Amitriptyline Amitriptyline is also commonly used for the treatment of urine marking, although there are no published controlled studies on this medication 8 . Like clomipramine, amitriptyline is a tricyclic antidepressant. Side effects include sedation, cardiac dysrhythmias, vomiting, diarrhea, and inappetance 19 , and these side effects seem to be more common with amitriptyline than with clomipramine 2 . Like clomipramine, this medication should be avoided in patients with seizure disorders 19 . Recommended dose : 0.5–1 mg/kg by mouth, every 12–24 hours 19 . Fluoxetine Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and has been successfully used for the treatment of a variety of behavioral disorders. Fluoxetine has been demonstrated to be successful at decreasing urine marking in cats, with benefits being observed in as little as two weeks 8 . In one placebo-controlled study, cats treated with fluoxetine demonstrated a significant decrease in urine marking by week two, with further improvements seen through week eight of the study. By week eight, 67 percent of the treated cats were showing no urine marking at all 8 . On withdrawal of the drug, cats who were demonstrating the most frequent marking prior to the study were more likely to return to marking, while cats who were only marking occasionally prior to fluoxetine treatment were less likely to resume marking 8 . Side effects of fluoxetine include anxiety, irritability, sedation, vomiting, diarrhea, and anorexia 14 . Fluoxetine should be avoided in patients with seizure disorders, diabetes mellitus, or liver disease 19 . Fluoxetine has a number of drug interactions, so the patient’s thorough medical history must be consulted prior to beginning treatment. Recommended dose : 1 mg/kg by mouth, every 24 hours 8 . Buspirone Buspirone is a non-benzodiazepine anxiolytic used in cats and dogs. Its mechanism is not well understood, but it appears to act as a partial agonist at serotonin (5-HT1A) receptors and as an agonist/antagonist of dopamine receptors in the central nervous system (CNS) 19 . Benefits in feline inappropriate Inappropriate toileting In contrast to marking or spraying, the term inappropriate toileting describes a cat who urinates or defecates in a normal manner (large volumes on horizontal surfaces), but does so in an inappropriate location (outside of the litterbox). Like marking, this behavior is frequently associated with anxiety and is observed more frequently in multi-cat households, suggesting an association with intercat aggression 18 . In inappropriate toileting, however, the behavior is not associated with signaling, but is instead associated with an aversion to some aspect of the litterbox setup and/or a preference for an alternative substrate or location. Understanding the cause of the cat’s inappropriate toileting can often help veterinarians and owners to determine effective solutions in these cases. Litterbox aversion In a cat with a litterbox aversion, there is some aspect of the box itself that the cat does not like. This can be related either to the physical setup of the box (for example, motorized self- cleaning litterboxes) or to previous experiences within the litterbox (for example, a cat with a history of urinary discomfort may come to fear entering the litterbox due to its association with that discomfort) 2 . Some litterbox aversions can be overcome by changing the characteristics of the litterbox, while other cases will require more intensive management. Although covered litterboxes offer many advantages from an owner perspective, odors become trapped within the box, which can make covered litterboxes undesirable to many cats 4 . Additionally, covered litterboxes can provide an opportunity
elimination cases are typically seen within two weeks of starting treatment 4 . A controlled study on buspirone found that it was effective in reducing urine spraying in 55 percent of cats, with 33 percent of cats experiencing complete resolution. After eight weeks of treatment, 47 percent of the successfully treated cats were able to discontinue medication without relapse, while 53 percent of patients required long-term therapy 8 . While success rates may be lower than those documented for clomipramine or fluoxetine, buspirone is a medication with a low risk of side effects and anecdotal evidence of efficacy, and therefore, it is a first choice for some veterinary behaviorists. Bradycardia, gastrointestinal disturbances, and stereotypic behaviors are possible, though uncommonly seen. Buspirone should be used with caution in patients with hepatic or renal disease 19 . Recommended dose : 1 mg/kg by mouth, every 12–24 hours 19 . Feliway™ Feliway™, a synthetic analog of the F3 fraction of feline facial pheromone, has a number of applications in the treatment of feline behavioral problem. As a pheromone, Feliway™ acts on the vomeronasal organ and olfactory organs, affecting social behavior and neuroendocrine release in cats 20 . In urine-marking cases, the benefit of Feliway™ lies primarily in increasing the cat’s perception of the home as a safe and secure environment 15 . Feliway™ in both spray and diffuser form has been reported to reduce or resolve urine marking, and may prove especially beneficial in cases of marking caused by a recent change in the environment (moving, renovations, new furniture, new pets, etc.) 8 . Anxitane™ Anxitane™ is a supplement containing L-theonine (green tea extract). L-theonine is a neurologically active amino acid, increasing levels of GABA and dopamine in the brain. While this product has not been studied for the management of urine marking, it can be beneficial in cats for the treatment of anxiety or fear-related disorders 21 . Due to a low risk of side effects and high margin of safety, this product may be a viable option for clients who would like to alleviate anxiety without the drawbacks that can accompany psychotropic medications. to become cornered by another cat in the home, the family dog, or children, all of which can also lead to a litterbox aversion. Cats experiencing early subclinical arthritis or other mobility issues may have trouble climbing out of litterboxes with high sides, thus making the litterbox an unappealing site for elimination 4 . Finally, extremely fastidious cats may develop an aversion to the litterbox due to a history of themselves or a housemate having an episode of diarrhea within the box; this experience may discourage them from returning to the litterbox in the future. Substrate aversion Substrate aversion refers to the cat disliking the litter itself. These cases often involve owners who are using litters that contain very large particles or a heavy scent 2 , or owners who are not regularly changing their cats’ litter 1 . Additionally, cats may develop a substrate aversion if they are returned to regular litter too soon after declaw surgery, as the litter irritates the healing incisions on their toes 1 . Cats with substrate aversion may perch on the edge of the litterbox instead of walking in the litter, and owners may notice that the cat does not truly dig or manipulate the litter to any significant extent 2 . The cat may urinate immediately next to the litterbox, without entering the litter itself 1 . Location aversion Location aversions are uncommon, but can occur. In order to test for location aversion, owners should simply move the litterbox to another area of the house. If the cat then uses the
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Book Code: VFL1524
EliteLearning.com/Veterinarian
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