what are the commonly used behavior-modifying medications in veterinary practice and their dosing protocols?

Question

Accepted Answer

The most commonly used behavior-modifying drug classes in veterinary practice are benzodiazepines (BZDs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, serotonin 2A antagonist/reuptake inhibitors (SARIs), and alpha-2 agonists. Specific agents within each class are listed below with available dosing guidance. 1 BZDs used in dogs and cats include alprazolam, diazepam, midazolam, lorazepam, and clonazepam. BZD dosing is highly individualized, and trial and error is required to find the optimal dose for each patient. They are administered 1–2 hours before a stressor and repeated 30 minutes before the event, with whole or half-dose increments used to titrate effect. For patients that do not accept tablets, BZDs can be made into a paste with a small amount of liquid and applied directly to the gums or tongue. All BZDs in this class can be dosed every 12–24 hours or as needed for veterinary visits. 1 Specific mg/kg doses for individual BZDs are not provided in the available guidelines; formulary verification is required before prescribing. TCAs used in dogs and cats include amitriptyline, nortriptyline, clomipramine, imipramine, and doxepin. SSRIs include fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram. Dual serotonin-norepinephrine reuptake inhibitors include venlafaxine and duloxetine. SARIs include trazodone and nefazodone. 1 Specific mg/kg doses for these agents are not provided in the available guidelines; formulary verification is required before prescribing. For fear-related veterinary visits specifically, suitable pre-visit medications include BZDs, gabapentin, trazodone, clonidine, and dexmedetomidine (an alpha-2A agonist), with atipamezole available as a reversal agent for dexmedetomidine. All of these agents can be administered every 12–24 hours or as needed. 1 Gabapentin has evidence supporting its use as a behavioral modifier and stress reducer in c