Epiphen solution alternatives?

Re: Epiphen solution alternatives?

Gareth Dowdeswell — Fri, 02 Mar 2012 14:13:54 GMT

Liver values all ok. Cat has been on phenobarb for 3 months. Intially started on 1/4 15mg Phenobarb tabs because it came in just before the Christmas break with a history of cluster seizures, meds controlled the seizures but cat was v lethargic so went onto solution to allow lower dosing. Didn't have Bob's amazing tip for reduced doses, didn't think it was really possible to more than 1/4 the tablets.

The owners have been away since we transferred back onto Phenobarb tabs so cat may be ok now it's built up some tolerance but was looking into alternatives in case it needs to get back onto a lower dose.

Re: Epiphen solution alternatives?

Rob Loxley — Thu, 01 Mar 2012 20:15:22 GMT

Was the cat previously on epiphen soln? I can't see why the efficacy or side effects of pheno, mg per mg, should vary much between epiphen soln and tablets.

We have a number of cases on the human 15mg tablets, dating from previous epiphen solution stock issues.

Phenoleptil is another option, as it comes in 12.5mg tablets, but I can see that dosing with epiphen solution might be easier in a cat.

Re: Epiphen solution alternatives?

Kate Richardson — Thu, 01 Mar 2012 19:42:32 GMT

How long has the cat been on phenobarbitone? If it has only recently started then it should develop some tolerance as time goes on, much like dogs do? And I assume liver function is normal?

Re: Epiphen solution alternatives?

Arlo Guthrie — Thu, 01 Mar 2012 19:36:32 GMT

[quote user="Martin Atkinson"]Top tip: crush the Epiphen tablet, mix the powder very thoroughly with butter, roll it into a cylinder and freeze. You can then cut it into much more manageable fractions than trying to break a tablet into more then 4. Upside is the cat will love it as well. Or, phenobarbital elixir is only £5.65 for 500ml from NVS, what's wrong with that?[/quote]

Martin, could I persuade you to post your top tip here as well!

http://www.vetsurgeon.org/blogs/veterinary-tips/default.aspx

Re: Epiphen solution alternatives?

Laurence Webb — Thu, 01 Mar 2012 19:14:48 GMT

From the BNF...

Elixir, phenobarbital 15 mg/5 mL in a suitable flavoured vehicle, containing alcohol 38%, net price 100 mL = 78p. Label: 2, 8, counselling, driving (see notes above) Note Some hospitals supply alcohol-free formulations of varying phenobarbital strengths

A pharmacy is going to charge a dispensing fee and mark-up, but 100ml of Elixir should be fairly cheap. The cat may end up more sedated due to the alcohol. It's not a massive amount, around the equivalent of an adult having around half a pint of beer, but that is half a pint of beer to someone that has never drunk and whose liver doesn't work properly. Don't know how easy getting hold of an alcohol free formulation would be.

Alternatively you could try to get some Epiphen solution from abroad. Should be OK under the cascade if you can't get a suitable equivalent within the UK. Or a specials manufacturer.

Re: Epiphen solution alternatives?

Laurence Webb — Thu, 01 Mar 2012 18:59:02 GMT

Be wary about the phenobarbitone elixir. We got some that was 40% ethanol. Not insignificant when you're giving a cat a ml or two....

Re: Epiphen solution alternatives?

Gareth Dowdeswell — Thu, 01 Mar 2012 17:55:58 GMT

[quote user="Martin Atkinson"]

Top tip: crush the Epiphen tablet, mix the powder very thoroughly with butter, roll it into a cylinder and freeze. You can then cut it into much more manageable fractions than trying to break a tablet into more then 4. Upside is the cat will love it as well. Or, phenobarbital elixir is only £5.65 for 500ml from NVS, what's wrong with that?

[/quote]

Didn't realise NVS did the elxir - when we spoke to them on the phone they didn't suggest that as an alternative! Elixir has been ordered.

Re: Epiphen solution alternatives?

Martin Atkinson — Thu, 01 Mar 2012 14:50:27 GMT

Re: Epiphen solution alternatives?

Rob Loxley — Thu, 01 Mar 2012 14:30:37 GMT

Can you get it from an online pharmacy on prescription - might be cheaper than though NVS too