Articles Chill Pills -- Anxiety Medications for Dogs
Chill Pills: Behavior-altering drugs can help dogs with phobias or anxiety. Because the recommended dosage range of clonazepam for anxiety in dogs is.
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Aggression and separation anxiety generally respond very quickly (within a week) to the use of medications, while depression and compulsive behavior may take up to several months.
I decided to switch to clonazepam, as its effects last longer. I increased the dosage to 2 mg (0.13 mg/kg), still well within the recommended range. Because the recommended dosage range of clonazepam for anxiety in dogs is similar to that for alprazolam, I tried giving Piglet the same dosage (1 mg), but quickly found out that was not enough. I gave this amount twice a day, at bedtime and after breakfast. With clonazepam, Piglet was able to sleep through the whole night.
The usual methodology is to start with a low dosage, and then increase if no improvement is seen after 3-4 weeks. Treatment must continue for at least 6-8 weeks before you can know for sure whether it helps.
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With my veterinarian's guidance, I started Piglet on 25 mg (1.7 mg/kg) twice a day, then increased to a very high dosage of 25 mg three times a day after a month. I tried giving Piglet amitriptyline for her noise phobia before she developed generalized anxiety disorder.
After that, Piglet became reactive to all of the construction sounds from next door, which gradually generalized to any loud noise she heard while on our walks. Most of our walks were spent trying to avoid these noises, and when she did hear them, she wanted to turn around and go home. We were out for a walk one day, soon after construction had started, when a stump digger close to us backfired loudly just as we were passing. Sounds that had never before bothered her, such as lawnmowers, leaf blowers, loud trucks, and even the sound of other dogs barking, now frightened her. This began to change three years ago, when my next-door neighbors compley rebuilt their house. As we could avoid “scary noises” most of the time, her anxiety attacks were not frequent and she was able to live with her phobias pretty well.
A dog behaviorist (veterinary or otherwise) can help you with this. It is also important to do behavior modification as well, as drugs alone will rarely resolve a severe anxiety problem by themselves, just as behavior modification alone often will not work without drugs. It is important that you work closely with your veterinarian, or with a veterinary behaviorist, when using anxiolytic drugs. All of these are prescription medications.
Chill Pills: Behavior-altering drugs can help dogs with phobias or anxiety disorders – but you have to learn which ones work best in each case.
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I was reassured to me to realize how high a dose could be given without being dangerous. It is important to be aware of this, as the dosage for seizure control is much higher than that used for anxiety. There are two recommended dosage levels for clonazepam: one for seizure control, and one for anxiety. Clonazepam is used less frequently than alprazolam, as it takes a little longer to be effective, but it is also longer lasting.
I wanted to use tramadol, an effective prescription pain reliever, but had seen warnings about combining it with SSRIs, due to the risk of serotonin syndrome, though I later learned that this could be done with caution. Instead, my vet suggested using Buprenex (buprenorphine), which is put into the cheek pouch and absorbed thru the mucosal membranes (this works very well with cats, they don’t really know how well it works for dogs).
We started Piglet on a once-a-day dose of 25 mg (1.67 mg/kg). I decided to make one further change and switch her to sertraline instead of fluoxetine. Sertraline is long-acting, similar to fluoxetine, which is desirable. I did discover that it was much more expensive, as there was no generic available at the time (a generic version has since been released and is quite inexpensive, see Cost Comparison below).
Her anxiety was under control, but she seemed to be on something of a roller coaster, becoming more reactive each hour after the alprazolam was given. I generally had to get up once during the night to give her a dose, as it was too short-acting for her to be able to make it all the way thru the night without waking and becoming anxious. After consulting with a veterinary behaviorist, I started giving Piglet 1 mg alprazolam every eight hours, to try to prevent her from becoming anxious.
It is the shortest-acting of this drug class in dogs, and does not take effect as quickly as the others. Diazepam is more sedating than the other drugs in this class, and may have less anxiolytic effect, so it is generally not recommended for anxiety.
