Bromide tablets received conditional FDA approval this month so I thought this was a good time for us to review Bromide and the do's and don'ts of this drug.
What should clients (and vets) know about bromide?
Bromide is one of my favorite anticonvulsant drugs for dogs. Seizures happen when there is too much excitability or too little inhibition in the brain therefore neurons fire. Making neurons' less able to "fire" reduces seizures. Below are answers to common client questions about bromide.
How does it work?
This drug makes neurons more negative making it harder to fire a nerve. Less firing = fewer seizures. It does not eliminate seizures, nor does it "cure" an epileptic dog.
Has this drug been shown to be safe in dogs (or cats)?
This medication should ONLY be used for dogs. Cats do not tolerate bromide!
How long does it take to be effective?
Bromide has a long half-life, therefore it takes about 3 months to reach the point of maximal expected efficacy (steady-state). You may notice side effects, and clinical improvement sooner than 3 months however, it won't be fully stable (or fully effective) until at least 3 months. Furthermore, this means that when the dose is adjusted, it won't be fully realized until 3 months after the dose adjustment is made. Key point: Don't give up too soon on this drug. It is slooooowww.
Side note for vets: Please try to take a therapeutic serum concentration at 3 months even if the dog is doing well. This is valuable information should they loose that seizure control in the future.
What side effects are common?
Some pets do not demonstrate any clinical side effects. In those that do,sedation, ataxia, weakness, increased drinking, urinating, appetite and occasionally vomiting can be noted. It is important to understand that bromide and phenobarbital have very similar side effects so if the dog is already on phenobarbital and we're adding bromide, side effects may be additive! Don't blame the bromide! Vets: try reducing the phenobarbital a bit and often side effects will improve. We're adding bromide because we think it may help the dog so don't play with the dose too much (if at all) in the first 3 months.
What other life-style changes do I need to make for my dog?
Bromide must be given every day, at about the same time each day. It isn't as picky as some other anticonvulsant drugs so little adjustments in the administration time is usually okay. Vets: I prefer this medication is given 20 mg/kg PO q12h, but it can also be give as 40 mg/kg PO q24h.
Additionally, this drug will be confused with chloride during excretion through the kidney. This means that your dog must be maintained on a "stable" salt diet. Not restricted, just consistent. In other words, feed the same food, and if you must give "treats" give the same treats, every day. A sudden increase in salt consumption can result in a serious decrease in bromide in the body, resulting in seizures. (Think: 4th of July BBQ when the dog steals a hot dog from the table...)
Incidentally, "bromide" also means: a trite and unoriginal idea or remark, typically intended to soothe or placate. Hmmm, I wonder if I can put this in a sentence in everyday life? :)
For some of you, this was a repeat TidBit Tuesday from November 2019. This is one of those topics I think is worth repeating and I hope you agree.
Stay safe, stay warm and be healthy. I'm available Mon-Sat, if you have a question, or a case that needs evaluation.
