What is an evidence-based oral pre-visit sedation protocol for anxious dogs and cats before appointments?

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For anxious dogs, the evidence-based pre-visit protocol combines oral gabapentin the evening before with gabapentin, melatonin, and oral-transmucosal acepromazine administered 90–120 minutes before the appointment. Specifically: gabapentin 20–25 mg/kg PO the night prior, then gabapentin 20–25 mg/kg PO plus melatonin 3–5 mg PO plus acepromazine 0.05 mg/kg oral-transmucosal, all given 90–120 minutes before arrival. This protocol reduced mean stress scores from 27.11 at baseline to 21.84, and increased sedation scores from 0.68 to 1.39, in anxious and aggressive dogs. 1 Older dogs showed greater stress reduction and deeper sedation with this regimen. 1 For anxious cats, gabapentin is the preferred pre-visit anxiolytic, supported by evidence as a behavioral modifier and stress reducer when given several hours before hospital visits. 7 The 2019 AAHA Dental Care Guidelines specifically recommend gabapentin for cats, ideally administered the evening before and at least 2 hours before presentation. 5 Specific mg/kg dosing for cats is not defined in the available sources. Trazodone is an established alternative for dogs and is listed alongside gabapentin as a commonly used pre-visit pharmaceutical in the 2020 AAHA Anesthesia and Monitoring Guidelines. 6 The 2019 AAHA Dental Care Guidelines recommend trazodone for dogs, given the evening before and at least 2 hours before presentation. 5 For cats, oral trazodone at 50, 75, and 100 mg produced activity reductions of 83%, 46%, and 66%, respectively, with peak sedation at 2 hours post-administration for the 100 mg dose; no adverse effects or laboratory abnormalities were detected at any dose. 3 Behavioral scores during examination at 90 minutes post-treatment were not significantly different from placebo at the 100 mg dose, suggesting sedation precedes full anxiolytic effect during the exam window. 3 Benzodiazepines (alprazolam, midazolam, lorazepam) and clonidine are additional owner-administered options for both dogs and cats,