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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28429
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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My small pomeranian mix has been on phenobarbital since

Customer Question

My small pomeranian mix has been on phenobarbital since December. Over three weeks ago she was diagnosed with IMHA and has not responded to the medications. Her vet is speculating her lack of response is due to the phenobarbital interfering with her IMHA meds. We started to taper her phenobarbital today and added keppra as a substitute. Since she is now taking the keppra, can we reduce her phenobarb at a faster rate without as great a risk of her seizures returning?
JA: I'm sorry to hear that. Seizures always look scary. Let's get you talking to the Veterinarian. What is the dog's name?
Customer: Foxy Brown
JA: Is there anything else the Veterinarian should be aware of about Brown?
Customer: She has had two blood transfusions and is on three medications to treat IMHA
Submitted: 1 month ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 month ago.

It's best that you don't hasten the taper. Even though you're instituting another anticonvulsant, we mustn't taper a barbiturate too quickly lest break-through seizures arise if for the only reason that we don't know how effective the levetiractam is going to be. Please note too, that in dogs, ongoing (21 days in the study) phenobarbital use significantly increased levetiracetam clearance and reduced half-life (from 3.43 hours. without phenobarbital to 1.73 hrs. after 21 days of phenobarbital; dosage adjustments may be required temporarily. Please respond with further questions or concerns if you wish.

Expert:  Dr. Michael Salkin replied 1 month ago.
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin