collected at trough, 4, 6, and 8 hours after tablet administration. Owners maintained records of adverse effects throughout study. Levetiracetam was quantitated in serum using immunoassay validated in cats. RESULTS Median dose 94.3 mg/kg q24h. Median (range) trough, 4, 6, and 8 hour serum levetiracetam concentrations were 7.0 (2.3-14.1), 82.6 (7.8-125.3), 92.3 (13.3-97.3), and 72 (22.8-96.4) μg/mL, respectively. Peak was not observed in 4 cats because of missed samples (n = 2) and failure to reach maximal concentration (Cmax ) by 8 hours (n = 2). Median time of maximal concentration (Tmax ) for the remaining 5 cats 5.2 (range 4-6) hours. Adverse effects were minimal and included ataxia (n = 1), sedation (n = 1), and vomiting or regurgitation (n = 1). All signs resolved without dose adjustment or additional treatment. CONCLUSIONS AND CLINICAL IMPORTANCE Mean trough serum levetiracetam concentrations were ≥5 μg/mL and adverse effects were minimal throughout dosing period, indicating that the drug was well tolerated. Once daily XRL (500 mg/cat) administration may provide an easier alternative to 3 times daily dosing of intermediate-release levetiracetam for epileptic cats.
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13
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Charalambous M, Pakozdy A, Bhatti SFM, Volk HA. Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy. BMC Vet Res 2018; 14:64. [PMID: 29499762 PMCID: PMC5834883 DOI: 10.1186/s12917-018-1386-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/21/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. However, there is a lack of information about the treatment of feline epilepsy and therefore a systematic review was constructed to assess current evidence for the AEDs' efficacy and tolerability in cats. The methods and materials of our former systematic reviews in canine epilepsy were mostly mirrored for the current systematic review in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. The studies were assessed with regards to their quality of evidence, i.e. study design, study population, diagnostic criteria and overall risk of bias and the outcome measures reported, i.e. prevalence and 95% confidence interval of the successful and affected population in each study and in total. RESULTS Forty studies describing clinical outcomes of AEDs' efficacy and safety were included. Only two studies were classified as "blinded randomised controlled trials". The majority of the studies offered high overall risk of bias and described low feline populations with unclear diagnostic criteria and short treatment or follow-up periods. Individual AED assessments of efficacy and safety profile showed that phenobarbital might currently be considered as the first choice AED followed by levetiracetam and imepitoin. Only imepitoin's safety profile was supported by strong level of evidence. Imepitoin's efficacy as well as remaining AEDs' efficacy and safety profile were supported by weak level of evidence. CONCLUSIONS This systematic review reflects an evidence-based assessment of the published data on the AEDs' efficacy and safety for feline epilepsy. Currently, phenobarbital is likely to be the first-line for feline epileptic patients followed by levetiracetam and imepitoin. It is essential that clinicians evaluate both AEDs' effectiveness and tolerability before tailoring AED to the individual patient. Further studies in feline epilepsy treatment are by far crucial in order to establish definite guidelines for AEDs' efficacy and safety.
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Affiliation(s)
- Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Sofie F. M. Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Holger A. Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Brookmans Park, UK
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15
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Szelecsenyi AC, Giger U, Golini L, Mothersill I, Torgerson PR, Steffen F. Survival in 76 cats with epilepsy of unknown cause: a retrospective study. Vet Rec 2017; 181:479. [PMID: 29097567 PMCID: PMC5748884 DOI: 10.1136/vr.104281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/12/2017] [Accepted: 08/18/2017] [Indexed: 11/04/2022]
Abstract
Survival of cats with epilepsy of unknown cause (EUC) has not been reported. Seizure semiology and its relationship to treatment outcome and survival was studied in a population of 76 cats. A questionnaire for seizure semiology was developed based on experimental data. Seizure semiology was characterised by owner interviews at least one year after discharge. Seizures were classified as (1) primary generalised and (2) focal without and (3) with secondary generalisation. Median age at seizure onset was four (range 0.3-18) years. One-third of cats with EUC presented with primary generalised seizures and 78 per cent of those with initially focal seizures progressed to secondary generalised seizures. Clinical signs of generalised seizures included sudden onset of loss of consciousness and tonic-clonic seizures, while cats with focal seizures had unilateral signs. Antiepileptic drug (AED) therapy was initiated in 62 cats. Complete remission rate was 42 per cent and the median survival time was 3.2 (range 1-11) years with or without AED, and 91 per cent were still alive at the time of interview. Neither semiology nor seizure type predicted survival, response to treatment and outcome in cats with EUC. A seizure-free status of more than 12 months was observed in 79 per cent of cats without AED.
