| Transdermal
Treatment for Aggressive Cat
Donald Tummons, D.V.M.
An 11 year-old male cat showed aggressive
behavior towards other cats and also started urinary
spraying. Buspirone 2.5mg/ml flavored suspension
was tried. It was extremely difficult for
the owner to give the oral suspension and after
a few days the cat was vomiting the medication.
Treatment
The owner was instructed to apply
0.1ml of transdermal buspirone 2.5mg/0.1ml pluronic
lecithin organogel (PLO) topically inside the
tip of the ear twice a day.
Outcome
After the first dose, the owner
noticed the medication made the cat too sleepy
and the dose was decreased to 0.05ml (1.25mg of
buspirone). The cat’s aggressive behavior
has been controlled on the lower dose with a few
exceptions and the owner then increased the dose
to 2.5mg of buspirone for a couple of doses.
The owner is amazed how easy it is to apply the
medication.
Amitriptyline for Behavioral
and Urinary Disorders
Amitriptyline hydrochloride
is one of the most widely used tricyclic
antidepressants (TCAs) in companion animal behavioral
medicine, exerting antihistaminic, anti-inflammatory,
analgesic, and antidepressant effects. Amitriptyline
increases synaptic activity of serotonin and norepinephrine,
has significant central and peripheral anticholinergic
activity, and stimulates beta-adrenergic receptors
in smooth muscle (e.g. the bladder), causing a
decrease in smooth muscle excitability and a subsequent
increase in bladder capacity and storage.
Although amitriptyline has been used successfully
to treat behavior-related and urinary tract disorders
in cats and dogs, the drug is not approved by
the FDA for veterinary use and therefore is not
available as a veterinary preparation.
Compendium 23(5) May 2001: 433-7
Imipramine
In animals, tricyclic antidepressants
have actions similar to those of phenothiazines
in altering avoidance behaviors. Imipramine has
been used for the following indications:
Cats: urethral incompetence
Dogs: treatment of separation
anxiety and other behaviors, cataplexy, urethral
incompetence
Horses: narcolepsy and
ejaculatory dysfunction
Naltrexone for Self-Mutilating
Behavior
“Naltrexone may be useful in the
treatment of self-mutilating or tail-chasing behaviors
in dogs or cats... [A synthetic opiate antagonist,]
naltrexone is generally considered to be contraindicated
in patients physically dependent on opiate drugs,
in hepatic failure or with acute hepatitis.”
Doses for Dogs:
As adjunctive therapy in behavior disorders:
For tail chasing or excessive licking: First
give 0.01mg/kg SubQ of naloxone to determine if
narcotic antagonists may be effective. If so,
give naltrexone PO at 1 - 2 mg/kg daily. Long-term
therapy may be required. (Crowill-Davis 1992)
For the adjunctive treatment of acral pruritic
dermatitis:
2.2mg/kg PO once daily for one month trial. Some
dogs exhibit drowsiness and minor changes in behavior.
50-60% of patients have benefited... (Rosychuck
1991)
Canine Acral Lick Dermatitis
involves excessive licking of the paws or flank,
even to the point of self-mutilation, and can
produce ulcerations and infections that require
medical treatment. Based on patterns of behavior
and response to medication, veterinary scientists
propose that canine acral lick dermatitis, also
known as canine compulsive disorder (CCD), is
an animal model of human obsessive-compulsive
disorder. A randomized, placebo-controlled, double-blind
crossover clinical study evaluated the efficacy
of the medication clomipramine for treatment of
CCD. Fifty one dogs with CCD were given clomipramine
3 mg/kg [1.3 mg/lb] of body weight orally every
12 hours for 4 weeks and then placebo for 4 weeks.
While drug therapy can be helpful, therapy may
need to include behavior modification to optimally
manage CCD.
J Am Vet Med Assoc 1998 Dec 15;213(12):1760-6
Click here to access the PubMed abstract of this article.
Arch Gen Psychiatry 1992 Jul;49(7):517-21
Click here to access the PubMed abstract of this article.
Fluoxetine for Refractory
Owner-Directed Dominance Aggression
Evidence suggests that
social dominance aggression may be modulated by
serotonergic mechanisms. Fluoxetine (Prozac®),
a specific inhibitor of serotonin reuptake, is
a popular human antidepressant which has been
used successfully to decrease social aggression
in dogs and monkeys.
J Am Vet Med Assoc 1996;209:1585-1587
Click here to access the PubMed abstract of this article.
Fluoxetine for Urine Spraying
in Cats
Administration of fluoxetine hydrochloride
for treatment of urine spraying in cats can be
expected to considerably reduce the rate of urine
marking. Pryor et al. recommend that most cats
should be treated more than eight weeks before
treatment is withdrawn. Cats that vertically marked
a mean of > or = 3 times per week were treated
for 8 weeks with fluoxetine (1mg/kg PO daily-
dosage individualized for each cat by a compounding
pharmacy) or fish-flavored liquid placebo. When
treatment was discontinued after 8 weeks, the
spraying rate of cats that had received treatment
varied. The main adverse reaction to the drug
was a reduction in food intake, which was observed
in 4 of 9 treated cats.
