Abstract
Phenobarbital is the drug of choice for control of canine epilepsy. Phenobarbital induces hepatic enzyme activity, can be hepatotoxic, and decreases serum thyroxine (T4) concentrations in some dogs. The duration of liver enzyme induction and T4 concentration decreases after discontinuation of phenobarbital is unknown. The purpose of this study was to characterize the changes in serum total T4 (TT4), free T4 (FT4), thyroid‐stimulating hormone (TSH), cholesterol and albumin concentrations, and activities in serum of alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma‐glutamyl transferase (GGT) after discontinuation of long‐term phenobarbital administration in normal dogs. Twelve normal dogs were administered phenobarbital at a dosage of approximately 4.4–6.6 mg/kg PO ql2h for 27 weeks. Blood was collected for analysis before and after 27 weeks of phenobarbital administration and then weekly for 10 weeks after discontinuation of the drug. The dogs were clinically normal throughout the study period. Serum ALT and ALP activity and TSH and cholesterol concentrations were significantly higher than baseline at week 27. Serum T4 and FT4 were significantly lower. Serum albumin and GGT were not changed from baseline at week 27. Changes in estimate of thyroid function (TT4, FT4, TSH) persisted for 1–4 weeks after discontinuation of phenobarbital, whereas changes in hepatic enzyme activity (ALT, ALP) and cholesterol concentration resolved in 3–5 weeks. To avoid false positive results, it is recommended that thyroid testing be performed at least 4 weeks after discontinuation of phenobarbital administration. Elevated serum activity of hepatic enzymes 6–8 weeks after discontinuation of phenobarbital may indicate hepatic disease.
Keywords: Anticonvulsants, Epilepsy, Hepatotoxicity, Hypothyroidism, Seizures
References
- 1. Chrisman CL. Seizures In: Chrisman CL, ed. Problems in Small Animal Neurology. Philadelphia , PA : Lea and Febiger; 1991: 191–203. [Google Scholar]
- 2. McNamara JO. Drugs effective in the therapy of the epilepsies In: Hardman JG, Limbird LE, eds. Goodman and Gilman's the Phar‐macologic Basis of Therapeutics. New York , NY : McGraw‐Hill; 1996: 468–472. [Google Scholar]
- 3. Dowling PM. Management of canine epilepsy with phenobarbital and potassium bromide. Can Vet J 1994;35:724–725. [PMC free article] [PubMed] [Google Scholar]
- 4. Boothe DM. Anticonvulsant drugs and analeptic agents In: Adams HR, ed. Veterinary Pharmacology and Therapeutics. Ames , IA : Iowa State University Press; 1995: 375. [Google Scholar]
- 5. Jacobs G., Calvert C., Kaufman A. Neutropenia and thrombocy‐topenia in three dogs treated with anticonvulsants. J Am Vet Assoc 1998;212:681–684. [PubMed] [Google Scholar]
- 6. Bunch SE, Castleman WL, Hornbuckle WE, et al. Hepatic cirrhosis associated with long‐term anticonvulsant therapy in dogs. J Am Vet Med Assoc 1982;181:357–362. [PubMed] [Google Scholar]
- 7. Bunch SE, Baldwin BH, Hornbuckle WE, et al. Compromised hepatic function in dogs treated with anticonvulsant drugs. J Am Vet Med Assoc 1984; 184:444–448. [PubMed] [Google Scholar]
- 8. Chauvet AE, Feldman EC, Kass PH. Effects of phenobarbital administration on results of serum biochemical analyses and adreno‐cortical function tests in epileptic dogs. J Am Vet Med Assoc 1995; 207:1305–1307. [PubMed] [Google Scholar]
- 9. Chastain CB, Panciera DL. Hypothyroid diseases In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. Philadelphia , PA : WB Saunders; 1995: 1497. [Google Scholar]
- 10. Belshaw BE. Thyroid diseases In: Ettinger SJ, ed. Textbook of Veterinary Internal Medicine. Philadelphia , PA : WB Saunders; 1983: 1596–1597. [Google Scholar]
- 11. Boothe DM. Effects of drugs on endocrine tests In: Bonagura JG, ed. Kirk's Current Veterinary Therapy. Philadelphia , PA : WB Saunders; 1995: 339–346. [Google Scholar]
- 12. Mueller PB. Effects of Long Term Phenobarbital Treatment on the Liver, Thyroid, and Adrenal Axis in Dogs. Bern, Switzerland: University of Bern; 1998. Thesis.
- 13. McClain RM, Levin AA, Posch T., et al. The effect of phenobarbital on the metabolism and excretion of thyroxine in rats. Toxicol Appl Pharmacol 1989;99:216–228. [DOI] [PubMed] [Google Scholar]
- 14. Curran PG, DeGroot LJ. The effect of hepatic enzyme‐inducing drugs on thyroid hormones and the thyroid gland. Endocr Rev 1991; 12:135–150. [DOI] [PubMed] [Google Scholar]
- 15. National Research Council . Guide for the Care and Use of Laboratory Animals. Washington , DC : National Academy Press; 1996. [Google Scholar]
- 16. Littell RC, Milliken GA, Stroup WW, et al. Analysis of repeated measures In: SAS System for Mixed Models. Cary , NC : SAS Institute; 1996: 87–134. [Google Scholar]
- 17. Bunch SE. Drug‐induced hepatic disease of dogs and cats In: Kirk RW, ed. Current Veterinary Therapy. Philadelphia , PA : WB Saunders; 1989: 878–884. [Google Scholar]
- 18. Dayrell‐Hart B., Steinberg SA, Van Winkle TJ, et al. Hepato‐toxicity of phenobarbital in dogs: 18 cases (1985–1989). J Am Vet Med Assoc 1991;199:1060–1066. [PubMed] [Google Scholar]
- 19. Johnson SE. Diseases of the liver In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. Philadelphia , PA : WB Saunders; 1995: 1322–1323. [Google Scholar]
- 20. Coles EH. Liver function In: Coles EH, ed. Veterinary Clinical Pathology. Philadelphia , PA : WB Saunders; 1986: 141, 147–148. [Google Scholar]
- 21. Badylak SF, VanVleet JE. Sequential morphologic and clinico‐pathologic alterations in dogs with experimentally induced glucocor‐ticoid hepatopathy. Am J Vet Res 1981;42:1310–1318. [PubMed] [Google Scholar]
- 22. Willard MD, Twedt DC. Gastrointestinal, pancreatic, and hepatic disorders In: Willard MD, Tvedten H., Turnwald G., eds. Small Animal Clinical Diagnosis by Laboratory Methods. Philadelphia , PA : WB Saunders; 1994: 207–208, 211. [Google Scholar]
- 23. Center SA, Slater MR, Manwarren T., et al. Diagnostic efficacy of serum alkaline phosphatase and γ‐glutamyltransferase in dogs with histologically confirmed hepatobiliary disease: 270 cases (1980–1990). J Am Vet Med Assoc 1992;201:1258–1264. [PubMed] [Google Scholar]
- 24. Feldman EC, Nelson RW. Hypothyroidism In: Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. Philadelphia , PA : WB Saunders; 1996: 69, 73, 76–81, 84, 104. [Google Scholar]
