Aging in cats: Common physical and functional changes.
Bellows J, Center S, Daristotle L, Estrada AH, Flickinger EA, Horwitz DF, Lascelles BD, Lepine A, Perea S, Scherk M, Shoveller AK. Bellows J, et al. J Feline Med Surg. 2016 Jul;18(7):533-50. doi: 10.1177/1098612X16649523. J Feline Med Surg. 2016. PMID: 27370392 Review.
Does your cat look forward to going to the vet? Most cats don’t, which might causes you to dread the visit just as fast. Luckily, there is an effective anti-anxiety medication for cats called gabapentin, but the uses of gabapentin in cats are not limited to anxiety. For example, it can also be used to manage several types of pain and help treat seizures. Keep reading to find out about the other uses of gabapentin for cats, as well as the appropriate dosage, administration, and side effects of this medicine Table of Contents: Pro Tip: Many pet insurance providers allow you to claim treatment for behavioral problems, including anxiety. However, similar to humans’ health insurance, pre-existing medical conditions might not be covered. Carefully read the terms and conditions to make sure you understand the policy prior to enrollment, or use Pawlicy Advisor as a transparent guiide. Gabapentin is an anticonvulsant and analgesic drug used to treat chronic pain in cats, dogs, and horses. The drug has been shown to be especially efficient in treating neuropathic pain in cats, usually in conjunction with other analgesic agents like nonsteroidal anti-inflammatory drugs (NSAIDs). Gabapentin is also prescribed for pain associated with malignancy and chronic arthritic pain in cats. Originally developed to control seizures in humans, gabapentin can also be used to treat seizures in animals, usually combined with other anti-seizure drugs. In some cases, gabapentin can be prescribed as adjunctive therapy for cats and dogs with refractory idiopathic epilepsy. While the drug is not labeled for use for anxiety, it has been increasingly used in veterinary medicine to treat anxiety and fear associated with stress in cats, especially while on the way to a vet visit. The number of clinical studies into gabapentin’s efficacy in cats has been limited, but a study from 2017 published in the Journal of the American Veterinary Medical Association confirmed that administering the medication to cats 90 minutes prior to a vet visit significantly reduces signs of stress-related behaviors during transportation and examination.What is gabapentin used for in cats?
Gabapentin for Cats: Dosage
The proper dosage, frequency, and form of administration for gabapentin should be determined by a vet according to the condition being treated, your cat's body weight, as well as their individual needs.
Gabapentin is given orally in the form of a tablet, capsule, or liquid. The drug can be administered with or without food, but if your cat vomits after taking Gabapentin on an empty stomach, consider giving future doses with food (or, even better, right before feeding).
The drug doesn’t have a strong taste and is usually well accepted by cats when given in liquid form or with food/treats. Be sure to measure liquid compounds of Gabapentin carefully. Note that some liquid formulations contain xylitol, a sweetener that’s toxic to dogs although not known if it is toxic to felines.
Gabapentin takes effect quickly, typically within one to two hours, and improvement in clinical signs should soon follow. The medication has a short half-life of about two to four hours.
The use of gabapentin to treat pain and seizures in feline patients is ‘extra label’ or ‘off label’. This means that the instructions provided by your vet might differ significantly from those on the label, which is why it is important to follow your vet’s instructions very carefully.
Gabapentin should not be discontinued abruptly in cats with epilepsy, especially after long-term use. It is ideal to wean off the medication over a period of about two to three weeks in order to reduce the risk of withdrawal seizures. Always consult your vet before stopping any medication.
If you miss a dose of Gabapentin, give it as soon as you remember. However, if it’s almost time for the next dose, skip the missed dose and take the next dose when it is due. Don’t give your cat two doses at once. Gabapentin is a short-acting drug and should stop working within 24 hours, even though effects can last longer in cats with kidney or liver disease.
The most common side effects of Gabapentin include sleepiness, occasional diarrhea, and incoordination. Some vets have experienced that higher doses of Gabapentin lead to sedation in cats with chronic kidney disease (CKD).
