Canine Epilepsy-Using Potassium Bromide to control seizures in dogs (2023)

POTASSIUMBROMIDE (KBr)

Canine Epilepsy-Using Potassium Bromide to control seizures in dogs (1)

NOTE: For the a quick summary of information on potassium bromide, click here.

PotassiumBromide (abbreviated as KBr) is often considered the firstchoice drug for any dogs with idiopathic epilepsy, and because it has noeffect on the liver, is often chosen for dogs withliver damage. Unlike Phenobarbital (Pb), which is processed by the liver, bromideworks by replacing chloride throughout the body,is stored in bodyfluids and eliminatedunchanged by the kidneys. However, wherePhenobarbital is effective almost immediately, Kbrcan take up to three or four months to reachits full effect. A loading dose may benecessary for dogs with frequent seizures or when Phenobarbitalmust be withdrawn rapidly because of liver disease.

JohnRossmeisl andKaren D. Inzana have published a study on bromide toxicosis in 31 dogs. Two ofthese dogs had generalized weakness with difficulty swallowing andmegaesophagus. These signs improved with reducing the dose.

SometimesKBr and Pb are used together. For those dogswith epilepsy whose seizures are not wellcontrolled by Pb alone, the addition of bromidecangreatly improve seizure control. This often allows either adecrease or total withdrawal of Phenobarbital.

Thereare actually two kinds of bromide -- potassium bromide and sodium bromide -- and both are equally effective atcontrolling seizures. Compounded with eitherpotassium or sodium, the bromide controls the seizures.Potassium bromide is preferred when sodium intake must be restricted (e.g., congestive heart failure).Sodium bromide is preferred when potassiumintake may need to be restricted (e.g., hypoadrenocorticism).

Bromideis a very old anti-convulsant which was used in the 1800's as both an anti-convulsant and a sedative. Because it has been around for so long and is seldom used in people, it has neverreceived FDA approval as a drug. Although ithas not gone through the rigorous testing required for FDA approval, bromide has been usedin dogs for a long time, and has proven to bereliable and safe.

**For a list of pharmacies that may be able to assist you in filling a prescription for potassium bromide, please seeDiscount Canine Pharmacies.

Dosage:

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Bothpotassium bromide and sodium bromide are available in liquid and capsule form.The liquid form, which comes in flavors, is generally less expensive and it is easier to adjust the dosein liquid than in capsules. The long halflife of bromide, about 24 days, means that the timingof an individual dose is much more flexible - unlike Phenobarbital(Pb), you don't have to stick to a strict12 hour schedule for giving the medication.Even though the dosing can be flexible, twice daily dosingis probably recommended because some animals cannot tolerate too much salt in their gastrointestinal tract at once --imagine eating a tablespoon of sodiumchloride.

Ifyou miss a dose or even a week of doses, there is not likely to be any adverse effect.The missed doses can simply be made up over thenext week ( i.e. double doses for a week).But the long half life also means thatthe effectiveness of a particular dose should not beevaluated until the patient has been on the dose for three or four months, unless aloading dose is given. And if the dog ishaving seizures, adding an extra does will not help.

Toavoid this wait, which simply is not tolerable in some seizing dogs, a loading dose can beadministered to dogs starting potassium/sodium bromide, or to dogs whose potassium/sodiumbromide concentrations are too low (if the patientis seizing). The loading dose is intended to rapidly achieve therapeutic concentrations.

Becauseabsorption, distribution and speed of metabolism can vary among dogs, published dose recommendations only serve asa general guide. Most new patients arestarted at the lower end of the dose range; however,patients with frequent or severe seizures are often best managed by starting at the higher end of the dose range or byusing a loading dose.

Anaverage maintenance dose for potassium bromide is 20 mg to 30 mg per kg of body weight (to convert pounds to kilogramsdivide your dogs weight by 2.2 or see conversion chart) given once a day. You may divide the dose and give potassium bromide twice a day. Sodium bromide has slightly more bromide comparedto an equal weight of potassium bromide, sothe dose of sodium bromide is 15% lower than for potassiumbromide. Your veterinarian will adjust thedosage based on blood levels, seizureactivity and side effects of the medication.

