cbd oil and phenobarbital for dogs

A Complete Guide To Phenobarbital For Dogs

Phenobarbital is a fairly common prescription medication in humans and animals alike, used to treat seizures in younger children and pets. It can be administered orally or through an injection. It takes hold relatively quickly and the effects last for a few days. Phenobarbital works by helping control electrical activity that occurs during a seizure.

The majority of seizures are caused by abnormal electrical activity in your dog’s brain. Neurons begin misfiring, leading to spasmodic jerks and contractions throughout your dog’s body. Phenobarbital reduces the electrical activity of your pet’s brain, reducing the likelihood that they will have a seizure. Much less commonly, though, phenobarbital may also be used to help dogs with anxiety or sleep issues. These instances involve short term prescriptions, however, rather than long term use of the medication.

Phenobarbital is usually administered once per day, typically at night. It comes in both tablet and liquid form and should be administered with food if possible. In cases of dogs with more severe epilepsy, they may end up taking dosages twice per day.

It’s very important that once your dog begins taking phenobarbital that dosages are not missed. Missed dosages have a tendency to trigger epileptic episodes. Your vet

A seizure is an unexpected surge of neuron activity within your dog’s brain. It can affect the way your dog feels, behaves, and moves. Most commonly, a seizure will look like convulsing spasms that last for a couple of minutes. Occasionally, instead of convulsing, dogs will simply go unconscious. This will look like your dog is walking around, going about their day, and then out of nowhere, they collapse unconscious.

Phenobarbital works by suppressing the overall electrical activity of your dog’s brain. It’s effective in around 60% to 80% of dogs. If your dog’s brain activity is generally low, then even when it sparks due to epilepsy, it isn’t high enough to cause a seizure – this is the underlying concept of phenobarbital as well as most epileptic medications.

Phenobarbital is one of the more popular prescriptions for seizures due to its low cost and effectiveness. Despite the fact that phenobarbital is not FDA approved for use with dogs, still one of the first medications that veterinarians will recommend for epileptic dogs. It takes around two weeks of use for phenobarbital to begin taking effect in a dog since the levels of phenobarbital in your pet’s bloodstream need to reach a certain level.

If your dog is still having semi-frequent seizures after having been on phenobarbital for

Fortunately, seizures aren’t too common in dogs, only occurring in about 0.5% of all canines – or one in every two hundred dogs. Seizures are not a disease in and of themselves, but rather a symptom of another underlying issue. Sometimes this is

Grand Mal

These are the most common kinds of seizures in dogs, and unfortunately, they are the most dangerous. Grand Mal seizures affect your pet’s entire body, causing them to convulse and spasm. These seizures can last anywhere from a few seconds to several minutes and can be especially dangerous if happening back to back.


A focal seizure is one that occurs in a specific region of your dog’s body. They occur when the abnormal surge of electrical activity in a dog’s brain is local to a specific area. This causes the seizure to only affect one of your dog’s limbs or one side of their body.


Psychomotor seizures are seizures that affect your dog’s behavior rather than their bodily movements. You may notice that your dog is acting oddly, running around, chasing imaginary objects, and seeming to be on edge. In humans, psychomotor seizures can manifest themselves as night terrors, where an individual is in a dreamlike state while awake and moving around. Psychomotor seizures are harder to identify, especially in dogs.

Breeds prone to epilepsy

While any dog at any age can develop epilepsy, there are few breeds that have a higher predisposition for having epileptic episodes. Breeders are generally pretty good about removing epileptic dogs from the gene pool, but this doesn’t guarantee that epilepsy won’t be passed down through a breed.

Some of the breeds that most frequently experience epilepsy include:

Keep in mind that just because a particular breed of dogs is on this list, it doesn’t mean

Unfortunately, seizure medications tend to have some of the worst side effects for their users, and phenobarbital is no exception. Phenobarbital is what’s known as an “extra-label” drug. This means that it is approved for use on humans by the FDA, but not approved for use on animals. Veterinarians are allowed to use extra-label drugs


Sedation is the most common side effect of phenobarbital. This is because of the way that phenobarbital works. The medication suppresses your dog’s brain activity to reduce the likelihood that they will have a seizure. However, this also reduces their energy levels, causing them to be more lethargic and sedentary. If your dog is sedated while using phenobarbital, they may need to lower their dosage or switch to a different medication altogether. Sedation is also relatively common when a dog is just beginning to use phenobarbital. This is normal and expected, and should go away after the first few weeks of use. If your dog is still sedated after the first few weeks, however, consult with your vet about resolving the issue.