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I started by giving Piglet this dosage of alprazolam whenever she would wake me up, which was generally a couple of hours after we went to sleep. I started Piglet at 0.25 mg (0.017 mg/kg), but that had little effect, so I went to 0.50 mg (0.03 mg/kg), which did help. Overall that discussed the use of alprazolam for noise phobias (see “References” below). She would usually settle down within an hour after getting the medication. In Piglet’s case, benzodiazepines were a lifesaver. It was helping, but it wasn’t enough. I found an article by Dr.
The general recommendation is to start with a low dose, then increase every two weeks as needed. These drugs do not take effect immediay, and several weeks’ treatment may be needed before their effectiveness can be fully ascertained. The tricyclic antidepressants most commonly used with dogs are amitriptyline (Elavil) and clomipramine (Clomicalm).
Anorexia (loss of appetite) is also common, but usually goes away after a few days. Giving with food and dividing the dosage between meals may decrease gastric side effects. The most common side effect of TCAs is sedation.
Amitriptyline’s most common side effects are dry mouth and sedation. Amitriptyline can relieve chronic pain, and has some action as an antihistamine. It is not useful for compulsive disorders. It is well suited to dogs with relatively mild anxiety disorders, including anxiety-related aggression and submissive urination.
They can also be used together (with dosage of each reduced proportionay). As with all anti-anxiety medications, you should start with a low dose and increase only as needed.“The key to treatment for noise phobias and panic is to give the benzodiazepines early and often,” says Dr. Their safety range is very wide, and they can be combined with most other medications, including TCAs and SSRIs, as well as with pain medications such as tramadol. Overall.
After consulting with the veterinary behaviorist, we started Piglet on fluoxetine, at a low dose of 10 mg (0.7 mg/kg) once a day, and then increased to 15 mg (1 mg/kg) after two weeks.
I’ve found Plumb’s Veterinary Drug Handbook to have the most current information on drug dosages and interactions. Some of the following is taken from that source, and some from various papers written by noted veterinary behaviorist Dr. Karen Overall and other veterinarians.
The fluoxetine was helping, but I still felt that she was on edge and overly reactive. It also seemed to sedate her for the first couple of days, but she was normal after that. Piglet did have some loss of appetite with this medication. Her blood work was fine when we rechecked it a couple of weeks after starting the drug. Fortunay, after about a week, this problem went away.
The recommended dosage range is quite wide, with the highest dose being 10 times the lowest dose. For dogs with thunder phobia, it should be given whenever a storm is expected, rather than waiting until it arrives, though more can be given at that time, if needed. Overall’s drug of choice for dogs with storm and noise phobias and dogs who panic. Alprazolam is Dr. Alprazolam has some effect if given after the dog becomes anxious, but it works far better if given ahead of time. It takes effect very quickly, within 20 minutes of being given, and does not tend to cause sedation.
See below for more information on dosages, interactions, side effects and contraindications.
Article by Mary Straus, published in the Whole Dog Journal, July 2006.
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A combination of Prozac (fluoxetine) and Clonidine would be his first choice now for dogs with storm phobias, while in the past he has used clomipramine and alprazolam (Clomicalm and Xanax).
We started Piglet on a low dose (10 mg, or 0.7 mg/kg) twice a day for a month, and then increased to 15 mg (1 mg/kg) twice a day for another month. Unfortunay, it did not help, and I weaned her off it.
He recommends starting with 1 mg/kg twice a day, increasing to twice as much (1 mg per pound of body weight twice a day) if needed. Buspirone is Dr. Dodman's first choice for treating generalized anxiety and noise phobias, but he says it's important to give a high enough dosage.
Buspirone also helped a client's dog that was growling and urine-marking after the arrival of a new baby.
Dodman has had a lot of problems with Xanax (alprazolam) causing paradoxical excitement in dogs. Clonidine helps with storm phobias, noise phobias, separation anxiety, and other types of fear-based behavior problems. Dr. He now prefers using Clonidine instead when quick action is needed. See Other Drugs below for more information.
It is important to do blood work before starting, especially for older dogs, and monitor periodically after that. SSRIs can be combined with TCAs using low-end doses of each, which may help them take effect faster and lessen the chances of side effects.