J Am Vet Med Assoc 2001 Dec 1;219(11):1557-61
Click here to access the PubMed abstract of this article.
Inappropriate Elimination
in Cats: Fluorescein to Find the Culprit
In a multi-cat household, it is
important to determine which cat is inappropriately
eliminating so that the proper intervention can
be made. Even if one cat is observed marking or
urinating outside the box, it does not rule out
the possibility that other cats are also behaving
inappropriately. When it is necessary to identify
which cat in a multi-cat household is spraying
or inappropriately eliminating, fluorescein can
be orally administered once daily in the evening
with food for three days. That cat's urine will
fluoresce under ultraviolet light for approximately
24 hours. To detect urine containing the fluorescein
indicator, the client needs to scan the household
with a commercial black light or black light purchased
from a novelty store. Although urine will commonly
glow, fluorescein treated urine fluoresces a characteristic
bright yellow. Caution clients that they may reveal
previously undiscovered sites of elimination;
advise them not to become alarmed or angry. By
administering the dye to different cats at two
day intervals, the culprit can be identified.
Pharmacological support for urine
spraying or marking is usually needed only for
cases with underlying anxiety or problems with
social interactions between cats (clomipramine),
or for cats with interstitial cystitis (amitriptyline,
doxepin). Administration of fluoxetine hydrochloride
for treatment of urine spraying in cats may also
considerably reduce the rate of urine marking.
Cyproheptadine to Control
Urine Spraying and as an Antipruritic in Cats
A 10-year-old castrated male domestic
cat was admitted to the hospital at the School
of Veterinary Medicine, Tufts University. A diagnosis
of territorial urine marking was made. Treatment
included behavior modification and the administration
of cyproheptadine, which resulted in the immediate
arrest of undesirable urine marking. Cyproheptadine
administration was adjusted to determine the lowest
dosage that effectively maintained the cat's consistent
use of the litter box. It was recommended to continue
cyproheptadine administration for at least 1 year
before any attempt to withdraw its use. Another
study recommended a dose of 2 mg, p.o., every
12 hours. This antihistamine, also prescribed
for its appetite stimulant effects in cats, has
antiandrogenic effects in other species.
J Am Vet Med Assoc 1999 Aug 15;215(4):501-2,
482
Click here to access the PubMed abstract of this article.
J Am Vet Med Assoc 1999 Feb 1;214(3):369-71,
351-2
Click here to access the PubMed abstract of this article.
Cyproheptadine hydrochloride was administered
to 20 presumed or proven allergic cats to determine
its efficacy in controlling pruritus. Each cat
received 2 mg, orally, every 12 hours. The pruritus
was satisfactorily controlled in 9 cats. Side
effects were seen in 8 cats, and included polyphagia,
sedation, vocalization, affectionate behavior,
and vomiting.
Can Vet J 1998 Oct;39(10):634-7
Click here to access the PubMed abstract of this article.
Clomipramine for Feline
Anxiety
A study of 11 cats assessed
the clinical response to a treatment regimen that
included clomipramine and behavior modification
in cats diagnosed with anxiety-related or obsessive-compulsive
disorders. Presenting signs were urine spraying
in seven cases, overgrooming in three and excessive
vocalization in one. Clomipramine was administered
orally once daily, with a mean starting dose of
0.4 mg/kg. If necessary, the dose was adjusted
according to the clinical response of each cat.
The average maintenance dosage was 0.3 mg/kg once
daily. The researchers concluded that clomipramine
was effective in controlling the signs of anxiety-related
and obsessive-compulsive disorders in 10 of 10
assessable cases when used in combination with
behavior modification, and the drug was well tolerated.
Aust Vet J 1998 May;76(5):317-21
Click here to access the PubMed abstract of this article.
Selegiline
is a monoamine oxidase (MAO) inhibitor indicated
for use in dogs to control signs associated with
canine cognitive dysfunction syndrome and uncomplicated
pituitary-dependent hyperadrenocorticism (PDH).
Studies suggest that selegiline may enhance survival
rates. The recommended dose for cognitive dysfunction
is 0.5 to 1 mg/kg, and for PDH is 1 mg/kg, orally
each morning. If no improvement is seen after
2 months, the dose can be increased to the maximum
of 2mg/kg/day. If there is no clinical improvement
after 1 month at 2mg/kg/day, alternative therapy
or further evaluation should be considered. “Overall,
selegiline is well tolerated... Gastrointestinal
disturbances, particularly vomiting and diarrhea,
are the most common side effects reported. Diarrhea
may resolve when the drug is discontinued or the
dose decreased. Other adverse effects include
hyperactivity, agitation, restlessness, and insomnia.
A dose reduction or discontinuation of therapy
also resolves these problems.”
Compendium March 2000; 22(3):204-5 |