Excessive Appetite/Thirst

Phenobarbital can also cause your pet’s appetite and thirst to increase. An increased appetite can be dangerous, as weight gain is a serious health issue with dogs. Fortunately, this is relatively easy to manage since all you need to do is monitor and control their food intake. Excessive thirst is less problematic, though it can lead to an increase in your dog using the bathroom inside. If your dog is drinking more while on phenobarbital, you might need to take them outside more often than before.


On the other end of the spectrum, dogs taking phenobarbital may appear more restless and hyperactive. This may look like excessive activity, your dog becoming more vocal, panting even when your dog is inactive, and otherwise being high strung.

Liver Damage

A more serious side effect of phenobarbital is liver damage. Long term use of phenobarbital (more than three months) can cause liver damage to occur to your dog. This can manifest in a variety of symptoms, including weight loss, jaundice, dark liver, and abnormal stools.

Phenobarbital and Liver Damage

Phenobarbital has been linked to liver damage in dogs that use the medication over a long period of time – more than three months. If your dog’s blood serum levels of phenobarbital are over 45 mcg/ml, then your dog is likely experiencing liver damage from phenobarbital. A healthy dosage of this medication should be around 30 mcg/ml. In order to make sure that your dog is getting the proper dosage of phenobarbital, check in with your vet every six months for new blood tests.

Damage to the liver by phenobarbital can cause scarring, liver disease, and possibly liver damage. While this tends to occur in a relatively small number of dogs, the potential risks are still there. If the damage is caught early enough, the damage can be reversed by reducing dosages or switching medications altogether. If the damage is not caught soon enough, though, it can become permanent and potentially fatal.

Being proactive is the best way to reduce the chances that your dog will experience severe liver damage from phenobarbital. Rather than waiting for symptoms of liver damage to occur, take your dog to the vet on a regular basis for bloodwork to make sure that their phenobarbital levels are still within a healthy range.

The earliest signs of liver damage involve issues related to your dog’s appetite. They may be excessively hungry or – on the opposite end – reluctant to eat. Dogs with liver issues might start losing weight as well and could drink more water than normal. Later on, more serious symptoms will start to surface, like jaundice, swollen stomach, dark brown urine, and lethargy. These later symptoms could indicate that your dog is experiencing liver failure.

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The Risks Of Phenobarbital

Liver damage is one of the most serious risks of phenobarbital use in dogs. High dosages over a long period of time can overwork and poison the liver, eventually leading to severe health conditions – including liver failure. However, liver failure is not the only health condition that can arise from long term use of phenobarbital.

While it is effective for treating seizures, phenobarbital is a harsh drug and shouldn’t be given to your pet if they have any of the following conditions:
  • Anemia
  • Heart disease
  • Hypovolemia
  • Hypoadrenocorticism
  • Respiratory issues

All of these existing conditions can be worsened through frequent phenobarbital use. When consulting with your vet, make sure that they are aware of any of these conditions that your dog may have, as well as any other conditions that aren’t mentioned on the list. There are plenty of alternative epilepsy treatments available, so there is no need to have your dog stuck on a harmful medication.

All of the issues that phenobarbital can create are entirely preventable. Frequent monitoring of your dog’s phenobarbital levels is a vital component of making sure that they are in good health while using this drug. Most of the symptoms of severe damage won’t surface until the damage is already permanent, so it’s better to err on the safe side and take precautions.

While it is possible for your pet to go into epilepsy remission, this takes several years, which means several years of phenobarbital therapy. Because of this fact, you need to ensure that it’s doing as little damage to their system as possible. If you are

Like any medication that your dog is on, drug interactions will need to be taken into consideration. If your dog is on any medication prior to being prescribed phenobarbital – whether it be prescription, over the counter, supplements, etc. – your vet will need to know what they are taking before you begin phenobarbital therapy.

Most notably, phenobarbital increases the activity of your dog’s liver. This means that medications that normally take effect by being broken down by the liver will likely be less effective. Depending on the medication, your vet may recommend that you increase the dosage of that medication or switch to something more potent.

