Strategies to treat
Treatment not only saves lives, but it means the difference between a life of quality or a life of pain and suffering. Treatment
can involve the dreaded behavior modification, but this is one case where drugs are essential and not optional. The rationale for behavioral medication follows.
Alprazolam (Xanax) is my preferred drug of choice for storm and noise phobias, and for all dogs who panic, whether the panic
is a solitary diagnosis or a co-morbid one with separation anxiety or other anxiety-related condition. This benzodiazepine
(BZ) is considered the classic "panicolytic" drug in human medicine, and has the advantage of a broad dosage range for anxiolytic
effects, and a more narrow range for sedation. With diazepam, the pattern is reversed; however, dogs, like people, are incredibly
individual in their response to benzodiazepines. Some dogs do better with one of these while other dogs show the reverse patterns.
The only drawback to these medications is that they can be addictive and abused by humans, so there is the occasional household
in which such medications should not be placed.
The key to treatment for noise phobias and panic is to give the BZ early and often. The half-life of diazepam in dogs is about
5h, and that of its intermediate metabolite, nordiazepam—which is active and highly sedative—is ~3h. The half-life of alprazolam
is somewhere in the 3 or 4-6h range but its intermediate metabolite is not sedating, less active, and more directly excreted
so you get a more moderate and continuous patterns of anti-anxiety effects. If clients are expecting storms, and if they
can get the dose of alprazolam into the dog two hours before hand and the other half ~30 minutes before hand, they can easily
achieve a great anti-anxiety effect.
The medication can then be repeated as needed, but clients should allow at least 2h between doses to assess effects. Generally,
alprazolam is repeated q.4-6h. This dosage can be used continuously over a period of days or weeks during a profound thunderstorm
season. If this scenario ensues, it is best to slowly withdraw the dog from the meds.
Dosages for alprazolam range from 0.01-0.001 mg/kg for dogs and 0.025-0.05 mg/kg for cats who panic (e.g. coming to the clinic).
Most people don't think of storm phobias in cats, but they may well occur because cats hide when distressed. We need to treat
all of these cats and dogs.
For most average size dogs, dosages in excess of 4 mg/DOG can result in ataxia, and there is one publication stating that
this is the maximum daily dosage. Such logic is unrealistic for big dogs, but as with all BZ, clients will need to experiment
with the dose to learn the best dosage level for their dogs. Clients need to learn about the potential side effects of different
dosages when the dog or cat is not distressed, and about the best dosage level to treat the panic during the experience. For
this reason, I recommend a trial run at the estimated dosage when the clients are home and the animal is calm.
If the animal is seriously sedated, the clients need to adjust the dose to a lesser one. If the animal is fine, but sleeps
more quickly or more deeply, the dose is a good one as long as the pet awakens without grogginess.
Tips from the pros
Here are some tips to consider. Many people prefer diazepam (0.5-2.0 mg/kg po q. 4-6h - dogs; 0.2-0.4 mg/kg po q. 12-24 h
- cats) because they swear that no matter how high the dose they cannot get an effect with alprazolam. There are some individuals
who have genetic variants of enzymes that metabolize these drugs that can cause extreme effects. However, mostly I think people
confuse an anxiolytic effect with a sedative one. And, they only give one or two doses. Instead, if you use alprazolam as
discussed and keep giving it to one full dose as needed, the dogs—and cats—begin to learn that they don't have to be so frightened.
This formula also works like a charm for dogs who get upset during veterinary visits. So for a 25 kg dog, I'd give 0.125 or
0.25 mg to start (the smallest tablet available is a scored 0.25 mg one) and evaluate the effect. If in 15-30 minutes the
dog isn't noticeably calmer, give him more.