Can I ask why you and your veterinarian choose Keppra over the other drug options?
Well… The vet didn’t know about FARS… Not many do. However after an internet search Keppra is found to be the most widely used for FARS and had the most success. Plus it’s very fast acting and has generally fewer side effects.
Just in case people aren’t aware…FARS is. Feline Audiogenic Reflex Seizures… Basically seizures caused by certain sounds- usually higher pitched things like the clunking of cutlery, keystrokes.etc. The last one the cat had was caused by the sound of someone shaking a spray paint can on a video. Highly prevalent in Birmans which he is.
And to top it off…he’s got blue blue eyes.
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of course he does !
Mr. Blue Eyes !
please share his name ?
His name is Thomas. He came with a sister but she developed FIP and unfortunately passed away. We then got Fred. Here’s the two of them.
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Correct Keppra has significantly less side effects but is not necessarily considered a feline friendly a feline friendly medications due to it having to be dosed 3 times a day and those three times being a pretty accurate 8 hours apart. If you have a crafty cat that can spit out or hold medications dosages can be missed. It requires less drug monitoring and causes less sedation (at least initially when started in comparison to phenobarbital). Please do not crush the Keppra pills that “do not crush” applies to both humans and animals.
The paper that shows Keppra being a more effective drug does have a major flaw in that the cats taking phenobarbital the majority did not receive serum drug concentration monitoring. As this was one of the first papers we do not know if the phenobarbital was able to reach therapeutic levels in these cats. Something to consider. We’ve extrapolated the theory of this disease from humans mostly and the cited papers do suggest a superiority of Keppra as the drug choice. But access to care and the human animal bond has to be considered when it comes to our cat patients.
Phenobarbital tends to be the more feline friendly with its every 12 hour administration and ability to reach a steady state which allows a little bit less accurate timing. The side effects in cats tend to be minimal and include sedation which tends to be in the first two weeks until steady state is reached, the the longer the cat is on the medications the more tolerant they are to the sedation side effects. (unless you find yourself with progression of the disease and need to increase the dosage, then you may see a bit of sedation until that new dose reaches steady state).
If you want to continue Keppra that’s fine but if you find yourself struggling with the three times a day and increasing stress in yourself and a cat with a form of epilepsy, I would consider the transition to Phenobarbital and give it a shot.
He is beautiful. How old is he?
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I may have missed someone else suggesting this, but a compounding pharmacy can make it a transdermal cream that just gets rubbed on his ear. Might be easier!
At least in the U.S. levetiracetam comes in a liquid which may be easier to administer than a pill.
We can get it at the compounding pharmacy. ( @chestnutmarebeware ) And had put in a call for it.
@Justmyluck it seems that vets are moving away from phenobarbital for feline seizures. The Keppra was ok to be crushed as long as it wasn’t the extended release which ours isn’t. The pill itself is already a broken pill as it’s half a human one. We will adjust if needed of course. Thomas is 15 and Fred is 14.
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I have no idea if this applies to this drug, I just wanted to say that not every drug is able to be used topically, unfortunately. I almost suggested it, but didn’t know if this is one that could be.
I was going to avoid outing myself I am a feline exclusive veterinarian and journal whore. I guarantee feline veterinarians are not moving away from Phenobarbital. It is considered and will be the hallmark epilepsy drug for cats until there is a veterinary exclusive Keppra XR for the tiniest of our small animals. I.e cats and small dogs. Feasibly speaking owners can not be expected to medicate their cats 3 times a day, those cats will end up euthanized due to the burden of care.
On another note not all drugs can be compounded into transdermal medications. Even if you find a pharmacy that will do it it does not mean it will be efficacious. Transdermal efficacy depends A LOT on the molecule size.
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Thank you for sharing your knowledge with us.
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So, I had one cat on four different pills who got very finicky towards the end and I currently have a cat on three different pills (and a second cat on one pill, but he’s the cat who would be behind me licking the banana flavored liquid clavamox from the bottle as I struggled to force the syringe into the mouth of either of the other two. He’s a weirdo).
I have done pretty much a variation on everything mentioned above - I have never had to pill three times a day. I am lucky for the most part that my cats like pill pockets and have been happy with them for years. I do make sure I have every flavor pill pocket I can find on hand, because after two weeks they’re all like, “yeah, this tastes of trickery and deceit! Oh wait, what’s this a different flavor? It smells delicious! Nom nom nom!”
I also have bacon flavored pill paste on hand (basically same stuff as pill pockets, but not pre-formed). It almost always works when the regular pill pockets won’t because it is so strongly scented that it brings all the cats running from all corners of the house as soon as I open it. Sadly, after a day or two, they all decide that it’s too much, but then they’re usually happy to go back to pill pockets. So basically I keep the bacon flavored as a temporary last resort.
I have also resorted to crushing pills (I think the only one of mine who has a coated pill is the one who likes banana flavored clavamox) and mixing it into wet food/squeezable treats/liquid supplements. I have also ground up kitty treats and rolled pill pockets in those (have not tried freeze dried fish, which is an extremely good idea, but similar concept). I have also dipped the pill pockets in tuna juice, wet food, squeezable treats, etc.
The least successful thing for me is using a pet piller and/or doing a purrito. But that’s mostly because my 3 meds a day girl who also has frequent URIs, absolutely hates being restrained or forced to take a med. She’ll let me do it once. Maybe even twice. But after the second time? She is in hiding and will only come out when I’m not around until she forgives. Which makes daily and twice daily meds hard, and especially bad for antibiotics
All this is to lead up to me saying, I just gave her her evening meds. She ate one! Ate around the other two, so out comes another pill pocket, which again, she ate one med, and spat out the methimazole. So I decided to take some of her kibble soaked with hydracare* (expensive meat flavored water supplement that is especially useful for cats with kidney disease) and see if I could use that as a pill pocket. She thought about it, but no…
But also, she doesn’t really like her prescription kibble anyway, though she tolerates it soaked in hydracare. So, if there is food or treats or anything else that your cat loves to eat, even if it’s hard, maybe try soaking it in something and then using that like a pill pocket?
*Just in case anyone is curious about hydracare, try to get samples first. It is apparently very hit or miss with cats, and I got lots of it free from my vet because my cats are the only ones from their practice who like it. They are a small practice, but still. Text
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Hahahahaha!