On the other side of the spectrum, some drugs may become more effective or cause phenobarbital to become more effective when used in conjunction with one another. When this happens, your vet may recommend that you lower the dosage of each to bring things back down to a healthy level. There may also be times when phenobarbital simply isn’t an option because of the way it interacts with certain drugs, so if your dog is already on medications prior to visiting the vet about epilepsy, be prepared to be prescribed something other than phenobarbital.

The following medications are all likely to have interaction when taken alongside phenobarbital:
  • Certain anticoagulants
  • Estrogen agents
  • Progestins
  • Beta-blockers
  • Tricyclic antidepressants
  • Opiate agonists
  • Aminophylline
  • Chloramphenicol
  • Doxycycline
  • Griseofulvin
  • Antihistamines
  • Quinidine
  • Rifampin

Keep in mind that this isn’t an exhaustive list of the medications that can interact with

Not all dogs will need to take phenobarbital for the entirety of their lives. Many are able to enter epilepsy remission after just a few years of going through phenobarbital therapy. If you think that your dog may be ready to end their epilepsy treatment, consult with your veterinarian before taking them off of the medication. As mentioned earlier, unexpectedly taking your pet off of phenobarbital can result in a seizure. So consult with your vet and follow their directions on removing phenobarbital from your pet’s routine.

If your dog has been completely seizure-free for two to three years, they are a good candidate for ceasing phenobarbital treatment. This is especially true if your dog has been suffering from the side effects of the medication. If you’ve noticed that your dog has been having worse reactions to the drug while also not having had any seizures over a long period of time, then it is likely a good time to try taking a break from phenobarbital therapy.

There are instances other than when your dog is in epilepsy remission that you will need to consider ceasing phenobarbital treatment, and that’s usually when the side effects become so severe that your dog’s health is in danger. While this usually only occurs after improper dosing, some dogs simply aren’t able to handle the medication.

If you find yourself in a situation like this, where your dog is clearly suffering as after

Phenobarbital is the go-to epilepsy prescription for several vets for a few reasons. Of course, the biggest reason is that it works. The majority of dogs will have a positive experience with phenobarbital treatment, so it’s a great option to start a dog on. It’s also inexpensive compared to many alternatives, which is important since the prescriptions usually last for a few years.

That said, there are dogs that simply aren’t compatible with this drug. Other prescriptions, preexisting conditions, and other factors might lead a vet to prescribe your pet another solution to epilepsy. Potassium bromide is a popular alternative to phenobarbital, especially in cases when your pet’s epilepsy is less severe. Like phenobarbital, it works by reducing the amount of activity in your dog’s brain, preventing seizures.

The major difference between the two drugs is that it takes much longer to build up the potassium bromide levels in your dog’s blood than it does to build up phenobarbital levels. This means that your dog might not experience any epileptic relief until four months of potassium bromide therapy. For this reason, phenobarbital and potassium bromide are often used in tandem with one another.

Levetiracetam is another potential alternative to phenobarbital. It’s a newer medication, but it is quickly gaining traction in the veterinary industry. However, because of its newness, there are still many unknown factors that vets are learning. An example of this is that vets are beginning to discover that dogs and cats seem to

Another popular alternative to phenobarbital is CBD. CBD is relatively new as a supplement for several health conditions, but research throughout the medical field is extremely promising. CBD has numerous health benefits, one of which includes reducing the frequency of seizures.

In higher dosages,CBD can be used to reduce the frequency of seizures and even interrupt them as they are happening, with little to no side effects. Most dogs have a healthy tolerance to the supplement, and even those that don’t are only ever likely to experience a slight lethargy. It is important to keep in mind, though, that CBD is a relatively new supplement and shouldn’t be used without first consulting a vet. It is also less effective than traditional epilepsy treatments and will need to be delivered and relatively high dosages to make a difference in epileptic dogs. CBD works in dogs by stimulating your pet’s ECS system. This system is responsible for regulating several processes within your dog’s body, including things like appetite, mood, sleep, and immunity. When your pet takes CBD, it interacts with this system, causing it to work more effectively. The result is multiple positive changes in your animal’s health, as well as the overall homeostasis of your dog’s system. This homeostasis is the primary source of health benefits in dogs that routinely take CBD supplements.