I knew enough not to reinforce her attention-seeking behaviors, but I did try various things, such as distracting her with clicker training (which would work only as long as I could keep it up, then she would go right back to her fearful behaviors), giving long, slow strokes, just putting my arm around her, sitting with her while compley ignoring her – nothing made any difference. When she was frightened by beeping sounds, she would pant, pace, tremble, try to hide, dig compulsively both indoors and out (to the point of making her nails bleed), and come to me for attention and comfort, though comforting her did not help. Piglet was normally a confident dog, cautious with people but not fearful, comfortable with other dogs, eager to explore new places.
Ten years ago, my dog Piglet (pictured above) woke me in the middle of the night, trembling violently and utterly terrified. It took me hours to track the source of her panic to a barely audible high-pitched beep that sounded once every two minutes, coming from a smoke alarm’s low battery indicator.
Combining Clomicalm with behavior modification therapy (BMT) for separation anxiety achieves a faster response than using BMT alone, but after three months, the results are similar.
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She had a few minor episodes, where she became restless, with some pacing and attention-seeking behaviors, but no panting, trying to hide, waking me up at night, etc. For the next few months after the surgery, Piglet did not have a single anxiety attack. At this time, I was giving her sertraline (25 mg once a day) and clonazepam (2 mg, twice a day). These episodes did not last very long, usually only about 20-30 minutes, before she was able to settle down again.
When used continuously, they create a physical dependence. The effects of BZs do not last very long, usually only a few hours.
We had to find something to help. Neither of us could live like this. Her noise phobias had escalated to generalized anxiety disorder (GAD). After that, she began waking at dawn, reacting to the sound of birds in my yard. Soon she was spending most of the night awake, pacing, panting, unable to rest and pawing at me to get up as well. Eventually, Piglet was startled on a walk by a loud chirping noise from a ground squirrel.
While I would urge anyone dealing with anxiety issues to first try natural methods of treatment, it is important to know there are medications that can offer your dog quality of life that may not be obtainable in any other way. Thus began Piglet’s long history of noise phobias. Below is the story of my struggle to help her cope with these phobias and, eventually, generalized anxiety disorder.
After discussion with my veterinarian and the veterinary behaviorist, we increased Piglet's clonazepam to 3 mg (0.2 mg/kg), on the high end of the range for anxiety, but still well below the dosage used for seizures. This helped some, but not enough.
Serotonin-enhancing drugs help in fearful conditions by stabilizing mood. These include "social anxiety," storm phobia, noise phobia, and separation anxiety.
She was on clomipramine for a total of only three weeks before I began weaning her off, as I did not feel it was helping, but in retrospect, I realize that she got much worse when I weaned her off the drug. After Piglet’s anxiety worsened, my vet and I decided to try clomipramine (Clomicalm). We started at 20 mg (1.3 mg/kg) twice a day. After two weeks, I increased to 25 mg (1.7 mg/kg) twice a day. Again, Piglet tolerated it well; she had no stomach upset, and blood work was normal after two weeks. It is very important not to give up too soon when giving TCAs or SSRIs.
My own vet prefers to use amitriptyline as the first choice when treating anxiety, not because it is the most effective drug, but because he feels it is safer than clomipramine. It is also inexpensive.
Dodman feels amitriptyline is not as effective as clomipramine. Prozac is equally or more effective than clomipramine, and is safe and inexpensive, so it would be a better choice than amitriptyline, but his preferred medication for anxiety is Buspirone (see above). Dr.
Dodman feels benzodiazepines should be used only as needed, not on a regular basis. Because of their addictiveness, Dr.
Tryptophan, an amino acid supplement, can be combined with Prozac for dogs with low serotonin levels. Buspirone can also be combined with Prozac to increase the release of serotonin.
The alprazolam did not sedate Piglet; it just relaxed her enough to be able to sleep, without anxiety waking her up during the night. Rather than giving her 0.5 mg (barely enough to help), after she had awakened me with her anxious behavior, I began giving her 1 mg (0.07 mg/kg) at bedtime. My vet then suggested that I give an increased dosage of alprazolam at bedtime, before Piglet became anxious. This made a huge difference. By giving it to her before she became anxious, she was able to sleep through most of the night.
