Erythema multiforme associated with zonisamide in a dog

Ackermann, Amanda L.; Frank, Linda A.; McEntee, Michael F.; May, Elizabeth

doi:10.1111/vde.12237

Cited by 16 publications

(18 citation statements)

References 7 publications

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“…Indeed, an anti‐inflammatory dose of glucocorticoid was employed to manage cutaneous drug hypersensitivity to avoid the risk of SIRS in a previous study 14. However, the reported case had not developed systemic symptoms (skin lesion was limited to the lips and philtrum) as presented in our cases, so healing may have been achievable simply with removal of the offending drugs without administration of an immunosuppressive dose of glucocorticoid 17. Although the situation there has not been scientifically established, our treatment decisions were based on evidence in the literature 12 13…”

Section: Discussionmentioning

confidence: 68%

“…14 However, the reported case had not developed systemic symptoms (skin lesion was limited to the lips and philtrum) as presented in our cases, so healing may have been achievable simply with removal of the offending drugs without administration of an immunosuppressive dose of glucocorticoid. 17 Although the situation there has not been scientifically established, our treatment decisions were based on evidence in the literature. 12 13 For the pain management of the three cases, avoidance of repetitive administration of intraoperative and postoperative analgesics was considered.…”

Section: Discussionmentioning

confidence: 99%

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Successful intensive management in dogs with postoperative cutaneous drug hypersensitivity

Sasaki¹,

Mutoh

Shiga

et al. 2018

Vet Record Case Reports

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This case report describes three cases of canine cutaneous drug hypersensitivity with systemic signs presumed to be secondary to perioperative drug administration suspected to induce either erythema multiforme (EM) or Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Tentative diagnoses on the canine EM and SJS/TEN disease spectrum were based on clinical and histological assessments. Although no general consensus has been reached regarding the diagnostic criteria and evidence-based treatment standards for this disease spectrum in veterinary medicine, along with early identification of dermatological signs and withdrawal of suspected drugs, commencement of intensive management as a patient with burn injury in a medical intensive care unit results in favourable outcomes even with generalised disease. This report highlights the importance of early identification and intensive care for the disease and the need for further investigation of the efficacy of adjunctive therapies with reported immunomodulatory agents including glucocorticoids and human immunoglobulins to establish evidence-based treatment standards.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Successful intensive management in dogs with postoperative cutaneous drug hypersensitivity

Sasaki¹,

Mutoh

Shiga

et al. 2018

Vet Record Case Reports

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“…This case series reports the occurrence of reversible behavior changes associated with zonisamide in three dogs with no pre-existing behavior problems prior to administration of zonisamide. Among various ASDs, ZNS has been frequently used in veterinary practice with several adverse effects being reported (2,7,(13)(14)(15)(16)(17)(25)(26)(27)(28)(29)(30)(31)(32). Reported type 1 adverse effects include sedation, vomiting, loss of appetite, and ataxia (2,7,25,28).…”

Section: Discussionmentioning

confidence: 99%

“…The recommended dose and monitoring strategy are as follows: oral starting dose at 3-7 mg/kg every 12 hours (q12h) or 7-10 mg/kg q12h in dogs with co-administered hepatic microsomal enzymes inducers such as phenobarbital, serum concentrations should be aimed between 10 and 40 mg/L according to the human target range, and the serum concentration measurements should be performed at least 1 week after treatment initiation or dosage adjustment given the approximate elimination half-life of 15 h (6,7). Reported adverse effects of ZNS in dogs in the clinical setting include sedation, generalized ataxia, vomiting, inappetence, and a few idiosyncratic reactions such as cutaneous reactions (13,14), acute hepatopathy (15,16), and renal tubular acidosis (17). In addition, aggression has been reported in a research setting investigating chronic toxicity of ZNS in dogs (18).…”

Section: Introductionmentioning

confidence: 99%

Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report

Kanazono¹,

Ukai

Hiramoto³

2021

Front. Vet. Sci.

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Psychiatric adverse effect associated with anti-seizure drugs has been well-recognized in human medicine. This case report describes three dogs with presumptive idiopathic epilepsy presented for abnormal behavior episodes. Abnormal behavior episodes included sudden rage and aggression to the family members, insomnia, restlessness, and/or constant attention-seeking behavior. MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. The abnormal behavior episodes deteriorated along with gradual dose increment of zonisamide and these episodes almost completely disappeared within 5 days after discontinuation of zonisamide. The exact same episodes relapsed within days after re-administration of zonisamide and disappeared again shortly after discontinuation of zonisamide. Dose adjustments of other anti-seizure medications in case 2 did not result in significant changes in these behavior episodes. Although psychiatric adverse effects including aggressive behavior associated with zonisamide are widely recognized in humans, this is the first report in dogs in the clinical setting.

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“…Superficial necrolytic dermatitis (SND) or more appropriate metabolic epidermal necrosis (MEN) was described to appear after several months to years of phenobarbital (PB) therapy and evidence supported its origin as a hepatocutaneous syndrome ( 9 , 10 ). Dermatologic signs have also been a concern in dogs treated with potassium bromide (panniculitis) ( 11 , 12 ) and zonisamide (erythema multiforme) ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Cutaneous Adverse Drug Reactions in Dogs Treated with Antiepileptic Drugs

et al. 2016

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Epilepsy is one of the most common neurologic disorders in dogs and life-long treatment with antiepileptic drugs (AED) is frequently required. Adverse events of AED targeting the skin are only rarely reported in veterinary medicine and the true incidence and spectrum of cutaneous reactions in epileptic dogs remains unknown. In this study, we hypothesized that cutaneous reactions commonly occur in epileptic dogs and are related to AED treatment. A retrospective case review of 185 dogs treated for epilepsy identified 20.0% with simultaneous appearance of dermatologic signs. In a subsequent prospective case investigation (n = 137), we identified newly appearing or distinct worsening of skin lesions following initiation of AED therapy in 10.9% of dogs treated for epilepsy (95% CI 6.8–17.7%). Cutaneous lesions were classified as probably drug-induced in 40.0% of these cases. Patch testing and intradermal testing were further investigated as potential diagnostic methods to confirm AED hypersensitivity. They were of high specificity but sensitivity and positive predictive value appeared inappropriate to recommend their routine use in clinical practice.

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Erythema multiforme associated with zonisamide in a dog

Cited by 16 publications

References 7 publications

Successful intensive management in dogs with postoperative cutaneous drug hypersensitivity

Successful intensive management in dogs with postoperative cutaneous drug hypersensitivity

Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report

Cutaneous Adverse Drug Reactions in Dogs Treated with Antiepileptic Drugs

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