In order to alleviate these side effects, the drug should be started in smaller doses and then gradually increased over time. It can also cause a false positive reading on urinary protein tests.
Overdose would likely cause increased severity of side effects including drowsiness, lethargy, ataxia, and depression. If you suspect an overdose or an adverse reaction to the medication, be sure to contact your vet or an emergency facility right away. If recognized promptly, gastric-emptying protocols including activated charcoal, cathartics, and emesis can be helpful.
Pro Tip: To help manage the cost of owning a cat and prepare for unexpected health-related emergencies, many pet parents choose to enroll in pet insurance. Pet insurance usually incurs a low monthly fee but can pay for up to tens of thousands of dollars in vet bills.
Precautions when Using Gabapentin
Gabapentin should not be given to cats who are allergic or hypersensitive to it. It should be used cautiously in veterinary patients with decreased liver and renal function.
This medicine should be used with extreme caution in cats with kidney problems, as the drug is eliminated from the body through the kidneys.
In laboratory animals, the drug was associated with birth defects and fetal loss. It’s also present in milk, which means that it should be used with caution in pregnant and nursing cats.
Gabapentin Drug Interactions
Gabapentin has been found to be more effective for pain management at the beginning of treatment when given in conjunction with another pain reliever such as morphine and hydrocodone. After a while, the second drug can be left out and gabapentin will remain the only pain reliever in the therapy.
Gabapentin should not be given within two hours of administering antacids or the antacids will obstruct the absorption of Gabapentin and make it less effective.
Make sure to let your vet know if your feline friend is taking any medications, supplements, or vitamins.
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Improving the feline experience at the time of the veterinary visit and time surrounding that visit is imperative in cats. Cats, however, can be a far more challenging species to judge behaviorally as they are often less interactive and more elusive than dogs. In stressful situations, such as the unexpected car ride or annual exam, the fearful and anxious cat may display aggressive behaviors such as biting and swatting, which can cause self trauma, harm to the owner, and/or harm to the veterinary staff. The therapies included in this brief article are meant to reduce anxiety and arousal in cats, with the goal of enhancing the entire veterinary visit experience for all involved. The author encourages the use of the included pharmacologic interventions IN TANDEM with other practices such as dedicated cat-friendly environments and “Fear Free” handling techniques (e.g. body wraps, feline pheromones, etc.). Whenever possible, a full physical exam should be done before prescribing pre-hospital sedatives.
Gabapentin binds to calcium a2-d receptors in the dorsal horn of the spinal cord and forebrain, having an inhibitory effect.1,2,3,4 It has long-term historical use as an adjunctive analgesic in both humans and animals1,4,5; however, its antiepileptic properties are likely responsible for sedation. In the acute setting, sedation following gabapentin administration is often profound. This was highlighted in a recent study in which both owners and veterinarians observed stress reduction, improved compliance, and less aggression in cats that received gabapentin 90 minutes prior to transport to the veterinary hospital.6 Owners need to be made aware that their pet will often appear considerably more sedate at home. Cats should be more closely supervised on stairs or when jumping place to place given ataxia that may occur following administration. Dosing recommendations and timelines are proposed below (Table 1).6 Gabapentin is an ideal agent to use alone, especially in those cats that may be older and have more chronic pain states, as the drug provides sedation and analgesia without undesirable adverse effects.4,5,6 It can be used in combination with the other included agents in cats needing additional sedation.
Trazodone is classified as a serotonin receptor antagonist and reuptake inhibitor (SARI),1,7,8 with historical use in anxious dogs. Two recent studies in two different feline populations – 1) a research setting7 and 2) client-owned cats in the clinical setting8 – indicated that trazodone was well tolerated and resulted in cats with improved behavior and tractability scores. Of note in the clinical study was that owners, too, observed key behavioral improvements following trazodone administration in comparison to placebo.8 In laboratory cats, trazodone caused no remarkable changes to physical exam and/or laboratory values7 adding to its margin of safety in older, potentially debilitated patients. Pharmacokinetic data have not been measured, but studies indicate peak sedation within 1-3 hours after dosing (Table 1).
