This email just arrived:
******************************************************************
Auburn University
College of Veterinary Medicine
Clinical Pharmacology Laboratory
Updated results for Accession 2010-46053
Accession Informtion
Accession Number: 2010-46053
Internal ID Number:
College of Veterinary Medicine
Clinical Pharmacology Laboratory
Updated results for Accession 2010-46053
Accession Informtion
Accession Number: 2010-46053
Internal ID Number:
Veterinarian: Dr. Donald G
Date Received: 8/26/2010
Date Updated: 8/31/2010 3:21:22 PM
Animal Name: Milkshake
Owner Name: Species: Feline
Results
Test: Feline Phenobarbital, (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010
Recomendations
The concentration of phenobarbital is in the mid therapeutic range (15 to 40-45 mcg/ml) most commonly associated with seizure control in dogs or cats.
The current concentration is about 25% less compared to the last recheck.
If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.
Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB
Test: Feline Keppra, (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010
Recomendations
The mid interval concentration of levetiracetam is in high to above the high therapeutic range most commonly associated with seizure control in humans (5.5 to 21 mcg/ml). The relevance of these concentrations to canine or feline epileptics has yet to be confirmed.
The half-life of levetiracetam is short (1 to 8 hr) and may drop > 75% during an 8 or 12 hr dosing interval. Consider collecting both a peak and trough such that a half-life can be used to predict the lowest concentrations that occur during an interval.
Accordingly, althouth the current concentration is approxiamtley 40% lower compared to the last recheck, these comparisons can not be made unless the previous sample also was collected at 4 hrs. If only one sample can be collected, then consider collecting a true trough (just before the next dose) such that the lowest concentration to
which the patient is exposed during a dosing interval can be verified.
If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.
Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB
Additional Recomendations: Multi-Test Discount
UPS 1z5vx3572310064219
Comments: 4hrs post. Seizure free since 10/1/08.
Date Updated: 8/31/2010 3:21:22 PM
Animal Name: Milkshake
Owner Name: Species: Feline
Results
Test: Feline Phenobarbital, (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010
Recomendations
The concentration of phenobarbital is in the mid therapeutic range (15 to 40-45 mcg/ml) most commonly associated with seizure control in dogs or cats.
The current concentration is about 25% less compared to the last recheck.
If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.
Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB
Test: Feline Keppra, (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010
Recomendations
The mid interval concentration of levetiracetam is in high to above the high therapeutic range most commonly associated with seizure control in humans (5.5 to 21 mcg/ml). The relevance of these concentrations to canine or feline epileptics has yet to be confirmed.
The half-life of levetiracetam is short (1 to 8 hr) and may drop > 75% during an 8 or 12 hr dosing interval. Consider collecting both a peak and trough such that a half-life can be used to predict the lowest concentrations that occur during an interval.
Accordingly, althouth the current concentration is approxiamtley 40% lower compared to the last recheck, these comparisons can not be made unless the previous sample also was collected at 4 hrs. If only one sample can be collected, then consider collecting a true trough (just before the next dose) such that the lowest concentration to
which the patient is exposed during a dosing interval can be verified.
If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.
Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB
Additional Recomendations: Multi-Test Discount
UPS 1z5vx3572310064219
Comments: 4hrs post. Seizure free since 10/1/08.
Levetiracetam dosage (125mg) reduced to BID (from TID) on July 1, 2010. Current dosage 125mg (approx) at 10AM and 10PM. Phenobarbital given at the same time, approx. 8mg BID. Continuing weight loss despite very healthy appetite. Appears to have some balance/strength issues. No other drugs. Controlled.
******************************************************
I'm quite happy with the phenobarb levels. Dr. G, has felt for some time that I should be aiming for reduction of the amount of phenobarbital, rather than trying to lower the Keppra/levetiracetam dosage, but I'm really hesitant to even consider that, because it's my admittedly unscientific feeling that the phenobarb is what's working at this point. I don't actually understand the recommendation about the Keppra and trough levels, even though I've reread it six times. What difference would it make to know the lowest amount of levetiracetam available over the 12 hour period? I must be missing something here. Maybe they mean that knowing the lowest amount available/functional would indicate if further reduction might be possible? I have no idea.
At any rate, I am (with fingers crossed!) feeling pleased that #1 - most of all! - there have not been any seizures for 700 days!, and #2 - the dosages have been significantly reduced and still appear to be working effectively. I don't know, at this point, what more I could ask. Well, except for maybe Milk could gain a couple of pounds, and Busy could stop chewing on his neck, and he could be just a smidge less wobbly......
At any rate, I am (with fingers crossed!) feeling pleased that #1 - most of all! - there have not been any seizures for 700 days!, and #2 - the dosages have been significantly reduced and still appear to be working effectively. I don't know, at this point, what more I could ask. Well, except for maybe Milk could gain a couple of pounds, and Busy could stop chewing on his neck, and he could be just a smidge less wobbly......
