Bromide

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Bromide.jpg

Potassium bromide (KBr) is an anticonvulsant drug indicated for treatment of recurrent generalised tonic-clonic seizures in dogs with hepatic insufficiency[1] and is frequently used as add-on therapy to phenobarbital[2].

Both phenobarbital and bromide are reasonable first-choice anticonvulsant drugs for dogs, but phenobarbital appears to be more effective and better tolerated during the first 6 months of treatment[3].

Potassium bromide is eliminated by the kidneys[4]. KBr monitoring in dogs is difficult because KBr has a long elimination half life of 25 to 46 days[5].

Side effects of KBr include reversible neurologic signs and are generally associated with adjunctive potassium bromide treatment or high serum bromide concentrations. Other side-effects include lethargy, weakness, decreased mentation, ataxia, paraparesis, polyphagia and gastrointestinal effects[6]. Hematology usually reveals hyperkalemia[7].

Administration of potassium bromide with food may alleviate gastrointestinal irritation and it is recommended that monitoring be done for polyphagia, thyroid hormone abnormalities, and high serum bromide concentrations[8].

In dogs, pancreatitis[9] and latency shifts in brainstem auditory evoked response have been reported[10].

Recommended dose is 20 - 40 mg/kg once daily given orally as a starting dose.

References

  1. Trepanier LA (1995) Use of bromide as an anticonvulsant for dogs with epilepsy. J Am Vet Med Assoc 207:163–166
  2. Podell M (1998) Antiepileptic drug therapy. Clin Tech in Small Anim Pract 13:185–192
  3. Boothe DM et al (2012) Comparison of phenobarbital with bromide as a first-choice antiepileptic drug for treatment of epilepsy in dogs. J Am Vet Med Assoc 240(9):1073-1083
  4. Dewey CW (2006) Anticounvulsant therapy in dogs and cats. Vet Clin N Am Small Anim Pract 36(5):1107–1127
  5. Trepanier LA & Babish JG (1995) Pharmacokinetic properties of bromide in dogs after single dose intravenous and oral administration. Res Vet Sci 58(3):248–251
  6. James LP et al (1997) Bromism: intoxication from a rare anticonvulsant therapy. Pediatr Emerg Care 13:268–270
  7. McConkey SE et al (2012) Compounding errors in 2 dogs receiving anticonvulsants. Can Vet J 53(4):391-394
  8. Baird-Heinz HE et al (2012) A systematic review of the safety of potassium bromide in dogs. J Am Vet Med Assoc 240(6):705-715
  9. Gaskill CL & Cribb AE (2000) Pancreatitis associated with potassium bromide/phenobarbital combination therapy in epileptic dogs. Can Vet J 41:555–558
  10. March PA et al (2002) Pharmacokinetics and toxicity of bromide following high-dose oral potassium bromide administration in healthy beagles. J Vet Pharmacol Ther 25:425–432