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Affiliation(s)
- Arlette Cornelia Szelecsenyi
- Department of Clinical Veterinary Medicine, Small Animal Clinic, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Urs Giger
- School of Veterinary Medicine, Section of Medical Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorenzo Golini
- Department of Clinical Veterinary Medicine, Small Animal Clinic, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Centre, Laboratory of EEG and Long Term Monitoring, Zürich, Switzerland
| | - Paul R Torgerson
- Section of Veterinary Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Frank Steffen
- Department of Small Animals, Neurology Service, VetSuisse Faculty - University of Zurich, Zurich, Switzerland
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Raimondi F, Shihab N, Gutierrez-Quintana R, Smith A, Trevail R, Sanchez-Masian D, Smith PM. Magnetic resonance imaging findings in epileptic cats with a normal interictal neurological examination: 188 cases. Vet Rec 2017; 180:610. [DOI: 10.1136/vr.104142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/25/2022]
Affiliation(s)
- F. Raimondi
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | - N. Shihab
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | | | - A. Smith
- Langford Small Animal Referral Hospital; Langford Road Bristol BS40 5DU UK
| | - R. Trevail
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | | | - P. M. Smith
- Davies Veterinary Specialists, Manor Farm Business Park; Higham Gobion Hitchin SG5 3HR UK
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17
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Engel O, von Klopmann T, Maiolini A, Freundt-Revilla J, Tipold A. Imepitoin is well tolerated in healthy and epileptic cats. BMC Vet Res 2017; 13:172. [PMID: 28606140 PMCID: PMC5469074 DOI: 10.1186/s12917-017-1087-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/31/2017] [Indexed: 12/04/2022] Open
Abstract
Background Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. Results In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. Conclusion In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.
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Affiliation(s)
- Odilo Engel
- Boehringer Ingelheim Vetmedica GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany.
| | | | - Arianna Maiolini
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Jessica Freundt-Revilla
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Andrea Tipold
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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18
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Blades Golubovic S, Rossmeisl JH. Status epilepticus in dogs and cats, part 1: etiopathogenesis, epidemiology, and diagnosis. J Vet Emerg Crit Care (San Antonio) 2017; 27:278-287. [PMID: 28445615 DOI: 10.1111/vec.12605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/28/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review current knowledge of the etiopathogenesis, diagnosis, and consequences of status epilepticus (SE) in veterinary patients. DATA SOURCES Human and veterinary literature, including clinical and laboratory research and reviews. ETIOPATHOGENESIS Status epilepticus is a common emergency in dogs and cats, and may be the first manifestation of a seizure disorder. It results from the failure of termination of an isolated seizure. Multiple factors are involved in SE, including initiation and maintenance of neuronal excitability, neuronal network synchronization, and brain microenvironmental contributions to ictogenesis. Underlying etiologies of epilepsy and SE in dogs and cats are generally classified as genetic (idiopathic), structural-metabolic, or unknown. DIAGNOSIS Diagnosis of convulsive SE is usually made based on historical information and the nature of the seizures. Patient specific variables, such as the history, age of seizure onset, and physical and interictal neurological examination findings can help hone the rule out list, and are used to guide selection and prioritization of diagnostic tests. Electroencephalographic monitoring is routinely used in people to diagnose SE and guide patient care decisions, but is infrequently performed in veterinary medicine. Nonconvulsive status epilepticus has been recognized in veterinary patients; routine electroencephalography would aid in the diagnosis of this phenomenon in dogs and cats. CLINICAL SEQUELAE Status epilepticus is a medical emergency that can result in life-threatening complications involving the brain and systemic organs. Status epilepticus often requires comprehensive diagnostic testing, treatment with multiple anticonvulsant agents, and intensive supportive care.
