Doses - BROMIDES, POTASSIUM BROMIDE, SODIUM BROMIDE
Because of the extraordinarily long serum half life in dogs (it may take up to 4-5 monthsfor blood levels to reach steady state), some dosing regimens include an initial oral bolus loadingdose to reduce this time period. Whether to load or not is still a controversial issue. Apparently themajority of clinicians using bromides at this time do not routinely load and achieve efficacy in manydogs long before serum steady-state is reached. If, however, reaching a sustainable "therapeutic"level with rapidity is important, loading should be considered.Dogs:
a) For adjunctive therapy (with either phenobarbital or primidone) of refractory seizures:30 - 40 mg/kg PO daily of potassium bromide (either as capsules or dissolved in water).
Elevated plasma concentrations may be obtained earlier by giving double or triple theabove dose the first day of therapy. Adjust dosage by monitoring adverse effects, efficacy and serum levels. (Schwartz-Porsche 1992)
b) For seizures: Loading dose: 400 mg/kg/day divided bid for 2-3 days, the go to maintenance dose. Maintenance dose: 22 - 30 mg/kg/day if concurrently using phenobarbital; 70-80 mg/kg/day as a single agent. Suggested therapeutic blood levels: 1 - 1.5mg/ml. May take several weeks to attain therapeutic levels. (Neer 1994)
Monitoring Parameters - 1) Efficacy/Toxicity; 2) Serum Levels; "Normal" therapeutic levels indogs probably range from 0.5 - 2.0 mg/ml. Most dogs can tolerate levels of at least 1.5 mg/ml andsome younger, otherwise healthy dogs can tolerate levels of up to 2.5 mg/ml.
Client Information - Clients must be committed to administering doses of anticonvulsant medications on a regular basis. Lack of good compliance with dosing regimens is a major cause oftherapeutic failures with anti-seizure medications. Clients should also understand and accept thatthis treatment involves using a non-approved "drug" Dose measurements of bromide solutionsshould be done with a needle-less syringe or other accurate measuring device. The dose may eitherbe sprinkled on the dog's food (assuming he/she consumes it entirely) or squirted in the side of themouth. Toxic effects (e.g., profound sedation, ataxia, stupor, GI effects) should be explained to theowner and if they occur, owners should report them.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Labeled or Human-Approved Products: None.
Neither potassium or sodium bromide are available in approved dosage forms in North America.
Reagent grade or USP grade may be obtained from various chemical supply houses to compoundan acceptable oral product. If purchasing a reagent grade, specify American Chemical Society(ACS) grade. At a concentration of 250 mg/ml (25 grams of potassium/sodium bromide qs ad to100 ml distilled water), both sodium and potassium bromide dissolve easily in water. Flavoringagents are not usually necessary for patient acceptance.
Dogs: 
a) For adjunctive therapy (with either phenobarbital or primidone) of refractory seizures:30 - 40 mg/kg PO daily of potassium bromide (either as capsules or dissolved in water). Elevated plasma concentrations may be obtained earlier by giving double or triple theabove dose the first day of therapy. Adjust dosage by monitoring adverse effects, efficacy and serum levels. (Schwartz-Porsche 1992)
b) For seizures: Loading dose: 400 mg/kg/day divided bid for 2-3 days, the go to maintenance dose. Maintenance dose: 22 - 30 mg/kg/day if concurrently using phenobarbital; 70-80 mg/kg/day as a single agent. Suggested therapeutic blood levels: 1 - 1.5mg/ml. May take several weeks to attain therapeutic levels. (Neer 1994)
Monitoring Parameters - 1) Efficacy/Toxicity; 2) Serum Levels; "Normal" therapeutic levels indogs probably range from 0.5 - 2.0 mg/ml. Most dogs can tolerate levels of at least 1.5 mg/ml andsome younger, otherwise healthy dogs can tolerate levels of up to 2.5 mg/ml.
Client Information - Clients must be committed to administering doses of anticonvulsant medications on a regular basis. Lack of good compliance with dosing regimens is a major cause oftherapeutic failures with anti-seizure medications. Clients should also understand and accept thatthis treatment involves using a non-approved "drug" Dose measurements of bromide solutionsshould be done with a needle-less syringe or other accurate measuring device. The dose may eitherbe sprinkled on the dog's food (assuming he/she consumes it entirely) or squirted in the side of themouth. Toxic effects (e.g., profound sedation, ataxia, stupor, GI effects) should be explained to theowner and if they occur, owners should report them.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Labeled or Human-Approved Products: None.
Neither potassium or sodium bromide are available in approved dosage forms in North America.
Reagent grade or USP grade may be obtained from various chemical supply houses to compoundan acceptable oral product. If purchasing a reagent grade, specify American Chemical Society(ACS) grade. At a concentration of 250 mg/ml (25 grams of potassium/sodium bromide qs ad to100 ml distilled water), both sodium and potassium bromide dissolve easily in water. Flavoringagents are not usually necessary for patient acceptance.