Aside from treating epilepsy, CBD can also help reduce a dog’s anxiety, improve their mood, bring back their appetite, treat conditions like glaucoma and IBD, and lower the pain levels of conditions like arthritis.


Ivana Vukasinovic grew up in Serbia and attended the University of Belgrade where she received a degree in Veterinary medicine in 2012 and later completed surgical residency working mostly with livestock. Her first year of practice was split between busy small animal practice and emergency clinic, and after two more years of treating many different species of animals, she opened her own veterinary pharmacy where an interest in canine and feline nutrition emerged with an accent on fighting animal obesity. In her free time, she acts as a foster parent for stray animals before their adoption, likes to read SF books and making salted caramel cookies.

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Phenobarbital for Dogs: Everything You Need To Know 

Epilepsy can affect any dog breed, with the most common dog breed affected being the Golden Retriever. It is a seizure disorder that is caused by abnormal electrical patterns in the brain.

Epilepsy in dogs means pet parents have to understand the symptoms, medication side effects, and know what to look out for when using phenobarbital for dogs.

Phenobarbital for dogs is a popular, and often- prescribed medication used to treat seizures in dogs. Anticonvulsant drugs like phenobarbital are used to treat seizures in dogs, including those caused by epilepsy. There are also numerous healthier alternatives like CBD for pets without the THC, instead of using phenobarbital for dogs.

Unfortunately, there is a higher incidence of seizures found in certain dog breeds like Goldens. When a dog is diagnosed with epilepsy, ongoing veterinary treatment is essential to prevent overheating, brain damage, and disruption to the body’s circulation.

What is Phenobarbital for Dogs?

Phenobarbital for dogs is a barbiturate that affects the nervous system in dogs. It’s a depressant that’s also known by the name Luminal or Barbital. Phenobarbital helps to reduce the severity of seizures, as well as the duration of each seizure.

What Happens During a Seizure?

We adore our dogs, and there’s nothing as frightening as watching your dog have a seizure. During a seizure, also called status epilepticus, anticonvulsants are given intravenously to your dog. That said, phenobarbital for dogs are usually given by mouth when used for long-term maintenance.

Anticonvulsant drugs like phenobarbital for dogs are usually started off on a low dose. This is then gradually adjusted until the seizures are controlled. When discontinuing an anti-convulsant, you should do so gradually to avoid triggering another seizure. Working closely with your veterinarian at all times is important when you have a dog that suffers from seizures.

Primary or Idiopathic Epilepsy

This refers to epileptic seizures of an unknown cause. It is inherited in certain breeds like the Golden Retriever and Beagle. A veterinarian has to first diagnose epilepsy, and at the same time eliminating other seizure causes, like those relating to structural brain abnormalities like hydrocephalus, encephalitis, or metabolic disorders like hepatic encephalopathy.

Idiopathic epilepsy usually affects dogs around 6 months to 5 years of age. Your veterinarian will do a full history and a neurological exam. If the epilepsy can’t be cured, then your veterinarian will prescribe an anticonvulsant drug for your furry best friend. Phenobarbital for pets is an anti-convulsant drug that is used on animals that suffer from seizures.

Your veterinarian will decide which drug is best for your dog, and also decide as to the dosage of the prescribed drug.

Dog Breeds Most Affected

Secondary Epilepsy

This is caused by seizures induced by viral or infectious diseases, metabolic disorders, nutritional imbalances caused by low-quality diets or traumatic injury to pets. Seizures can also be seen in dogs with a thyroid condition.

Certain dog breeds like the Golden Retriever, Springer Spaniels and Irish Setters may be more prone to this. Symptoms include partial paralysis, weakened reflexes, inability to feel paw position in all 4 legs, loss of balance, difficulty swallowing, and vomiting.

Treatment will usually involve thyroid replacement therapy. As usual, it’s best to always work closely together with your veterinarian for the best advice and veterinary treatment.

What Causes Seizures in Dogs?

  • Brain trauma
  • Liver disease
  • Kidney failure
  • Anemia
  • Toxins- poisoning via plants, toads, chemicals
  • Electrolyte imbalances
  • Stroke
  • High or low blood pressure

Laboratory Tests

Your veterinarian will do diagnostic testing via CT scans, MRI scans, plain x-rays with a special dye called myelegrapghy. Some tests will include the use of an electroencephalogram which will record electrical activity in the muscles and nerves.