FORVETERINARIANS:

Theloading dose is based on patient volume of distribution of potassiumbromide(0.3 l/kg) and the target concentration (1.5 mg/ml or 1.5 gm/l). (The loading dose is 1.5gm/l X 0.3 l/kg or 0.450 gm/kg (450 mg/kg).This 450 mg/kg dose is divided over 5 days (90 mg/kg/day) and added to a maintenance dose of 20 to 30 mg/kg (averageof 25 mg/kg) per day.) Thus, a new patient will receive120 mg/kg of potassium bromide each day for 5 days, and then back down to 25 mg/kg per day.

Highchloride (salt) intake can increase the elimination of bromide, which means that if your dog's salt intakeincreases, you may need to adjust the bromidedose. It is not necessary for dogs taking bromide tobe on a low salt diet, but it is important that the salt content of the diet not be drastically changed during treatment,as this will affect bromide levels. (SeeMonitoring therapy below). Ideally, it's best to keepthe diet stable if you can.

Monitoring Therapy:

Todetermine the correct dose of bromide, it can be very helpful to monitor its level in the blood . Any change in dose should be made based upon the actual concentration in the blood. If you have used aloading dose, It is recommended that your vet collect a single sample within a week of the loading dose to see how closeyou came to therapeutic levels with thisloading dose, and then another sample at one monthto see if your maintenance dose is sufficient to maintain the concentrations established by the loading dose.The maintenance dose would be modified if theone month sample is not the same as the post-loading sample.

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Ifyou have started with a regular dosingschedule, your veterinarian will want to test the bromide levels after about a month and then at six monthintervals, once the blood level has reached atherapeutic range. The published therapeutic or targetrange for Bromide is 2 to 3 mg/ml for dogsnot on Phenobarbital at the same time, and 1.0 to 2.0 mg/ml if the dog is also receivingPhenobarbital. Published therapeutic rangesare only an approximation.

Ifyou are switching foods, please be aware of the chloride levels in both the new and old food so that you and your vetcan adjust the dose accordingly and canclosely monitor the level of bromide in the blood. Anychange in food should be done gradually. Wesuggest the following as a reasonable schedule:

Mix 3/4 old food with 1/4 new food for 3-5 days;

Mix 1/2 old food with 1/2 new food for 3-5 days;

Mix 1/4 old food with 3/4 new food for 3-5 days;

100% new food.

SIDE EFFECTS:

Themost common side effects of bromide therapy are sedation, ataxia (hind end weakness and loss of coordination),increased urination and rare skin disorders. Increased urination, hunger and thirst are also common for dogs taking bromide alone or with Pb.Occasionally, abnormal behavior, such asirritability or restlessness can also require a reductionin dose. Side effects are more common in patients whosepotassium bromide concentrations are greater than 2.5 mg/ml and the symptomsusually go away within a week after the dose is decreased.If the dog is too groggy and is onboth Phenobarbital and bromide, it may bepreferable to decrease the Phenobarbital dose, rather than the bromide. Ifthe dose of bromide is to be decreased, we recommendmonitoring of blood levels before any dose change in order to establisha target if seizures begin again.

Potassiumbromide can also cause stomach upset, nausea and vomiting.If this occurs, you may wish to trygiving the drug with food, or dividing thedaily dosage into two or more portions; you and your vet may also wish to consider switching to sodium bromide whichis just as effective but doesn't cause thesame stomach symptoms. And some dogs preferthetaste of sodium bromide.

Also,Bromide should be used with caution in dogs with renalinsufficiency.

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Bromidetoxicity is uncommon, however, it is a potential side effect of bromide use and most of the potential side effectsthat have been discussed on our list are frombromide toxicity. Bromide toxicity can occurin dogs with renal insufficiency or those that are on a very high dose of bromide. Signs of bromide toxicity includesevere ataxia, sedation or stupor and musclespasms. Usually, reducing the dose by 10% to 25% is sufficient to take care of these signs.

DISC

ONTINUING THERAPY:

Thedecision to stop therapy must be made very carefully, but is reasonable to consider in dogs that areseizure-free for one to two years. The doseis gradually tapered over a period of 6 months. The majorrisk of discontinuing drug therapy is seizure recurrence, which is most likely to occur during withdrawal or withinseveral months of stopping therapy.

