Alternative drugs to phenobarbital in canine epileptic patients

Abstract

Epilepsy is one of the most common chronic neurological diseases in companion animals. The first choice for anti-epileptic drugs has consistently been phenobarbital. However, the presence of side effects or contraindications for its use, or poor control of seizures in some canine patients, may require the replacement of phenobarbital, or the addition of more anti-epileptic drugs to the treatment protocol. This article describes the indications, mechanism of action, pharmacokinetics, recommended doses and adverse effects of anti-epileptic drugs whic can be used in place of phenobarbital. A review of the current literature and the administration of each anti-epileptic drug in veterinary practice is also presented. Bromide and imepitoin are overall good options for adjunctive or alternative anti-epileptic medications. However, the pros and cons of each drug need to be considered, in order to choose the most suitable therapeutic protocol for each case. Pharmaco-resistant epilepsy occurs when seizure activity fails to be controlled with two or more anti-epileptic drugs. In the latter situation, some more recently studied alternative anti-epileptic drugs can be considered, such as levetiracetam, gabapentin, pregabalin, zonisamide, felbamate and topiramate. Non-medical options include a medium chain triglyceride oil enriched diet, and cannabidiol.