Blood tests are also used to detect metabolic disorders which may affect the nervous system in dogs. Cerebrospinal fluid may also be analyzed and tested for meningitis, encephalitis, cancer, or an injury to the spinal cord itself.


Dosage will differ among dogs. Your veterinarian will prescribe the correct phenobarbital dosage for your dog after considering a few things like weight, seizure severity, and regularity. This drug is usually prescribed for every 12 hours. Starting dose of phenobarbital is 1mg per pound of your dog’s weight.

Your veterinarian will weigh your dog. Dosing should not be missed, and a dosing schedule for Phenobarbital is recommended so that the drug is given at the same time each day, and that a dose is not missed. If a dose is missed, it could lead to a severe seizure episode.

Rule of thumb here is to never double up on a missed dose with this drug. Administer the missed dose, and then wait for a full 12 hours before giving the next dose.

Side Effects

One of the most common side effects of phenobarbital is excessive hunger and thirst. There are also other side effects. These may include the following:

  • Excessive anxiety
  • Ataxia
  • Depression
  • Liver damage/failure
  • Hyperactivity
  • Jaundice
  • Vomiting
  • Weight loss
  • Anorexia
  • Weight gain from excessive hunger

Drug Interactions with Other Medications

Dogs on certain medications should not take phenobarbital. You will need to consult with your veterinarian about your dog’s past and present health conditions, and also, as to what meds he or she may be currently on. Consult with your veterinarian if your dog is on any of the following meds:

  • Anticoagulants
  • Beta-adrenergic blocker
  • Corticosteroids
  • Diazepam (along with other central nervous system depressants)
  • Doxycycline
  • Furosemide
  • Griseofulvin
  • Metronidazole
  • Rifampin
  • Theophylline
  • Valproic acid
  • Phenytoin sodium
  • Opiate agonists
  • Phenothiazine
  • Aminophylline
  • Antihistamines

Drug Interaction With Other Health Conditions

Dogs with certain health conditions should not be taking this drug. These include the following:

  • Heart disease
  • Anemia
  • Kidney disease
  • Respiratory issues
  • Hypovolemia
  • Liver disease
  • Addison’s disease

Alternative Meds for Phenobarbital

If your dog is suffering from any of the numerous side effects from Phenobarbital, it’s best to immediately consult with your veterinarian. Alternate meds may include the following:

Potassium bromide (K-Brovet)

As usual, it’s always good to supplement your dog’s high-quality dog food formula with supplements for optimal health. A healthy diet is important for dogs that suffer from seizures. Because anti-seizure meds are closely linked to kidney damage and toxicity, a healthy and balanced diet will help your dog recover.

Whether your dog is an active youngster or an older senior, diet and supplements are key factors in fighting diseases, and boosting immunity. Read the promising results from numerous CBD clinical trials and seizures.

What is CBD Oil for Dogs?

CBD is a component of the cannabis plant that does not have a psychoactive effect when it is free of delta-9- tetrahydrocannabinol (THC). Pet CBD products should contain less than 0.3 % THC, if any at all.

CBD is a non-psychotropic phytocannabinoid, and offers both therapeutic and medicinal purposes for humans and pets naturally in the form of capsules, dog treats, transdermal patches and tinctures made specifically for pets.

It’s a supplement that can be taken every day with other doggie supplements, and is the new superfood of 2020. As a nutraceutical, CBD benefits optimal well-being in all pets by reducing inflammation and anxiety. The key here is to only purchase high-quality CBD oil for your pets via tinctures, treats, sprays or lotions.

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CBD oil is packed with essential minerals like iron, zinc, and magnesium which are all beneficial for canine health. Zinc is key to hair health, and good skin and coats in pets. Cannabidiol oil also contains elastin and collagen which promotes healthy hair in people. It is high in antioxidants, and yields vitamins A, E, and C, which protects from free-radicals caused by everyday pollution.

C02 Extraction

Extraction of CBD oil takes place via a carbon dioxide process called CO2 extraction. This uses pressurized carbon dioxide to extract the CBD from the entire plant. CO2 functions as a solvent when reaching extreme temperatures, yet because it is under boiling point, it’s cold.

It is processed to create oil from the plant. It is also a clean and environmentally friendly process. This is one of the best methods used to ensure a high-quality cannabidiol oil for your pets.


