First-choice antiepileptic in cats
4-year-old domestic shorthair cat with recurrent generalised seizures (four in two months). Interictal neurological examination, blood work, MRI and CSF are normal.
Which maintenance antiepileptic do you choose?
chevron_right Show answer and explanation
A. Potassium bromide
In cats bromide frequently causes eosinophilic pneumonitis/bronchitis, which can be severe. It is not recommended in this species.
B. Oral diazepam
Oral diazepam can cause idiosyncratic acute hepatic necrosis in cats, often fatal. Use it only as parenteral or intranasal emergency rescue.
C. Phenobarbital, with serum level monitoring
Correct. It is effective and usually well tolerated in cats, with less hepatotoxicity than in dogs. Watch for initial sedation, polyphagia and rare idiosyncratic reactions (cytopenias, facial dermatitis, lymphadenopathy).
D. Imepitoin
Imepitoin is licensed only in dogs; in cats there are insufficient data to recommend it as first choice.
lightbulb Key takeaway
In cats, phenobarbital is first choice and levetiracetam the most used alternative or add-on (also as pulses for clusters). Avoid bromide and oral diazepam. Measure levels at 2 weeks, as in dogs.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.