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 . 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 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
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