This is an optional and additional step in the processing of CBD oil for pets and people. Cannabidiol is an active compound in hemp. When CBD is extracted using the CO2 method, cannabidiol oil is removed from the plant.

Winterization is an important step because it further purifies the hemp extract, and allows for removal of additional phytonutrients like terpenes and flavonoids.

After the winterization process, you’ll have a CBD isolate which contain no other phytonutrients, and is THC-free. As a consumer, it’s best to consider asking for a certificate of analysis (COA), so that you can ensure that you’re purchasing a high-quality CBD tincture, treat, capsule, transdermal patch or lotion for your furry best friend.

Low-quality CBD oils may contain contaminants like pesticides. Hemp CBD oil for pets is a nutraceutical that delivers numerous health benefits naturally without side effects.

Consulting with a holistic veterinarian will help ensure that you’re using the correct dosage and potency for optimal efficacy for a particular condition. If the dosage is too low, it may not be effective.

That said, most veterinarians and CBD experts recommend that when starting off with a CBD product, it’s best to begin with a low dosage, and to slowly work your way up.

Studies Show That CBD May Benefit Certain Health Conditions in Pets

It’s also may be beneficial for numerous other health conditions that are common in dogs. These conditions include:

  1. Chronic pain & anxiety reliever (great for dogs that are ill or recovering from surgery)
  2. May help with canine depression resulting from pain after a surgery or illness
  3. May provide relief from cancer side effects like chemotherapy and radiation
  4. Promotes healthy skin and coat by preventing sebaceous gland cells from secreting too much sebum & may help prevent and treat hot spots in dogs.
  5. May provide benefits to dogs with neurological disorders
  6. Helps decrease inflammation in dogs
  7. May help prevent cognitive decline
  8. May be beneficial for cardiac health
  9. CBD may be beneficial in preventing tumor growth
  10. CBD helps with diabetes prevention by reducing diabetes up to 56%, and reducing associated inflammation in diabetic dogs.
  11. May help with digestive issues
  12. May help with blood disorders
  13. Fights off free radicals, and may prevent the development of cancer

That said, there still needs to be more research done on the benefits of CBD as an effective treatment for the above mentioned health conditions. But this is what we know today about CBD and how it’s used for seizures after being approved by the FDA.

CBD for Epilepsy in Dogs

The American Kennel Club (AKC) discussed a major clinical trial that studied the use of CBD for dogs with epilepsy at Colorado State University headed by Dr. McGrath. The study adds that the “Efficacy of Cannabidiol (CBD) for the Treatment of Canine Epilepsy”.

According to Dr. McGrath, up to 30% of dogs receiving standard anti-epileptic therapy remain uncontrolled for their seizures, and the side effects of the antiepileptic drugs are often unacceptable.

“CBD is a non-psychotropic component of the Cannabis sativa plant, which has been shown to have anti-convulsant properties. This randomized, double-blinded, placebo-controlled, crossover clinical trial study will be utilized to prove its effectiveness.

“The timeliness and importance of research into the role of Cannabis in veterinary medicine cannot be emphasized enough,” stated Dr. McGrath. “With the changing public perception of Cannabis, it is time that we put science behind the stories and claims.

We need to know if this drug is safe and if it works. If CBD is effective for treating epilepsy, it has the potential to save the lives of dogs around the world, ” via the AKC. There are numerous other studies that attribute CBD’s effectiveness in reducing inflammation that is linked to seizure activity in dogs.

If your dog is struggling with seizures, or just feeling out of sorts, hemp CBD for pets may be an option. Just recently, Epidiolex was approved by the FDA. It’s the first and only FDA approved for the treatment of seizures in people. With all the current CBD research still ongoing, hemp CBD for pets does seem to be effective in pain management, as an anti-inflammatory, and as an anti-seizure supplement in dogs.

As with all health conditions including mild or chronic pain, it’s best to always consult with your veterinarian. So far, we’ve seen how CBD improves immunity and boosts health in both pets and people.

As a hemp-based supplement for dogs that’s available via tinctures, treats, capsules, lotions, sprays and more, it helps to also reduce stress, tension and promote relaxation.

Author Bio

Sam Shaw is a health and wellness guest contributor and entrepreneur from Los Angeles. He loves to write about all things sustainability, holistic health, and pet wellness.

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