Animal Health Solutions

40 Covetrus | ph: 855.724.3461 | fx: 888.329.3861 | northamerica.covetrus.com Potassium bromide is a commonly used anticonvulsant in veterinary medicine for the control of epilepsy. Epilepsy is a common problem in small animal veterinary medicine, with 0.55-2.3% of the referral hospital population presenting for seizure activity. 1 Epilepsy can have various underlying causes, including extracranial (metabolic encephalopathy, electrolyte associated encephalopathies, etc.) and intracranial (idiopathic epilepsy, secondary epilepsy) causes. Idiopathic epilepsy is the most common cause of epilepsy and is the diagnosis most often used when evaluating anticonvulsant efficacy. Dogs with idiopathic epilepsy typically start having seizures between the ages of six months and six years. They have a normal inter-ictal neurologic exam and have no evidence of a metabolic or electrolyte associated encephalopathy on routine lab work. If advanced imaging (MRI, CT) is available, results would be normal; cerebral spinal fluid evaluation would also be normal. Treatment with anticonvulsants is recommended when the patient experiences greater than one seizure every six months, acute repetitive seizures (three or more in a 24-hour period), status epilepticus (ictal period lasting longer than five minutes), unusually severe/prolonged post-ictal symptoms, or a patient with a structural encephalopathy (tumor, stroke, encephalitis, trauma, etc.). 2 There are various anticonvulsant options, including potassium bromide. The American College of Veterinary Internal Medicine (ACVIM) put out a consensus statement in 2015 with recommendations based on available peer reviewed literature concerning the efficacy of various anticonvulsants. Drugs were evaluated as either monotherapies or add-on therapies. Bromide was one of the most highly recommended anticonvulsants, being moderately recommended as a monotherapy and moderately recommended as an add-on therapy. 2 Potassium bromide is therefore recommended as both a monotherapy and an add-on therapy for treatment of canine idiopathic epilepsy. The mechanism of action involves hyperpolarization of neurons via movement of negatively charged bromide ions intracellularly through chloride channels. The ACVIM Consensus statement recommends a starting dose of 40mg/kg/day, but lower doses may be used to minimize side effects. 2 As bromide has a very long half-life of 24 days, a loading dose is required if rapid serum steady state concentrations are needed. 1 Typical loading doses range from 400-600 mg/kg PO given over a 4-to-5-day period, in addition to the maintenance dose. Side effects such as lethargy, weakness, and ataxia may be significantly more profound when loading doses are used. This dose can also be given Using bromide as a therapeutic option for dogs with epilepsy Dr. Adam E. Moeser

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