A truly magic potion: Lets talk pre-visit pharmaceuticals

June 30, 2019
Lisa Radosta, DVM, DACVB
Lisa Radosta, DVM, DACVB

Dr. Radosta is the owner of Florida Veterinary Behavior Service in West Palm Beach, Florida. She completed a residency in behavioral medicine at University of Pennsylvania where she received two national research awards. She has authored textbook chapters; writes a column for the Palm Beach Post and podcasts CE for VetGirl. She has published research papers on thyroid disease and clinician client communication and has lectured across the country and internationally. She is the behavior section editor for Small Animal Advances in Medicine and Surgery, sits on the American Animal Hospital Association Behavior Management Guidelines Task Force and the Fear Free Advisory Board.

Dealing with pre-veterinary visit pharmaceuticals requires good decision making, excellent guidelines and, sure, just a touch of magic.

Use your wand (and knowledge of pharmaceuticals) to help patients with fear, anxiety or stress. (jpleskachevskaia/stock.adobe.com)

The tides are turning as veterinary healthcare teams all over the world recognize and try to alleviate the signs of fear, anxiety and stress in their patients. One way we can modulate patient stress is to use pre-visit pharmaceuticals. Pre-visit pharmaceuticals (i.e., oral and transmucosal medications and oral supplements) are administered at home before a visit to the veterinary clinic. Every veterinarian wants to know which magical combination will turn their aggressive patient into Sleeping Beauty. And while there isn't a magic potion, there are some decision-making guidelines that can help make you feel like a knight in shining armor.

General guidelines for dogs and cats

Because sedatives and anxiolytics are unreliable in their effects on any particular animal, test doses are necessary to ensure success. Trials can be done at home, but test runs are best done at the hospital. Time of administration in relation to arrival at the veterinary hospital is extremely important for success. Just follow these steps:

  • Administer oral medications 3 hours prior to veterinary visits.

  • Administer transmucosal medications 45 to 60 minutes prior to veterinary visits.

  • Test medications prior to use for an appointment to ensure proper dosing.

General guidelines for prescribing

Follow these guidelines when it comes to prescribing pharmaceuticals:

  • Decide on desired outcome (e.g, sedation, decreased fear, decreased anxiety or decreased aggression).

  • Choose a medication based on effect.

  • Start low- to mid-range.

  • Increase dose if no side effects and clinical effect hasn't been achieved.

  • If 50% or greater of desired effect has been achieved with a medication, consider adding an additional medication instead of discontinuing.

Making decisions

Before you prescribe a medication, you should know the medication's effect, duration of action, dosing range and contraindications. The medication class doesn't always match up with the clinical effect of the medication. For example, trazodone is a serotonin antagonist/reuptake inhibitor (SARI). However, its primary clinical effect on dogs and cats is sedation. The duration of action will help guide when medications should be dosed. For example, Sileo (Zoetis) has a duration of action lasting about two hours. Knowing the dosing range will help you feel more confident with increasing to an effective dosage. Finally, understanding which medications the medication of choice interacts with will help you to feel confident combining medications. Now, go out and slay some dragons!

Dr. Lisa Radosta owns Florida Veterinary Behavior Service in West Palm Beach, Florida, and co-owns Dog Nerds, an online pet behavior training resource.