The Veterinary Apothecary: Drug therapies for canine behaviors

In this episode of The Veterinary Apothecary, dvm360 talks with veterinary behavior experts Christopher Pachel, DVM, DACVB, CABC, owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon; and Carlo Siracusa, DVM, PhD, DACVB, DECAWBM, a professor of clinical small-animal behavior and welfare at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, where he is also the director of the animal behavior service and of the primary care education section. The discussion focuses on drug therapies for canine behavior conditions, including tasipimidine oral solution (Tessie; Orion Corporation), the first product approved by the FDA for the treatment of both noise aversion and separation anxiety in dogs. Kristen Coppock Crossley, MA, lead editor for dvm360, hosts the series.

The following is a transcript of the program:

dvm360: What should veterinarians and pet owners know about using pharmaceutical therapies for the treatment of noise aversion or separation anxiety in dogs?

Christopher Pachel, DVM, DACVB, CABC: One of the things to remember is that even when we're using medication support to address things like noise phobia or separation anxiety, the medication attenuates or dampens down some of the emotional response but doesn't automatically reframe that animal's learning history. So I want to make sure that we're not putting too much hope that the medication is going to fix it…. What are we doing to actually teach this animal either new associations or teaching them more appropriate coping strategies for those things that are stressful to them?

Carlo Siracusa, DVM, PhD, DACVB, DECAWBM: Medication should never be the only treatment that we start. Medication has to be part of a more complex or multimodal approach that would include several components, one being changes in the environment. So, as a general rule, I would say [to make] the environment more friendly and safe for the dog that is experiencing fear.

Another part of the treatment is [educating] the owner about what is possible to do and what is not possible. There are a lot of misconceptions [about] what we can actually do. For example, many people think that you should not pay attention to a dog that is showing signs of fear or distress, because [then] you will be reinforcing their behavior [and] make it more likely to happen, but this is actually a false belief that does not have a scientific foundation.

When animals, including humans, experience an increase in emotional arousal that says, “We are very fearful,” or very anxious, or even sometimes very happy, whenever we feel that our emotions are taking over, our brain centers that manage this excessive emotional arousal will inhibit the brain center that is responsible for the reward response. In other words, when we are too nervous, we don't really learn easily from consequences like reward and punishment. So at that point, we really don't have to think too much about this. We are in a lifesaving mode; therefore, when our pets are in this stage, we can just touch them, comfort them, [and] offer them some food without being afraid of reinforcing their fear. So this is part of the treatment, too.

Pachel: [Pharmaceutical therapies are] absolutely part of a multimodal approach. Sometimes we might use medication to kind of get our foot in the door, but I do worry that if we're using medication without supporting that with some form of training, behavior modification, or some form of learning, we may be wasting that window to some degree. So I really want to be able to do that cohesively and collaboratively in a way that actually maximizes that entire clinical response.

dvm360: What is the value of a treatment for both conditions as opposed to 2 separate medications?

Siracusa: It's not infrequent to see dogs that present both problems at the same time, so there is definitely an advantage—from a strictly veterinary obligation point of view—that we have a drug that is FDA approved for both problems. However, if I should pick one element that makes Tessie different from other drugs, including drugs of the same family, it is the bioavailability. [This] is a drug that has a very high bioavailability, so this means that the majority of the drug that we give is actually then converted into something effective, something that is helping us.

View Pachel’s response: Treating noise aversion and separation anxiety together

dvm360: The drug has been determined as safe for dogs, but there are some reported adverse effects, such as vomiting, lethargy, and diarrhea. Is there anything about tasipimidine oral solution that veterinarians or pet owners should be concerned about?

Pachel: This particular medication, tasipimidine—or Tessie, as it's been labeled—is in the category of α-2 agonists, which is a category that we've used for quite some time in veterinary medicine. So things that we know about drugs like dexmedetomidine, clonidine, or guanfacine, those same caveats apply here. Now, there's a slightly different selectivity in terms of those α-2 receptors, so I'm not saying they are equivalent—they are different medications—but that healthy dose of caution and awareness that we bring to any drugs in this particular category would apply here as well, keeping in mind [that] every dog is their own unique creature, their own sort of self-contained organism, so some dogs may experience certain [adverse] effects but not others, and others may not experience [adverse] effects at all. So, diagnose the problem, prescribe cautiously, observe for those effects, and make sure that we are advising our clients of what to watch for so they don't end up in a panic situation if their pet happens to be one of the ones who experiences some of these concerns.

Siracusa: I don't think there are specific precautions other than the usual precaution to use this drug only under the supervision of veterinarians. We always recommend making trials before the expected stressful event, so we know in advance if there are [adverse] effects. But let's say there are relatively mild [adverse] effects; that would definitely not preclude me from using this medication. There are also concerns related to the specific family of drugs that can also interfere with blood pressure and cardiac function, so you definitely want to use this drug in dogs that are healthy and [in which] you do not anticipate possible problems caused by the hypotensive effect, which, again, doesn't raise to a level of concern in the general population.

dvm360: The drug is not recommended for administration with food. What advice would you have for pet owners in administering an oral drug without food?

Pachel: This is a tricky one. We're all so accustomed to either wrapping them in a pill pocket or a pill wrap of some sort, or chasing that medication with food. In fact, some of our other medications actually are better absorbed when given with food. So this is a little bit of a conflict for a lot of our common administration strategies. In some cases, we can teach the animal to manually accept pills. Maybe in our training, we are teaching them to do that with food as a motivator, but during the actual medication administration, that meaning may not be a part of the picture. In other cases, we may have animals who are simply comfortable just taking the medication, and it's not that big of a concern.

This is, again, going to be one of those areas where we're going to have to be mindful of that individual variability as we see what is practical. So again, from the prescriber standpoint, I think that's a really important question for us to ask our pet parents and those caregivers. If we're not giving it with food, can you administer this? And then we give it a try, see how it goes.

Siracusa: I think it is to be taken with a grain of salt, that is, it doesn't have to be administered with the regular meal, which is a significant amount of food that will delay absorption. But in general, to administer medication, you do not actually recommend putting the medication in the regular meal to avoid a negative association. Let's say the dog doesn't like the taste of the drug; administering a small amount of highly palatable, highly valuable food for the dog usually doesn't represent a problem. Again, it will delay absorption, but it's not necessarily that it would neutralize the effect of the medication. In the end, our goal is to get the dog to take that medication.

dvm360: What else would you like veterinarian professionals or pet owners to know about this dual-use therapy, or canine behavior drug therapies in general?

Siracusa: Don't consider drug treatment as the only option or main option. Medication is not the miracle cure that will resolve everything, but when it's necessary, it is not usually an extreme or particularly dangerous option. Now there are drugs on the market that have been tested on pets. They are specifically formulated, they're safe, [with] minimum [adverse] effects comparable to other medications that we routinely use.

Pachel: Anytime we get a new medication that's available, we want it to be the magic pill. I want it, you want it, the pet parents want it. We want it to be the magic pill, and that doesn't really exist, so really being mindful of the particular indications, contrary indications, and then prescribing responsibly. [Saying], “Hey, where does this fit within our toolbox? Within our overall pharmaceutical arsenal?” to be able to really see where this fits. And even if we love this new option, it's probably not going to be the right fit for every dog, so don't abandon the strategies that we've used successfully. This is something we can add to that toolbox rather than kicking everything else to the curb. This will be something that will broaden our ability to prescribe responsibly and with significant safety and efficacy data to then be able to do our job even better.

RELATED ARTICLE: FDA approves first drug for both noise aversion and separation anxiety in dogs