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I have a 10 year old 8.5 lb Shih Tzu who has had maybe 3…

Hi! I have a...

Hi! I have a 10 year old 8.5 lb Shih Tzu who has had maybe 3 seizures over the past 3 years, then suddenly he has been having them more frequently over the past 2 months. He has a grade 4 heart murmur and it is enlarged (shown on x-ray). So the vet I am currently going to started him on enalapril 2.5mg dose every 12 hours, because he thought that it could be he is not getting good blood flow. He took that for about 2.5 weeks and was doing good, but then he had a bad seizure one night and he didn't come out of it like he usually does. I took him back and he upped the dose of Enalapril to 5mg every 12 and he started him on Zonisamide 25 mg every 12. Well I tried upping them both but at the time he wouldnt eat anything for a few days. I finally got some meds in him but he started being so lethargic and having diarrhea. So i backed off on the Zonisamide, and cut back to 2.5 mg enalapril and he is seeming so much better. But he is still having little mini attacks when he gets excited getting out of the cage. He ends up on his side and can't really move and ends up peeing a little. So I guess my question is, which med should i be starting to up first? I understand some of the problem could be that he wasn't really eating much and he doesn't really eat a ton anyway, that's just how he has always been. Any advice is welcome and thank you!

Veterinarian's Assistant: I'll do all I can to help. Seizures always look scary. Let's get you talking to the Veterinarian. What is the dog's name?

Bee

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Bee?

Not that I can think of right now!

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Answered in 4 minutes by:
3/12/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,938
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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I'm sorry to hear of this with Bee. We know that enalapril can increase renal blood flow but it doesn't increase heart output or stroke volume and so its ability to increase blood flow to Bee's brain must be circumspect. In fact, because it acts as a vasopressor (blood pressure reducer), blood flow to his brain might actually be reduced. I would keep Bee's enalapril dose at the smallest needed to keep his systemic blood pressure in the normal range and I would consider increasing his zonisamide dose within the range of 1-4 mg/lb twice daily while trying to avoid a dose that causes excessive sedation and ataxia ("drunken sailor"). If adverse effects aren't acceptable, switching to levetiracetam should be considered. i would avoid the over-sedating phenobarbital at his age. Please respond with further questions or concerns if you wish.

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Customer reply replied 4 months ago
I am not familiar with the zonisamide because he was just put on it, but should I see a decrease in seizures in a relatively short amount of time, or how do I know I have the dosage right? (with the recommendation of 1-4 mg/lb)And thank you for your response, it was very informative!

You're quite welcome. Yes, efficacy should be noted soon after administration (within days) as unlike phenobarbital, zonisamide doesn't need to reach a steady state to be effective. Monitoring zonisamide blood levels may be useful in veterinary patients but this hasn't been confirmed nor have veterinary therapeutic blood concentrations been identified. Hence, we're left with trial and error; in other words, the smallest dose given every 12 hours that effectively reduces the frequency and severity of seizures is the correct dose. Please continue our conversation if you wish.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,938
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified
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Thank you for your kind accept. I appreciate it. 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.

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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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