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Reply To: Levetiracetam use in hepatic insufficiency

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Thanks for this.

Following on from what Sara has said… was the thinking that this dog was having seizures due to the liver disease? What other meds was this dog on? You are right, there is very little evidence to support exactly what drugs to use in cases that have seizures due to severe liver disase/hepatic encephalopathy. I think it would be fine in these cases to escualte yo the 60mg/kg dose for short term control. The following drugs can be cnsidered:

1. Avoid benzodiazepines
2. Phenobarbital (4 mg/kg IV q 3-6 h for 4 doses)
3. Potassium Bromide: Loading: 400-600 mg/kg/day divided over 1-5 days PO with food; can be given per rectum if needed. Maintenance: 20-30 mg/kg PO q 24 h. Sodium bromide can be used if an IV form is necessary.
4. Propofol 1-3.5 mg/kg IV bolus, followed by CRI of 0.01-0.25 mg/kg/min.
5. Keppra 20 mg/kg (up to 60 mg/kg) PO or IV q 8 h (there is no evidence-based medicine to support this).

Hope that helps.

Scott x