DRUG INTERACTIONS:

Bromideis eliminated from the body by the kidneys. Bromide and chloride compete for re-absorption by the kidneys. Asubstantial increase in dietary chloride(salt) will cause decreased re-absorption of bromide bythe kidneys, resulting in more bromide being eliminated. That means that if the amount of salt in the diet increases,bromide levels will decrease, which couldlead to seizures. Conversely, switching to a diet lowin chloride will cause bromide levels to increase, which could cause bromide intoxication.

Itis not necessary for dogs taking bromide to be on a low salt diet, but it is important that the salt content of thediet not be drastically changed duringtreatment, as this will affect bromide levels.

Diureticsalso increase bromide excretion and can lower the level ofbromide in the blood.

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IF ALL THIS IS MAKING YOU GLAZE OVER,HERE ARE THE BASICS:

1.Potassiumand sodium bromide are drugs given to control seizures indogs. Unless you give a loadingdose, it can take up to three or fourmonthsbefore it really begins towork.

2.Whenfirst started, blood levels should be checked at one month andthen every six months;if you have given aloading dose, then levelsshould be checkedsooner.

3.Thedosing schedule is more flexible than with Phenobarbital becauseof bromide'slong half life, but please beaware of the chloride (salt)content in yourdog's food and ifit changes, discuss changing the dosewith your veterinarian.

4. There can be side effects, most of whichdisappear in a few weeks. These can includeexcessive hunger, thirst and the need to urinate,lethargyand ataxia (loss of coordination). If the drug upsets yourdog's stomach, try giving it with food or in two doses. Iftheproblemcontinues, discuss switching frompotassium bromide tosodium bromide.

5.JohnRossmeisl andKaren D. Inzana have published a study on bromide toxicosis in 31 dogs. Two ofthese dogs had generalized weakness with difficulty swallowing andmegaesophagus. These signs improved with reducing the dose.

6.Don'tstop Kbr cold turkey unless instructed by your veterinarian.

Canine Epilepsy-Using Potassium Bromide to control seizures in dogs (2)

Sources:

William B. Thomas, DVM, MS, CommonNeurologic Problems, Idiopathic Epilepsy in Dogs, Veterinary Clinics of North America:Small Animal Practice, Volume 30, Number 1, January, 2000; Texas A& M College ofVeterinary Medicine, Kbr Handout, found at:http://www.cvm.tamu.edu/vcpl/publications/Kbr_handout.htm

(Video) Aims of Dog Epilepsy Treatment (what to do when the meds don't work) - Dog Health Vet Advice

Rossmeisland Inzana. Clinical signs, risk factors, and outcomes associated with bromidetoxicosis (bromism) in dogs with idiopathic epilepsy. JAVMA 2009:234:1425-1431.

Dr. W. Jean Dodds, DVM; Joanne Carson, PhD.

FAQs

Does potassium bromide stop seizures in dogs? ›

Potassium bromide is an antiepileptic drug that is used in dogs to control seizures that are not controlled by phenobarbital alone, or in dogs that do not tolerate phenobarbital well. Potassium bromide works by decreasing seizure activity within the central nervous system.

How long does it take for potassium bromide to work in dogs? ›

Potassium bromide does not begin working right away. It may take six to twelve weeks before we see improved seizure control with potassium bromide. Do not become discouraged by this fact. We will monitor blood levels 3 weeks and 3-4 months after starting the medication.

How often should I give my dog potassium bromide? ›

Dosage. Dogs: 15-35 milligrams per kilogram of body weight by mouth once daily with food (maintenance dose). A loading dose is given initially, 400-600 milligrams per kilogram of body weight given by mouth divided into several doses per day for 1-5 days before lowering the dose to the maintenance dose.

How long does potassium bromide stay in a dog's system? ›

KBr monitoring in dogs is difficult because KBr has a long elimination half life of 25 to 46 days [7,8]. Side effects like general lethargy, general weakness, decreased mentation, ataxia, paraparesis, polyphagia and gastrointestinal affections may occur [9-14].

Does potassium bromide stop seizures? ›

For many years, both potassium bromide (KBr) and phenobarbital (PB) have been used in human and veterinary medicine as anti-seizure medications.

How effective is potassium bromide? ›

In fact, seizure control with potassium bromide is so effective that now many practitioners reach for it as a first choice therapy without even using phenobarbital. Potassium bromide is given either as a pill or as oral liquid once daily.

Is potassium bromide better than phenobarbital? ›

This study demonstrates that both phenobarbital and bromide are reasonable first-choice AEDs [antiepileptic drugs], but phenobarbital may be more efficacious.

