Small Animal/Exotics
PHARM PROFILE
POTASSIUM BROMIDE
Julie M. Ducoté, DVM
Texas A&M University
P
otassium bromide (KBr) is an
anticonvulsant used to control
seizures in dogs. KBr is not an
approved drug; it is available for in-
vestigational use. Pet owners should
be informed of this before the drug is
prescribed.
PHARMACOLOGY
Bromide competes with chloride
for transport across the neuronal cell
membrane, causing hyperpolariza-
tion of the cell membrane and thus
raising the seizure threshold. KBr is
absorbed orally and is eliminated by
the kidneys. The half-life in dogs and
cats is approximately 24 and 10 days,
respectively.1,2
INDICATIONS
Potassium bromide is indicated for
use in combination with phenobar-
bital in dogs in which seizures are
not well controlled with phenobarbi-
tal alone.1,3–5 KBr may also be used as
the sole anticonvulsant drug in dogs
in which phenobarbital is contrain-
dicated because of its potential hepa-
totoxic effects.3–7 KBr is currently be-
ing evaluated for use in cats.
CAUTIONS
Common adverse effects seen with
Pharm Profile introduces drugs that are new to the veterinary market as well as new indications for existing drugs. If you would like
Pharm Profile to cover a particular agent, please contact column editor GiGi Davidson, BS, RPh, North Carolina State University,
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20TH ANNIVERSARY
KBr administration include ataxia,
transient sedation, polyuria/polydip-
sia, and polyphagia.1 Dividing the
daily dose and administering it with
food may help to avoid gastrointesti-
nal side effects. KBr should be used
with caution in dogs with renal in-
sufficiency. 8–10 Safety during preg-
nancy and lactation has not been es-
tablished.
ACUTE TOXICITY
Bromide toxicity is uncommon, al-
though it may occur in dogs with re-
nal insufficiency or those on a high
dose of KBr. Signs of bromide toxici-
ty include ataxia, sedation or stupor,
and muscle spasm.8–10 Reducing the
dose by 10% to 25% is usually ade-
quate to resolve clinical signs.3 If the
dog is stuporous because of acute
overdose, gastric lavage should be
performed; however, this will remove
bromide only from the stomach. Di-
uresis with 0.9% sodium chloride will
help lower serum bromide levels.8–9
DRUG INTERACTIONS
Diuretics increase bromide excre-
tion and lower serum bromide
levels.10 Diets high in salt or chloride
will increase bromide elimination
and result in poor seizure control.11
Compendium July 1999
Bromide and chloride compete for
renal tubular reabsorption; increased
dietary chloride will cause increased
urinary excretion of bromide.11
DOSAGE AND ADMINISTRATION
The recommended daily mainte-
nance dose of KBr is 30 to 40 mg/kg
orally 1,3–7; the pharmacokinetics of
rectal and parenteral administration
in dogs are currently under investiga-
tion.12 A loading dose of 450 to 600
mg/kg, usually divided over 5 days,
can be used initially if rapid seizure
control is desired.3,4,7,10 During these
5 days, it is also important to give the
maintenance dose; thus, a typical load-
ing protocol would be 120 mg/kg/day
plus 35 mg/kg/day for 5 days. Serum
bromide levels are measured within
the first few days after completion of
the loading dose. Side effects may be
more likely during these 5 days.
Weaning from phenobarbital (if re-
quired) should be done after 2 to 3
months of KBr maintenance therapy
or after 1 to 2 days of the KBr load-
ing dose.
Therapeutic drug monitoring is es-
sential and should be performed after
the first 2 to 3 months of therapy,
loading, or any change in dosage.4
Even when the patient is doing well,
Compendium July 1999 20TH ANNIVERSARY
Client Counseling Information
■ Although its use in animals is extralabel, KBr is a
safe and effective anticonvulsant for dogs. It is
frequently used alone or in combination with
phenobarbital to control seizures.
■ Side effects of KBr are unusual but may include
drowsiness, difficulty walking, or vomiting. Giving
the drug with food may decrease stomach irritation.
■ KBr is administered orally in powder, capsule, or
liquid solution; if given as a liquid, it should be
kept refrigerated.
■ Dogs on KBr must be periodically returned to
the veterinary hospital to have blood drawn to
ensure that serum bromide levels are within the
therapeutic range (i.e., the range at which most
dogs’ seizures are controlled).
serum bromide levels should be checked every 6 months.
Therapeutic serum levels for most dogs are 1 to 3 mg/ml
but may vary depending on the animal’s tolerance.3,4,10
Many diagnostic and clinical pharmacology laboratories
can measure bromide levels (the cost is usually $15 to $30).
PREPARATIONS
Potassium bromide is available in powder form from
any chemical supply company (request medicinal or Amer-
ican Chemical Society [ACS] grade).4 Many pharmacists
frequently compound KBr into liquid solutions, capsules,
and chewable tablet forms.
STORAGE AND HANDLING
Potassium bromide in powder or capsule form should be
stored at room temperature. Once formulated into a liquid
solution, it should be kept refrigerated and discarded after
6 months.4
Small Animal/Exotics
References
1. Podell M, Fenner WR: Bromide therapy in refractory canine idio-
pathic epilepsy. J Vet Intern Med 7:318–327, 1993.
2. George K, Boothe DM, Nguyen J, LeGrange S: Disposition of bro-
mide in cats following oral administration of the potassium salt
(Abstr). Proc 14th ACVIM Forum:757, 1996.
3. Trepanier LA: Use of bromide as an anticonvulsant for dogs with
epilepsy. JAVMA 207(2):163–166, 1995.
4. Boothe DM: Anticonvulsant therapy in small animals. Vet Clin
North Am Small Anim Pract 28(2):411–448, 1998.
5. Pearce LK: Potassium bromide as an adjunct to phenobarbital for the
management of uncontrolled seizures in dogs. Prog Vet Neurol
1(1):95–101, 1990.
6. Podell M: How to keep epileptic dogs out of your emergency clinic.
Proc 15th ACVIM Forum:292–293, 1997.
7. Sisson A: Current experiences with anticonvulsants in dogs and cats.
Proc 15th ACVIM Forum:596–598, 1997.
8. Nichols ES, Trepanier LA, Linn K: Bromide toxicosis secondary to re-
nal insufficiency in an epileptic dog. JAVMA 208(2):231–233, 1996.
9. Yohn SE, Morrison WB, Sharp PB: Bromide toxicosis (bromism) in
a dog treated with potassium bromide for refractory seizures. JAVMA
201(3):468–470, 1992.
10. Plumb DC: Veterinary Drug Handbook. Ames, IA, Iowa State Uni-
versity Press, 1995, pp 89–90.
11. Shaw N, Trepanier LA, Center SA, Garland S: High dietary chloride
content associated with loss of therapeutic serum bromide concentra-
tions in an epileptic dog. JAVMA 208(2):234–236, 1996.
12. Dewey CW, Ducoté JM, Coates JR, et al: Intrarectally administered
potassium bromide loading in normal dogs. J Vet Intern Med 13:238,
1999.
ABOUT THE AUTHOR
Dr. Ducoté is affiliated with the Department of Small
Animal Medicine and Surgery, College of Veterinary
Medicine, Texas A&M University, College Station,
Texas.