Behaviour Modifying Drugs - Overview
Although many drugs are used to treat behavioural conditions in animals, there are only three psychoactive drugs specifically licensed for use in companion animals to treat behavioural problems. These are:
- Clomipramine (EU and USA license for the treatment of separation related problems in dogs).
- Selegiline (EU License for the treatment of behavioural problems with an emotional underlying origin).
- Fluoxetine (EU and USA license for the treatment of separation anxiety in dogs, when used in combination with behavioural therapy. Subsequently withdrawn from European market).
A range of other drugs are used to treat behavioural conditions, including beta-adrenoceptor antagonists, benzodiazepines, azapirones, anticonvulsants and triazolopyridines. Some of these drugs are licensed for use in a companion animal species for another condition, but many are not licensed for use in any companion animal species. Examples are listed in the table below, however, most uses listed are unapproved, care should therefore be taken with their use:
| Class of Drug | Drugs | Uses | Side Effects |
|---|---|---|---|
| Tranquillisers | Acepromazine | Sedation/restraint (no specific indication in behavioural therapy) | Hypotension, CNS stimulation, contradictory responses. Caution in boxers and greyhounds |
| Benzodiazepines | Alprazolam, Clonazepam, Clorazepate, Diazepam, Lorazepam, Oxazepam | Acute anxiety, panic, short-term management of noise phobias, | Hepatic necrosis (potentially fatal), Sedation, ataxia, increased appetite, paradoxical excitation |
| Tricyclic Antidepressants (TCAs) | Amitriptyline, Clomipramine, Doxepin, Imipramine | Anxiety, separation anxiety, canine and feline fear aggression, feline urine marking, feline compulsive grooming, stereotypy, some narcoleptic disorders | Sedation, gastrointestinal (GI) effects, dry mouth, increased thirst, urinary retention |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Fluoxetine, Fluvoxamine, Paroxetine, Sertraline | Aggression, canine separation anxiety, compulsive disorders, feline urine marking | Lethargy, inappetence, anorexia, GI effects |
| Beta Blockers | Propranolol | Canine fear aggression, noise phobia | Bradycardia, lethargy, hypotension, syncope |
| Azapirones | Busiprone | Phobia, anxiety, feline urine marking, interact aggression | Uncommon, not sedating |
| Triazolopyridines | Trazodone | ||
| Anticonvulsants | Carbamazepine, Gabapentin, Levetiracetam, Phenobarbital, Potassium bromide | Canine and feline compulsive tail chasing, unprovoked canine rage aggression | Lethargy, ataxia, polyuria, polydipsia, polyphagia |
| Hormones | Medroxyprogesterone acetate, Megestrol acetate | Last resort for aggression and feline urine marking | Polyphagia, polydipsia, sedation, diabete mellitus, pyometra, mammary hyperplasia, endometrial hyperplasia, carcinoma |
| Glial Modulators | Propentofylline | ||
| Monoamine Oxidase Inhibitors (MAO-Is) | Selegiline | Canine and feline cognitive dysfunction syndrome, fear related problems, spraying, hyperactivity, compulsive/stereoptypical disorders, specific phobias | GI effects, restlessness or lethargy, anorexia |
Benzodiazepines are the only class of drug that consistently succeeds in all models, but this may be why they have a dangerous disinhibitory effect on aggression. These drugs eliminate avoidant responses to many kinds of aversive events, increasing confidence in a number of exploratory tests. This is why benzodiazepines can cause dangerous levels of disinhibition in aggressive dogs. Benzodiazepines also inhibit memory formation by affecting NMDA (glutamate) receptors in the hippocampus, which limits their usefulness in behavioural therapy where any kind of learning is required, which is in most situations. They are useful for memory blocking if given at sub-sedative doses prior to or during a predicted traumatic event such as a thunderstorm. When used at low doses, they act as mild tranquillisers, this can help moderate excitement. At medium doses they lessen anxiety, which can encourage social interaction in a constructive way [1].
Drugs such as Acepromazine (ACP), which act on dopamine receptors, and synthetic hormone analogues like megestrol acetate (Ovarid), have little or no rational use in behavioural therapy for reasons of non-specificity, and adverse effects which make their use unjustifiable.
Phenothiazines such as ACP have a very varied level of effect and duration of action and dull both normal and abnormal behaviours which is an out of date approach to behavioural therapy[1].
The first port of call when using medication for behavioural problems should be drugs licensed for veterinary use. These drugs have established data about their efficacy, side effects, contraindications and toxicity, which makes expected outcomes more reliable[2].