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Affiliation(s)
| | - John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, 24060
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Balducci F, De Risio L, Shea A, Canal S, Stabile F, Bernardini M. Neurogenic urinary retention in cats following severe cluster seizures. J Feline Med Surg 2016; 19:246-250. [DOI: 10.1177/1098612x15602739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Case series summary Four cats that presented with severe cluster seizures developed neurogenic urinary retention in the postictal phase. None of the cats had previous seizures. Micturition was reported as normal in all cats for 3 or more years before seizure onset. All cats required a continuous rate infusion of propofol to control the seizure activity. In all cats manual bladder expression was performed every 8 h until recovery of normal micturition. One cat was started on phenoxybenzamine to reduce internal urethral sphincter tone. All cats recovered normal micturition within 4 weeks of the last cluster of seizures. Relevance and novel information Transient neurogenic urinary retention has not previously been reported in cats or dogs following severe cluster seizures. Urinary retention should be considered a potential postictal deficit, requiring prompt recognition and treatment to avoid urinary tract infection and detrusor muscle atony.
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Affiliation(s)
- Federica Balducci
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
| | - Luisa De Risio
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Anita Shea
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Sara Canal
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
| | - Fabio Stabile
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Marco Bernardini
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
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Sasaki K, Shimoda M. Possible drug-drug interaction in dogs and cats resulted from alteration in drug metabolism: A mini review. J Adv Res 2015; 6:383-92. [PMID: 26257936 PMCID: PMC4522589 DOI: 10.1016/j.jare.2015.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/10/2015] [Accepted: 02/15/2015] [Indexed: 12/13/2022] Open
Abstract
Pharmacokinetic drug-drug interactions (in particular at metabolism) may result in fatal adverse effects in some cases. This basic information, therefore, is needed for drug therapy even in veterinary medicine, as multidrug therapy is not rare in canines and felines. The aim of this review was focused on possible drug-drug interactions in dogs and cats. The interaction includes enzyme induction by phenobarbital, enzyme inhibition by ketoconazole and fluoroquinolones, and down-regulation of enzymes by dexamethasone. A final conclusion based upon the available literatures and author's experience is given at the end of the review.
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Affiliation(s)
| | - Minoru Shimoda
- Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Tokyo 183-8509, Japan
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Delamaide Gasper JA, Barnes Heller HL, Robertson M, Trepanier LA. Therapeutic serum phenobarbital concentrations obtained using chronic transdermal administration of phenobarbital in healthy cats. J Feline Med Surg 2014; 17:359-63. [DOI: 10.1177/1098612x14545141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seizures are a common cause of neurologic disease, and phenobarbital (PB) is the most commonly used antiepileptic drug. Chronic oral dosing can be challenging for cat owners, leading to poor compliance. The purpose of this study was to determine if the transdermal administration of PB could achieve serum PB concentrations of between 15 and 45 μg/ml in healthy cats. Nineteen healthy cats were enrolled in three groups. Transdermal PB in pluronic lecithin organogel (PLO) was applied to the pinnae for 14 days at a dosage of 3 mg/kg q12h in group 1 (n = 6 cats) and 9 mg/kg q12h in group 2 (n = 7 cats). Transdermal PB in Lipoderm Activemax was similarly applied at 9 mg/kg q12h for 14 days in group 3 (n = 6 cats). Steady-state serum PB concentrations were measured at trough, and at 2, 4 and 6 h after the morning dose on day 15. In group 1, median concentrations ranged from 6.0–7.5 μg/ml throughout the day (observed range 0–11 μg/ml). Group 2 median concentrations were 26.0 μg/ml (observed range 18.0–37.0 μg/ml). For group 3, median concentrations ranged from 15.0–17.0 μg/ml throughout the day (range 5–29 μg/ml). Side effects were mild. One cat was withdrawn from group 2 owing to ataxia and sedation. These results show therapeutic serum PB concentrations can be achieved in cats following chronic transdermal administration of PB in PLO at a dosage of 9 mg/kg q12h. More individual variation was noted using Lipoderm Activemax. Transdermal administration may be an alternative for cats that are difficult to medicate orally.
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Affiliation(s)
- Joy A Delamaide Gasper
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Heidi L Barnes Heller
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Michelle Robertson
- UW Veterinary Care Pharmacy, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Lauren A Trepanier
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
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