Clomipramine is also very effective at treating compulsive disorders. Clomipramine is best suited for situations involving anxiety, including separation anxiety, as opposed to reactivity.
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TCAs can cause bone marrow suppression. It’s important to do blood work a couple of weeks after starting this drug (as well as before, for older dogs), then monitor every six months to a year thereafter.
Because buspirone has few side effects and does not cause sedation, it is an excellent first choice for treating dogs with aggression or anxiety that is not too severe. Again, it’s best to start at a low dose and increase if needed. It must be given continuously for at least four to six weeks in order to determine whether or not it will help. Buspirone can be combined with TCAs or SSRIs, though it is questionable whether this helps or not.
Sertraline is useful particularly for generalized anxiety and panic disorder. Fluoxetine is used to treat aggression, obsessive-compulsive disorders, separation anxiety, panic and avoidance disorders, including post-traumatic stress disorder. Paroxetine is used to treat depression, social anxiety, and agitation associated with depression. Fluoxetine works well for conditions involving reactivity, including some forms of aggression.
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Because fluoxetine (Prozac) is considered to be two-and-a-half times as effective as sertraline (Zoloft) at the same dosage level in humans, but the dosage ranges given for dogs are similar, I twice tried to switch Piglet from sertraline to fluoxetine, but both times she got much worse and I switched her back. Within a few days, she was back to normal. I finally decided to increase her SSRIs, though both my vet and the veterinary behaviorist were concerned with doing this. I then increased her sertraline dosage from 25 mg to 37.5 mg (2.5 mg/kg) once a day.
Fluoxetine (Prozac) is the most commonly used SSRI with dogs, and has the longest half-life in people. Others include sertraline (Zoloft) and paroxetine (Paxil), all with similar potential side effects, though paroxetine is more difficult to wean off and may have a shorter half-life, leading to more variation in its effects.
I learned about buspirone from Amy Cook, a dog trainer in Oakland, California, who has a special interest in fearful dogs. Amy has dealt with fear and anxiety in many dogs, including two of her own, and has learned a lot about the medications used for treatment.
I put her back on Metacam and added tramadol, in case pain was still contributing to her anxiety, but that also did not help. She was not as bad as she had been originally, but she was still having full-blown anxiety attacks periodically, and was on edge most of the time. I spent another couple of months trying different things. I took her off Metacam (a prescription arthritis pain reliever), thinking that it might be upsetting her stomach, but that didn’t help.
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Dodman prefers using SSRIs to TCAs, as the effects are similar but SSRIs are safer. Dr.
They should be used with caution in fear-aggressive dogs, as they may lower fear-based inhibition and increase the likelihood of the dog biting. Benzodiazepines commonly used with dogs include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). These drugs are used to treat anxiety, noise phobias (including thunder phobia), panic attacks, and separation anxiety.
However, many of these drugs were tested on animals before use in humans, and they have been used off-label by many vets. With the exception of clomipramine, the FDA has not approved the use of these drugs in dogs, as the drug companies have not submitted the necessary research. Following is a summary of the different types of anti-anxiety drugs, what they are commonly used for, and what you need to know before using them.
However, as time went on, I noticed no improvement in her behavior, even after we increased the dose, so I weaned her off it. Piglet tolerated the drug very well, and she did not have problems with sedation or other side effects.
Buspirone helped a number of Amy’s clients, as well as the dog of a colleague that had developed noise phobias and was unable to continue her flyball participation because of it. That dog responded wonderfully to Buspirone and was able to return to her flyball team with the help of this medication.
All of the follow-up blood work he has done over twenty years has been normal. Dodman does not feel it is necessary to do blood work or other tests prior to starting healthy dogs on SSRIs. Because of their safety margin, Dr.
I also think that the small tumor in her foot may have been bothering her for a long time, though I was unaware of it. After she recovered from this surgery, Piglet’s anxiety level reduced. Although I know for certain that the tooth had just broken, it’s possible it was cracked and painful for a while before it was removed; she had stopped being an avid chewer some time before that, although my vet could find nothing wrong with her teeth. I believe that she must have been experiencing some chronic pain that lowered her anxiety threshold. In fact, she became almost normal again.