Background
Pharmacologic options for treatment of anxiety disorders are often similar, regardless of the cause of anxiety; effectiveness can be optimized when medication is used in conjunction with behavior modification, environmental management, and enrichment. For detailed information on agent selection and use, visit Plumbs.com.
Medications for Situational Anxiety/Episodic Stressors
Gabapentin and trazodone are commonly used in anxious, stressed, or fearful dogs and cats. Published evidence supporting medications used to mitigate fear-based responses to acutely stressful situations (eg, car travel, veterinary appointments, storms) are summarized in Table 1.
Although no drug has been proven to be more effective than another, medications like dexmedetomidine and pregabalin have been approved as safe and effective by regulatory agencies (eg, FDA, Health Canada). Acepromazine is not considered to have antianxiety/anxiolytic properties, and use should be limited as an addition to multimodal protocols.1
Table 1. Medications Used for Fear-Based Responses in Dogs & Cats
a FDA and Health Canada approved indications
Long-Term Medications for Anxiety
Fluoxetine (a selective serotonin reuptake inhibitor [SSRI]) and clomipramine (a tricyclic antidepressant [TCA]) have been approved in the United States and Canada for treatment of separation anxiety in dogs in conjunction with a behavior modification plan.
Other SSRIs and TCAs are available and may be useful but should only be considered when the approved medications are ineffective or not tolerated. Second-line medications include buspirone and venlafaxine.
The effects of chronic medications may be delayed up to several weeks. When discontinuing treatment, these medications should be tapered gradually over several weeks.
Medication Combinations
Because of the delayed onset of fluoxetine and clomipramine, a rapidly effective medication (eg, gabapentin, trazodone, alprazolam) can be considered for short-term concurrent use; however, combinations that include trazodone may increase the risk for serotonin syndrome.