Consider drug therapy Although it is important for clients to realize that medications are not a cure-all and they are only intended as an adjunct to the other therapies described, psychotropic drugs can prove beneficial in the management of feline marking. A number of drugs are available for use in these cases. A recent meta-analysis 12 collected data from ten previous studies that examined the use of Feliway™, clomipramine, and fluoxetine in the treatment of feline urine spraying. All ten studies demonstrated a significant reduction in urine spraying using any of these three drugs/products, suggesting that all treatments for urine marking are likely to produce at least some benefit. The most successful protocol appeared to be a combination of fluoxetine, cleaning of soiled areas, and environmental modification; however, the author of the meta- analysis felt that this was largely due to the three-pronged treatment approach and not due to any specific benefit of the fluoxetine. It is important to note that all behavioral medications used in cats are used in an extra-label manner. Clients should be informed of this extra-label use, as well as possible side effects of treatment. Additionally, owners should give the first few doses at a time that someone will be home with the cat, in order to monitor for adverse effects. Finally, veterinarians should always obtain baseline blood cell count and serum biochemistry, if one was not recently obtained as part of the patient’s medical workup 14 . If the cat is going to remain on chronic medications, veterinarians should periodically recheck this bloodwork, giving special attention to hepatic and renal values. When first starting any of these medications, the owner should be consulted every two weeks (either via phone, email, or recheck appointments) to discuss whether improvement has been noted. If a reduction in spraying is seen with medication, treatment should be continued for eight to twelve weeks. At that point, if the cat is still doing well, the owner can attempt to gradually wean the cat from medication. Drug dosages should be decreased by 25 percent weekly, with the cat monitored closely for a recurrence of marking. If marking recurs, cats should remain at that dose for two weeks to see whether the marking stabilizes as the cat acclimates to the lower dose. If the cat continues marking beyond two weeks, veterinarians should increase the drug dosage to the last effective level and the cat can remain on the drug long-term 14 . Because medicating cats can be a challenge, transdermal medications have been rising in popularity among cat owners. While this option may be appealing, recent studies have demonstrated that psychotropic medication is not well-absorbed through this route, and therefore, behavioral drugs in cats must be given orally 14 . Clomipramine Clomipramine is a tricyclic antidepressant, inhibiting the reuptake of serotonin and norepinephrine at the neuronal membrane 19 . Clomipramine has been demonstrated to be effective at reducing or controlling urine marking in cats, with effects typically seen approximately two to four weeks after beginning therapy 14 . In one study of 25 cats with urine marking, 20 of those cats (80 percent) demonstrated a 75 percent or greater reduction in spraying within four weeks of beginning clomipramine treatment. In 17 of the study cats (68 percent), the urine spraying was reduced by 90 percent or more 8 . Side effects of clomipramine include urine retention, tachycardia, depression, sedation, vomiting, diarrhea, and inappetance 14, 19 . Additionally, clomipramine is contraindicated in patients with seizure disorders (tricyclic antidepressants may lower the seizure threshold), liver disease, or a known hypersensitivity to the drug 19 . Recommended dose : 0.25–0.5 mg/kg by mouth, every 24 hours 14 .
Cats have evolved as solitary hunters, and therefore, cats frequently prefer to eat out of sight of the other cats in the home. In a multi-cat home, placing small bowls in different areas of the house can decrease stress associated with eating, decrease competition for resources, and thus, limit urine marking 17 . Additionally, these bowls should be located in quiet areas, away from loud appliances that may disturb the cat while eating. Some timid or anxious cats may benefit from staying in a small, quiet area where they can take a break from the other pets in the home. Giving the cat four to six hours per day in this quiet isolated area (complete with food and water bowls, a litterbox, resting places, and one- on-one interaction with the owner) can alleviate anxiety in many timid or anxious cats 14 . Some cats may even respond well to a free-access crate, which they can retreat to for privacy 17 . Other pets can be kept out of these ‘safe havens’ using a variety of methods. For example, owners can use a baby gate at the entrance to a room to keep dogs out while allowing cats to jump over the gate, or an electronic cat door can be used to limit access to one specific cat 17 . Urine marking can be triggered by the presence of outdoor cats that are visible from within the home, or that are otherwise interacting with the indoor cats (due to the indoor cats being allowed occasional outdoor access, the presence of cat door, etc.). In these cases, the owner’s primary goal is to decrease awareness of these outdoor cats as much as possible. First, owners should make efforts to keep these cats from coming onto the property. This may require the use of motion detectors or cat repellant sprays, but sometimes can be as simple as a client ceasing to feed stray cats in the yard. Clients should also ensure that garbage cans are kept secure; this can be another item that attracts cats into the area 8 . Finally, the owner must limit their cat’s ability to visualize outdoor cats that may still wander onto the property. Windows can be blocked using blinds or drapes. Resources such as food, water, and litterboxes should not be placed within sight of windows; resting areas should be placed away from windows, or at windows overlooking a location free of outdoor cats 15 . Environmental enrichment can provide significant benefits in the management of urine marking, by providing outlets for play and energy release, which help to decrease anxiety. Veterinary professionals should encourage owners to play with their cats regularly, using fishing-rod style toys and other play options as preferred by their cat 15 . Owners may also be able to provide a window perch, if the presence of outdoor cats is not a factor contributing to urine marking, or play cat-friendly DVDs on the television 17 . Three-dimensional surfaces, such as climbing toys and ladders, can increase the complexity of the environment and provide significant enrichment for cats. Free-range cats will typically roam large distances in the course of their normal social interactions, so owners must make efforts to recreate this stimulating environment within the home. One easy and effective means of providing environmental enrichment for cats is changing the method of feeding. Clients can use puzzle feeders to deliver small amounts of food or hide small amounts of food around the home (ideally on elevated surfaces, such as a bookcase) in order to promote normal foraging behavior and provide an outlet for play and activity 18 . When managing cases of urine marking, it is important that owners refrain from using any sort of punishment 8 . Some individuals advocate the use of cat repellants or “booby traps” to keep cats away from areas where they have marked, but these methods often encourage the cat to seek out another area of the home for marking. Additionally, the increased stress and anxiety that is triggered by these aversive methods can sometimes lead to worsening of the urine marking, or to new behavioral problems in the cat (such as over grooming, FLUTD, intercat aggression, etc.) 15 . For these reasons, owners should avoid aversive methods of managing urine marking.
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