Psychotropic Medications for cats

Psychotropic Medications for Cats

FROM Herron, M. Integrated Care: Feline Psychopharmacology, Nutrition, & Supplements. Presented at: 2022 American Association of Feline Practitioners Conference, Pittsburgh, Pennsylvania. October 27-30, 2022

The main SSRIs used in cats are fluoxetine (Prozac/Reconcile), paroxetine (Paxil), and sertraline (Zoloft). Out of these drugs, fluoxetine is the drug most used in cats. It may increase aggression in feisty cats. Other fluoxetine side effects include lethargy and reduced grooming. Because it curbs appetite, fluoxetine may place finicky and obese cats at risk for hepatic lipidosis, and diabetic cats in danger of hypoglycemic episodes. Urine retention is a rare but possible adverse effect of fluoxetine.

Sertraline has a lower adverse event profile than fluoxetine, is metabolized by the liver, and is the safest daily medication for cats with kidney disease and epilepsy.

Tricyclic antidepressants (TCA) block reuptake of both serotonin and norepinephrine, thereby extending the availability of both. Their potency rests mostly in the work of serotonin, though norepinephrine also regulates anxiety. TCAs have anticholinergic action, which confers heftier side effects, but they also offer antihistamine properties, which bring calming vibes to aggressive, bullying cats.

The TCA clomipramine (Clomicalm), FDA-labeled for separation anxiety in dogs, is the most popular TCA in cats. Its antihistamine properties soothe, but its moderate anticholinergic action contraindicates it for cats with glaucoma, keratoconjunctivitis sicca (KCS) and chronic constipation. It should also be avoided in cats suffering seizures or cardiovascular disease. Rarely, urine retention can occur.

Buspirone (Buspar) – the only azapirone commercially available in the U.S. – profoundly affects feline behavior and pulls scared cats out of their shells, earning the nickname the bravery drug . Because buspirone brings out boldness, it is only suitable for NON-aggressive cats. It is also used to halt urine marking, buspirone ushers in clinical improvements 1-2 weeks after therapy is initiated. On the downside, buspirone is best given twice daily and can cause mild side effects, including increased friendliness, assertive social interactions, exacerbation of existing aggression, and rarely sedation or agitation.

Monoamine oxidase inhibitors (MAOIs) downregulate monoamine oxidase B, sparing the key neurotransmitters norepinephrine, serotonin, and dopamine. By enhancing the latter, the MAOI Selegiline (Anipryl) slows the progress of cognitive dysfunction syndrome (CDS) in cats. [Also for dogs]. Side effects, which are uncommon, consist of sedation, lowered appetite, GI upset, and irritability.

All the standing anxiolytics can be given in overdoses that drown the synaptic cleft in serotonin. This can result in serotonin syndrome, a potentially deadly physiologic storm characterized by agitation, seizures, hyperthermia, and tachycardia. The antihistamine cyproheptadine is used to treat serotonin syndrome.

Benzodiazepines These receptor agonists wear many hats including hypnotic sedatives, anxiolytics, muscle relaxants, anticonvulsants, and appetite stimulants. The optimal benzo choice for cats is lorazepam, which can be used daily for inter-cat aggression or on an as-needed basis for veterinary visits and/or car travel.

Acepromazine A phenothiazine neuroleptic that functions as a tranquilizer rather than an anxiolytic, acepromazine can be piggybacked onto anxiolytics like gabapentin or lorazepam when greater sedation is needed.

Traditionally used for chronic and neuropathic pain, gabapentin lessens stress in cats when given at a dose of 100 mg per cat (dose range is 50-200 mg/cat) 90 minutes prior to an anxiety-provoking event, such as placement into a carrier.

The use of calming pheromones such as Feliway, delivered via a room diffuser, can help calm cats and reduce conflict.

It is a regrettable fact that too many veterinarians have no formal training in ethology/animal behavior. According to a 2015 letter from veterinarians with the American College of Veterinary Behaviorists: “ of the 30 veterinary schools on the mainland U.S., only 12 have a board-certified behaviorist on staff? Also, the same number of schools offer an introductory behavior course although only a few have it as part of the required curriculum. Those numbers tell us that less than half of our veterinary schools offer training in behavior at all. Considering that behavior problems lead to euthanasia and relinquishment to shelters at staggering numbers and can directly affect patient care in the hospital, veterinary students today are still left unprepared to prevent, diagnose and manage these cases in practice.”