|
Principles of Pharmacologic Treatment |  |
| Facile drug use, particularly in the absence of a diagnosis, is not a component of rational treatment and should be avoided. Drug treatment for almost any behavioral condition is most useful when combined with behavior modification. |
| Prior to incorporating behavioral pharmacology into any treatment program, practitioners should have a reasonable diagnosis or list of diagnoses, an appreciation for the putative mechanism of action of the available drugs, and a clear understanding of potential side effects. In addition, they should have some idea of how the drug will specifically alter the behavior in question. This is critical because it will not only help clients to watch for adverse effects and improvements,
but can also help confirm or reject the original diagnosis. Without these guidelines, behavioral drugs may not be given long enough or at a sufficient dosage to attain the desired effect, clients will be unable to participate in the evaluation process, and there will be no objective behavioral criteria with which to assess improvement. |
| It is important to teach clients to be observant and recognize specific signs of potential adverse reactions. Such reactions can be minimized by performing a premedication CBC, urinalysis, and serum biochemistry profile and by taking a complete behavioral and medical history. Baseline ECGs are recommended for patients with a history of arrhythmia, heart disease, or prior drug reactions; that are on more than one medication; or that may undergo anesthesia or sedation. Liver
dyscrasias and cardiac arrhythmias may not rule out the use of a drug, but knowing that they exist can serve as a guide to dosage and anticipated side effects. Because clients may be distressed after a behavioral consultation, a written reminder of situations for which they should be alert may be helpful. It should also be kept in mind that with few exceptions (eg, clomipramine for separation anxiety in dogs, selegiline for cognitive dysfunction in dogs), the use of the majority of
medications prescribed for behavioral problems in pets is extra-label. |
| Most medications used to treat behavioral problems are tricyclic antidepressants or selective serotonin reuptake inhibitors. Prolonged treatment may be necessary for some pets to prevent relapse, but with good physical and laboratory monitoring there are few associated risks. See
Table:
Drugs that May Be Useful in the Treatment of Canine Behavioral Diagnoses and Table:
Drugs that May Be Useful in the Treatment of Feline Behavioral Diagnoses for recommended dosages for canine and feline behavioral drugs. There have been few well-designed, prospective clinical trials of medication use for behavioral problems in animals, so it should be kept in mind that many of these dosages are based on extrapolation from human use and clinical experience with pets. |
