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Principles of Pharmacologic and Natural Treatment for Behavioral Problems

By Gary M. Landsberg, BSc, DVM, MRCVS, DACVB, DECAWBM, Director, Veterinary Affairs and Product Development, CanCog Technologies, and Veterinary Behaviourist, North Toronto Veterinary Behaviour Specialty Clinic

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Psychotropic drugs and natural products can be used to reestablish a more stable emotional state and improve trainability in animals that are anxious, fearful, or overly reactive. Drugs might also be effective in the treatment of behavior that is abnormal, pathologic, or lacking impulse control. In addition, drugs may be indicated to improve compromised welfare. However, whereas drugs can improve the animal's emotional state and facilitate new learning, only with concurrent behavior modification can new neuronal pathways be established, new behaviors learned, and fearful responses to stimuli changed to positive ones.

Evidence-based decision making is a way to provide the best information and treatment options. Treatment should be selected using the evidence combined with the clinician’s expertise regarding the animal, client, and problem. Very few drugs have been adequately tested in rigorous, randomized, controlled trials for use in veterinary behavioral therapy. In fact, most drugs used in veterinary behavioral therapy are human drugs, very few of which have had pharmacokinetics established for animal species. This can lead to inaccurate assumptions with respect to dosage, duration of effect, contraindications, and adverse effects. In addition, there is a wide range of published dosages based on the application, individual variability, and desired outcome. Therefore, practitioners should remain current with the most recent veterinary behavior literature with respect to indications, recommended dosages, evidence of efficacy, potential adverse effects, and contraindications before dispensing any of these medications. (For dosing guidelines, see Table: Drug Dosages for Behavioral Therapy in Dogs and Cats). Depending on the drug and patient, compounding may be required to achieve an appropriate dosage and formulation for administration; however, reformulation may alter a drug’s pharmacokinetics, safety, efficacy, and stability. Recent studies on the use of transdermal preparations of behavioral drugs such as fluoxetine, amitripyline, and buspirone have found little to no absorption of transdermal preparations versus oral dosing.

A variety of natural products have been used to treat anxiety; however, only a few have demonstrated any evidence to support efficacy. Products that have published studies indicating potential therapeutic effects to calm and reduce underlying fear and anxiety include the canine appeasing pheromone (Adaptil®), the feline cheek gland pheromones (Feliway® and Felifriend®), a feline pheromone that might aid in scratching post training (Feliscratch®), l-theanine (Anxitane®), α-casozepine (Zylkene®), a diet supplemented with α-casozepine and l-tryptophan (Royal Canin Calm™ Feline and Canine), a product combining Magnolia officinalis and Phellodendron amurense (Harmonease®), a Souroubea sp supplement (Sin Susto™), as well as perhaps melatonin, and lavender aromatherapy.

Drug Dosages for Behavioral Therapy in Dogs and Cats

Drug

Dog Dosage

Cat Dosage

Tranquilizer

Acepromazine

0.5–2 mg/kg, prna to tid

0.5–2 mg/kg, prn

Benzodiazepines

Alprazolam

0.01–0.1 mg/kg, prn to qid

0.125–0.25 mg/cat, prn to tid

Clonazepam

0.1–1 mg/kg, bid-tid

0.05–0.2 mg/kg, one to three times/day

Clorazepate

0.5–2 mg/kg, prn to tid

0.2–1 mg/kg, one to two times/day

Diazepam

0.5–2 mg/kg, prn (eg, every 4–6 hr)

0.2–1 mg/kg, prn to tidb

Lorazepam

0.025–0.2 mg/kg/day to prn

0.025–0.08 mg/kg, one to two times/day

Oxazepam

0.2–1 mg/kg, one to two times/day

0.2–0.5 mg/kg, one to two times/day

Tricyclic Antidepressants

Amitriptyline

1–4 mg/kg, bid

0.5–2 mg/kg/day

Clomipramine

1–3 mg/kg, bidc

0.25–1 mg/kg/dayc

Doxepin

3–5 mg/kg, bid-tid

0.5–1 mg/kg, one to two times/day

Imipramine

1–4 mg/kg, one to two times/day

0.5–1 mg/kg, one to two times/day

Selective Serotonin Reuptake Inhibitors

Fluoxetine

1–3 mg/kg/dayc

0.5–1.5 mg/kg/day

Fluvoxamine

1–2 mg/kg, one to two times/day

0.25–0.5 mg/kg/day

Paroxetine

0.5–2 mg/kg/day

0.25–1 mg/kg/day

Sertraline

1–3 mg/kg/day or divided bid

0.5–1.5 mg/kg/day

β-Blocker

Propranolol

0.2–3 mg/kg, prn to bid

0.2–1 mg/kg, tid

α2-Agonist

Clonidine

0.01–0.05 mg/kg, prn to bid

Azapirone

Buspirone

0.5–2 mg/kg, one to three times/day

0.5–1 mg/kg, one to three times/day

Serotonin Antagonist Reuptake Inhibitor

Trazodone

3–8 mg/kg, prn to tid

Anticonvulsants

Carbamazepine

4–8 mg/kg, bid-tid

2–6 mg/kg, one to two times/day

Gabapentin

5–30 mg/kg, bid-tid

3–10 mg/kg, bid-tid

Levetiracetam

20 mg/kg, tid

10–20 mg/kg, tid

Phenobarbitald

2–5 mg/kg, bid (to 10 mg/kg, prn for sedation)

1–3 mg/kg, bid

Potassium bromided

10–40 mg/kg/day, or divided bid

Not recommended

Glial Modulator

Propentofyllinee

2.5–5 mg/kg, bid

Monoamine Oxidase Inhibitor

Selegilinec,e

0.5–1 mg/kg/day (in morning)

0.5–1 mg/kg/day (in morning)

a prn = as needed

b Rare reports of hepatic necrosis with diazepam in cats and potentially with other benzodiazepines

c Licensed and labeled for veterinary behavior use in some countries

d Titrate upward if inadequate clinical improvement and serum levels not adequate

e Licensed and labeled for cognitive dysfunction in some countries

A physical examination and blood and urine tests should be part of a minimum database before dispensing drugs to ensure there are no underlying medical problems that may be causing or contributing to the behavioral signs, or that might have an impact on drug selection and use. For tricyclic antidepressants and selective serotonin reuptake inhibitors, 4 wk may be required to achieve optimal therapeutic effect.

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