What are the side effects of potassium bromide for dogs? ›

The most common side effect is sedation that usually resolves on its own. Other possible side effects include irritability, restlessness, mild vomiting, decreased appetite, constipation, increased appetite, increased thirst, and increased urination.

What is the best anti seizure medication for dogs? ›

Phenobarbital: Phenobarbital is usually the first line drug chosen for primary epilepsy. Common short-term side effects of phenobarbital in dogs are mild sedation and some incoordination.

What not to feed a dog that has seizures? ›

Food that causes seizures. According to the ASPCA, caffeine, dark chocolate, mushrooms, theobromine, ethanol, and xylitol can cause your dog's seizures. Theobromine is what makes chocolate toxic to dogs.

Does potassium bromide make dogs sleepy? ›

Dogs: Bromides can cause drowsiness for up to 3 weeks after starting the drug. Most dogs will eventually get used to this and not be drowsy with continuing therapy. Vomiting or reduced appetite due to gastrointestinal tract irritation.

How much does potassium bromide for dogs cost? ›

The cost of potassium bromide for dogs depends on the dosage strength. A bottle of 60 500-mg tablets costs $35 on average. The same average price applies to liquid forms with a dosage of 250 mg/ml.

How long does epilepsy medication take to work in dogs? ›

Measure liquid forms carefully. Do not stop this medication abruptly in order to prevent withdrawal seizures. This medication should take effect within 1 to 2 hours; however, effects may not be visibly obvious and therefore laboratory tests may need to be done to evaluate whether the medication is working.

Is potassium bromide a sedative? ›

Potassium bromide (KBr) is a chemical compound isolated from the Mediterranean Sea in 1826(1). KBr and other inorganic bromide salts produce sedative effects(2). Therefore, it was prescribed as an anxiolytic, sedative-hypnotic or antiepileptic agent(2).

Does potassium bromide have to be refrigerated? ›

Potassium bromide suspension must be stored in the refrigerator and expires after 30 days. After the expiry date, the Potassium Bromide degrades such that the product becomes ineffective for seizure control.

What is the permanent solution for seizures? ›

Treatments include: medicines called anti-epileptic drugs (AEDs) surgery to remove a small part of the brain that's causing the seizures. a procedure to put a small electrical device inside the body that can help control seizures.

What stops seizures fast? ›

The names of benzodiazepines that are most commonly used as rescue medications include diazepam, lorazepam, clonazepam, and midazolam. The availability of these medicines in different forms and how they are used may vary from country to country.

Is there any permanent solution for epilepsy? ›

But unlike with other brain-related conditions, about two dozen medications can successfully treat many cases of epilepsy. Although there is no cure, these anti-seizure drugs turn the disease into a chronic, but well-managed condition for many to the point where it barely interferes with life.

How long do dogs live with epilepsy? ›

The median number of years that a dog lived with epilepsy was 2.3 years. Females lived longer with epilepsy than males (P = . 036). Seizure type (primary generalized versus focal seizures) was not significantly associated with survival time.

Can potassium stop seizures? ›

Potassium bromide (KBr) can control certain types of epileptic seizures and should be considered as an option for the treatment of children with refractory epilepsy, a study says.

What does bromide do to the brain? ›

High levels of bromide chronically impair the membrane of neurons, which progressively impairs neuronal transmission, leading to toxicity, known as bromism. Bromide has an elimination half-life of 9 to 12 days, which can lead to excessive accumulation. Doses of 0.5 to 1 gram per day of bromide can lead to bromism.

Is Keppra the same as potassium bromide? ›

Keppra differs from traditional anti-seizure medication in the fact that it does not contain either Potassium Bromide or Phenobarbital, which means it has a wider margin of safety, especially for dogs suffering from a damaged liver, or liver problems.

What is the most used anti-seizure medication? ›

Below are 10 of the most common.
  1. Lamotrigine (Lamictal) Lamotrigine (Lamictal) can be used for both focal onset and generalized seizures. ...
  2. Levetiracetam (Keppra, Spritam) ...
  3. Phenytoin (Dilantin) ...
  4. Zonisamide (Zonegran) ...
  5. Carbamazepine (Tegretol) ...
  6. Oxcarbazepine (Trileptal) ...
  7. Valproic acid derivatives. ...
  8. Topiramate (Topamax)
Apr 28, 2022

How do you stop a dog from having seizures? ›

The two most commonly used medications to treat seizures in dogs are phenobarbital and potassium bromide. Research into the use of other anticonvulsants is ongoing, and newer anticonvulsants, such as zonisamide (Zonegran®) and levetiracetam (Keppra®), are becoming more popular.

