Abstract
Dear Editors, — This letter is in reference to the recent article entitled ‘The seizuring cat: diagnostic work-up and therapy’ by Kerry Smith Bailey and Curtis W Dewey (JFMS 2009; 11: 385–394); in particular, the authors' categorization of diazepam as contraindicated in the cat. I believe this designation to be wrong and unfair.
Over the past 3 decades, oral and injectable diazepam has saved the lives of thousands of cats in its clinical use as a behavior-modifying agent, appetite stimulant, and in its use for seizure control. All of us are aware of the two dated publications (both published 13 years ago) implicating the adverse effect of oral diazepam in the genesis of fatal hepatotoxicity in 17 cats. Such rare reactions occur with many therapeutic agents and, when they do occur, are properly designated as idiosyncratic reactions. No additional reports of diazepam-induced fatal hepatotoxicity have, to my knowledge, been published in the past 13 years.
I fully recognize that most clinical uses of diazepam have been replaced by medications superior in efficacy and lower in side effects, and that any time oral diazepam is administered, prudent advice and precautions to the client should be presented. However, oral diazepam is still an extremely useful adjunctive therapy for seizuring cats not well controlled with phenobarbital alone, in cluster seizures, and in status epilepticus.
Equally of concern is the authors' failure to categorize the use of potassium bromide (KBr) as ‘contraindicated in the cat’. Fifty percent of cats receiving KBr had clinical reactions, 40% developed moderate to severe bronchoalveolitis/pulmonary fibrosis and some of those unfortunate cats were euthanized due to the severity of the clinical signs. Is it appropriate to categorize a 50% reaction rate as ‘idiosyncratic’, as the authors have done? The general lack of efficacy and the high rate of asthma/pulmonary fibosis, along with cats humanely euthanized due to complications, should be enough to generate a ‘not recommended’ or ‘malpractice’ designation.
Finally, there is little scientific support for the authors' assertion that the clinical signs caused by KBr administration ‘abate with discontinuation of the drug’. Anecdotal reports on the Veterinary Information Network suggest that in some cats the pulmonary damage may be irreversible.