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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 30381
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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I took my dog to the ER vet after she had 2 seizures in the

Customer Question

I took my dog to the ER vet after she had 2 seizures in the same day. She had never had a seizure before. The vet recommended keeping her overnight and giving loading does of Phenobarbital. At 6am today, yet called and said she did well through the night and he was giving her her final loading dose. She was discharged to us at 2pm. Around 3pm, she was home with us and had a 15 second, focalized seizure. I am very concerned...the loading, intravenous phenobarbital doses are supposed to work her up to a maintenance level, with her being on 3mg of Phenobarb every 12 hours. I feel that it's not a good sign she had a seize as soon as she got home.4 yo, female, spayed, italian greyhound
Submitted: 2 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 2 months ago.

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Expert:  Dr. Michael Salkin replied 2 months ago.

I'm sorry to hear of this with your IG. "Loading" can be done in a number of ways. Some suggest an initial IV loading dose while others administer an intial loading dose followed by increments at variable intervals. If she did well while hospitalized, she then is initially placed on a dose of between 0.9 - 1.4 mg per pound of body weight every 12 hours - the first dose 12 hours after the last hospital dose or later if more convenient for caretakers - and the dosage is adjusted based on drug levels, efficacy, and adverse effect. It isn't clear to me what "...working up to a maintenance level with her being on 3 mg of phenobarbital every 12 hours." implies. Please clarify this for me.

Customer: replied 2 months ago.
She received all the loading doses by IV at the vet, and had done well. So they sent her home with us and her phenobarbital pills, to be taken every 12 hours.
Expert:  Dr. Michael Salkin replied 2 months ago.

How much does she weigh and how many mg of phenobarbital are to be given every 12 hours, please?

Customer: replied 2 months ago.
11lbs, 3mg I believe. But she hadn't even had a pill at home yet when she had the seizure at hone. It was less than 12 from her last loading dose.
Expert:  Dr. Michael Salkin replied 2 months ago.

Thank you. At 11 pounds, she'll need 15 mg (1/4 gr) of phenobarbital twice daily initially. There's reason to believe that she wasn't fully loaded when released or perhaps phenobarbital isn't the anticonvulsant of choice for her. It's too early to evaluate its effectiveness. We need more of a track record. Please make a note of her episode today, give her the proper dose, and continue to monitor her. The goal is to decrease the frequency and severity of seizures; not necessarily stop them altogether although that's our goal. Please continue our conversation if you wish.

Customer: replied 2 months ago.
She had a 2nd one...I'm at the Er vet as discharge instructions said to bring her if she has more than 2 in 24 hours. I was wrong, she's on 16.2mgs. She had 4 loading doses at vet.
Expert:  Dr. Michael Salkin replied 2 months ago.

Thank you for the additional information. Yes, she's clustering (more than one seizure within a 24 hour period) and will need higher than normal doses of phenobarbital, the addition of another anticonvulsant (bromide, levetiracetam, e.g.) to the phenobarbital or stopping the phenobarbital and initiating either levetiracetam, zonisamide, or bromide. Please continue our conversation if you wish.