Acepromazine is part of the phenothiazine class of sedatives and has widespread use within the veterinary world primarily during the perianesthetic period. Acepromazine elicits behavior-modifying effects primarily by drug binding and blockade of dopamine receptors in the basal ganglia and limbic system.1,2 The drug exists for veterinary use in two forms – oral and injectable. The injectable form, when administered oral transmucosally (OTM) offers very reliable moderate to marked sedation in cats within 20-30 minutes. With this route of administration, the dose closely follows recommended intramuscular (IM) dosing (Table 1).1,2,4 In the aggressive or fearful cat, this drug is best given 30-60 minutes prior to the hospital visit with administration guidelines similar to OTM buprenorphine (effects are most profound following absorption from the oral mucosa). Given a higher prevalence of heart disease in cats, acepromazine should be avoided in any cat with a heart murmur of unknown origin and cats with known hypertrophic cardiomyopathy (HCM) as safer alternatives exist and the effects of acepromazine are NOT reversible. Other contraindications include disease states that would deter one from using acepromazine in an anesthetic protocol.
In considering what pharmacologic intervention to start with, it is recommended to move in a stepwise process. Gabapentin and trazadone are recommended as first line choices in ameliorating feline anxiety and aggression as they have both been shown to be safe and effective options to improve feline veterinary visits. They can be given independently (start with one, as you can always add more if needed) or together in those cats requiring increased sedation. All of these oral therapies can be combined with standard anesthetic protocols; however, when using acepromazine OTM, any additional doses of injectable acepromazine should be dose reduced. As a final reminder, all of these therapies should be combined with cat-friendly practices and low-stress handling techniques.
| Drug | Dose | When to Administer* | Contraindications |
| Acepromazine | Recommended: Injectable (OTM): 0.01-0.05 mg/kg
Small volumes can be diluted with 0.9% saline for easier administration |
Time of onset ~30 minutes, so best given 30-60 minutes before hospital visit |
|
| Gabapentin | 15-30 mg/kg
For most average cats, 100 mg capsule recommended |
Give PO the night prior to hospital visit, then repeat same dose the morning of hospital visit (at least 2 hours prior) | |
| Trazodone | 5-10 mg/kg
For most average cats, 50 mg tablet recommended |
Give PO the night prior to hospital visit, then repeat same dose the morning of hospital visit (at least 2 hours prior) |
|
Table 1: Dosing and timeline of administration for sedative agents. Timing regimen should be adjusted based on cat’s appointment time.
References:
- Lumb and Jones’ Veterinary Anesthesia, 4th Thurman JC, Tranquilli WJ, Benson GJ. Baltimore: Williams & Wilkins; 2007.
- Essentials of Small Animal Anesthesia and Analgesia, 2nd Grimm KA, Tranquilli WJ, Lamont LA. Wiley-Blackwell; 2011.
- Lamont LA. Adjunctive Analgesic Therapy in Veterinary Medicine. Vet Clin: SA Prac 2008;38:1187-1203.
- Dyson DH. Analgesia and Chemical Restraint for the Emergent Veterinary Patient. Vet Clin: SA Prac 2008;38:1329-1352.
- Pypendop BH, Siao KT, Ilkiw JE. Thermal antinociceptive effect of orally administered gabapentin in healthy cats. A J Vet Res 2010;71:1027-1032.
- Van Haaften KA et al. Effects of a single preappointment dose of gabapentinon signs of stress in cats during transportation and veterinary examination. J Am Vet Med Assoc 2017;251(10):1175-1181.
- Orlando JM et al. Use of oral trazodone for sedation in cats: a pilot study. J Feline Med Surg 2016;18(6):476-482.
- Stevens BJ et al. Efficacy of a single dose of trazodone hydrochloride given to cats prior to veterinary visits to reduce signs of transport- and examination-related anxiety. J Am Vet Med Assoc 2016;249(2):202-207.