What are the side effects of epilepsy medication for dogs? ›

Mild side effects are common when first starting treatment for epilepsy in dogs (or increasing the dose) with Phenobarbitone or Bromide and include increased thirst and appetite, more frequent urination, mild sedation and mild wobbliness in the back legs.

What makes seizures worse in dogs? ›

Loud or sharp noises may prolong the seizure or make it worse. Other animals in the household may be frightened or threatened by the seizuring dog. Remove them from the immediate area if this is a concern.

Why is my dog still having seizures on medication? ›

It can take months to get seizure activity under control, and your pet can continue to have seizures while on medication. Based on your pet's seizure activity and the therapeutic blood levels of the medication, adjustments in dosage may be necessary. Remember, these medications are not a cure for seizures.

What vitamins are the most important to protect against seizures in dogs? ›

Other Vitamins for Dogs With Seizures — Some pet owners have found vitamins such as B Complex and milk thistle (important to use if your pet is taking antiepileptic medication that can affect liver health) to be helpful as well.

What do you give a dog to stop seizures? ›

The two most commonly used medications to treat seizures in dogs are phenobarbital and potassium bromide. Research into the use of other anticonvulsants is ongoing, and newer anticonvulsants, such as zonisamide (Zonegran®) and levetiracetam (Keppra®), are becoming more popular.

What can I give my dog to reduce seizures? ›

Phenobarbital. Phenobarbital has been used for decades to suppress seizures in dogs and is typically the first medication prescribed by vets for dogs experiencing seizures. It is estimated that 80% of dogs on phenobarbital experience a decrease in seizure frequency of 50% or more.

What helps dogs come out of seizures? ›

MEDICATIONS FOR DOG SEIZURES

There are several different anti-convulsants available for dogs. Zonisamide has become the most popular, as it works well with minimal side effects. Phenobarbital, potassium bromide, and levetiracetam (Keppra) are other medications your veterinarian may discuss with you.

Is there a natural way to stop seizures in dogs? ›

There are several natural remedies and methods designed to prevent or stop seizures in dogs, some of the more common are:
  1. Essential Fatty Acids. Pet owners and veterinarians alike recommend routinely introducing fatty acids into a dog's diet. ...
  2. Dietary Changes. ...
  3. Homeopathic Oils. ...
  4. Acupressure. ...
  5. Melatonin. ...
  6. Honey.

Can seizures be cured permanently in dogs? ›

Epilepsy is unfortunately a neurological condition that the animal is born with and as such cannot be cured. Treatment for epilepsy in dogs aims at 'controlling' the seizures.

Can you stop a dog seizure before it happens? ›

Drugs such as potassium bromide or phenobarbital can help control seizures. As always, ask your veterinarian for recommendations for your dog's specific problem. Alternative therapies are sometimes helpful. Some owners report a drop in dog seizure activity after using acupuncture but, again, check with your vet first.

Does honey stop seizures in dogs? ›

Give a Snack. After dogs come out of a seizure, a little all-natural vanilla ice cream, honey, or natural maple syrup will help to raise their sugar levels back up. Follow with a protein such as little kibble, cheese stick, a spoonful of cottage cheese, chicken, etc. to help stabilize those sugar levels.

How do you treat an older dog with seizures? ›

Your veterinarian may prescribe anti-seizure medications like phenobarbital for dogs, potassium bromide, levetiracetam, or zonisamide. Some dogs start out with just one of these medications.

Can Benadryl help with dog seizures? ›

If your dog has glaucoma, high blood pressure, seizures or epilepsy, or cardiovascular disease, don't give him Benadryl. It could make these conditions worse. Don't give your dog Benadryl if she is pregnant.

What causes seizures in dogs other than epilepsy? ›

The most common extracranial causes are hypoglycemia, hypocalcemia, hyperthermia, hypothyroidism, liver disease, or ingested poisons such as caffeine, and chocolate. Intracranial causes of seizures are diseases that cause either structural or functional changes inside the dog's brain.

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