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My wife and I have a 9 year old. He's been on Phenobarbital

My wife and I have...
My wife and I have a 9 year old ***** *****. He's been on Phenobarbital 16.2 MG tabs 1 & 3/4 twice a day. Seizures continued 1 to 2 a day but mild and over quickly. We recently moved to a new town and new vet put him on a loading dose of potassium bromide 250mg 4 per day so 1000th total.
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: His name is ***** ***** he is showing signs of acute overdose so we stopped the potassium bromide but we don't know if we should continue the phenobarbital at the same dose. He weighs 20 pounds and from what I've read, 1000mg seems to be way to much for his size also that his seizures were not life threatening
JA: Is there anything else the Veterinarian should be aware of about Snoopy?
Customer: He's been on phenobarbital since May
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Answered in 7 minutes by:
8/21/2017
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,179
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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To answer you directly, you must never "cold turkey" phenobarbital lest withdrawal seizures arise. I recommend your continuing to dose his phenobarbital as you've been doing with the goal to increase the dose because this dose didn't stop Snoopy's seizures effectively.

Loading dosage recommendations for potassium bromide are generally in the 500-600 mg/kg range divided in multiple doses and given over 1-5 days orally with food. That would be equivalent to 4500 - 5400 mg for Snoopy divided over 1-5 days and so 1000 mg daily wasn't too much for his size unless you were seeing acute toxicity as evidenced by muscle pain, conscious propioceptive deficits (not knowing where one's limbs are in space), anisocoria (unequal pupil size), hyporeflexia (below normal or absent reflexes), and other neurologic deficits. Please respond with further questions or concerns if you wish.

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Customer reply replied 3 months ago
We will continue the phenobarbital dose but the potassium bromide definitely put him into overdose symptoms. At first he seemed comatose then drunken stupor, sever tremors,frequent urination,vomited once. He's walking around now but stumbling and running into walls. So was I correct to stop giving potassium bromide for now?

Certainly. You've described the neurologic deficits of acute bromide toxicity. I regret that my state board of veterinary examiners doesn't allow me to speak to customers by phone in this venue but other experts in this category may be able to assist you in this regard. Please let me know if you'd like another expert to do so and I'll opt out of this conversation. Please stay in the conversation if you wish.

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Customer reply replied 3 months ago
Friday was the first day with 1000 MG
Saturday morning was bad so only gave 500 MG for the day. Today he was not given any potassium bromide so how long should it take for him to recover?

The bromides have egregiously long half-lives - 16-46 days in dogs - and so it's difficult to predict when he'll completely normalize. He may be left with a transient sedation for up to 3 weeks but conversely some dogs show signs of iiritability and restlessness. For what it's worth, I don't prescribe bromides due to their unfavorable pharmacokinetics. Please continue our conversation if you wish.

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Customer reply replied 3 months ago
we will keep the phenobarbital dose the same. Is that your recommendation?
Thank you for confirming my decision to stop the bromide, it was tough but I did a lot of reading.
So we should not expect a full recovery any time soon (as in day's)? We are so sad!

Yes, the same phenobarbital dose needs to be onboard. This is going to sedate him more than I would like because the bromide will still affect him but it's unavoidable at this time. Once the bromide effect is gone, the phenobarbital dose needs to be increased. Correct, don't expect a dramatic improvement over the next few days but at least the bromide wasn't given for more than two days.

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Customer reply replied 3 months ago
My wife and I thank you for your help.
We are truly grateful. We will continue to pray for him and that God bless you for your service.

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,179
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified
Dr. Michael Salkin and 87 other Dog Veterinary Specialists are ready to help you
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Thank you for your kind accept. I appreciate it.

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Customer reply replied 3 months ago
Just wanted to let you know that Snoopy passed away on monday. We rushed him to the vet but died in my wife's arms as we drove. Thank you again for helping us. I wish I had better news.

My condolences for your loss of Snoopy. I appreciate your taking the time to let me know. You may receive an inappropriate follow-up from the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.

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Hi,

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

Dr. Michael Salkin
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Dr. Michael Salkin
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,179
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