Treating Feline Psychogenic Alopecia

Pharmacists working closely with veterinarians in formulating animal medica­tions in usable dosage forms and proper dosage strengths can often assist in the treat­ment of Feline Psychogenic Alopecia (FPA). In dealing with this condition, it is impor­tant that the client remember that FPA is a lifetime problem that may reoccur anytime a cat feels stressed, nervous, or bored. In addition, the client should understand that medi­cations used to treat FPA rarely produce immediate results. Patience will be re­quired! Veterinarians who have diagnosed this psychogenic ailment may wish to enlist the assistance of a com­pounding pharmacist, not only to prepare medications, but also to reinforce instructions given to clients for administra­tion of the drugs.

Of course, the most effec­tive treatment, and possibly the only cure, for FPA is to alter whatever is causing the emotional stress. Unfortu­nately, removal of the trigger that causes a cat to pull its fur is not always possible. While the Elizabethan collar may have assisted in the final diag­noses of FPA by allowing the veterinarian to rule out other maladies as the source of alopecia, most owners do not want their cat to wear this device throughout their life. In addition, stress caused by the collar is almost certainly counter-productive to im­provement in the condition. Although it is often difficult to arrive at a successful regimen of therapy, because excessive grooming from FPA can cause breakage of the skin resulting in serious infection, the at­tempt to find a drug therapy solution is a very important effort.

Although medication should be considered as a last resort due to possible negative side effects, good results have been achieved through medica­tion therapy. Aside from Neurosyn^,, and Ovabang, most medications that could possi­bly be utilized in treating FPA are not approved for use in animals. (Neurosyn^,, and Ovaban- are approved only for canine, not feline, use.) Megestrol does not actually treat psychogenic problems. Normally this drug is intended to address the itch which is believed to prompt fur-pulling. Megestrol is, however, often used in cats diagnosed with FPA. Each of the other drugs which may be utilized success­fully in treatment of FPA, for example diazepam, phenobar­bital, clomipramine, and ami­triptyline, act as a sedative. Response times vary, but range from 2 to 4 weeks. Each of the drugs may affect appetite for food and water, and may cause gastrointestinal and urinary tract effects. These drugs may also induce irritability and depression, depending on the individual animal. It may be necessary to attempt therapy with more than one drug before finding the most effec­ tive one for the particular patient.

In the past, injectables and oral medications have been the best dosage forms available for drugs used to treat FPA. Injec­tions were often extremely difficult and dangerous for caregivers, and medications that could be given by mouth were perhaps the best choice. Now however, these drugs show promise as candidates for transdermal delivery. If effective in this form, gastro­intestinal and harmful liver effects can be avoided. It will be important that the patient listed on the veterinary pre­scription be clearly identified by species, breed and weight to assist the compounding phar­macist prepare the medication you have ordered for the exact needs of your patient.

Because these medications can cause many irritating and frustrating side effects, clients should take therapy of this kind very seriously. All medications that cause sedation are also likely to cause motor incoordi­nation such as inability to jump or attack on target. This may be very frustrating to a cat and result in more anxiety. Since defensive ability may be al­tered, this side effect should be considered especially in cats that spend time outdoors.

Determining the proper drug, proper dose and best dosage form for each patient can be achieved, particularly when veterinarian, pharmacist and client work as a team to treat the patient.

The tables included here may be used as a quick refer­ence for drugs, dosages and side effects. An ACVP PetTalk Newsletter which describes FPA and its treatment to clients is available from the ACVP Pharmacist who has provided this publication.

PSYCHOTROPIC DRUGS PROVIDE EXCELLENT OPPORTUNITIES FOR COLLABORATIVE RESEARCH

Transdermal delivery systems have proved to be remarkably effective and have improved both outcomes and compliance in both human and animal patients. However, this development does not provide a panacea for problems associ­ated with administering medi­cations to animals. The Ameri­can College of Veterinary Pharmacists is committed to developing this innovation for use in animal patients. One important task in accomplish­ing this goal is to gather clini­cal data to support the use of transdermal delivery systems for any particular drug, or evidence that transdermal delivery is not recommended.

In a recent VetTalk, Information-at-a-Glance, (Volume 05,Number 02) initial transdermal dosages for cats for phenobar­bital, clomipramine and ami­triptyline were recommended. These recommendations were made relative to pharmacology which supports efficacy, and based primarily on extrapila­tion of oral and/or injectable doses.

In order to determine and document the efficacy and safety of this route of adminis­tration which offers so many advantages over oral and inject­able delivery systems, ACVP pharmacists are very interested in working with veterinarians to document the efficacy and safety of these and other drugs in this dosage form.

One such study of transdermal methimazole being treated for hyperthyroidism was recently pub­lished in the InternationalJournal of Pharmaceutical Com­pounding (Vol 6 No 5) and docu­ments the clinical success to transdermal methimazole in 16 cases.

Veterinarians interested in participating in a study of the efficacy and safety of transdermal delivery of one of these psycotropic drugs in a feline patient being treated for FPA should contact the American College of Veteri­nary Pharmacists at 877-838­6337, or discuss the possibility with an ACVP pharmacist in their area.

INFORMATION-AT-A-GLANCE FOR THE VETERINARIAN

 MEDICATIONS USED TO TREAT FELINE PSYCOGENIC ALOPECIA

MEDICATION                      ACTION                                       RESPONSE TIME                   AMOUNT GIVEN
Diazepam (Valium)		Sedation		2 – 4 weeks	I – 2 mg, once to twice daily as needed
Phenobarbital		Sedation		2 – 4 weeks	0.5 – 2 mg/kg twice daily as needed
Clomipramine (Anafranil)		Sedation, alters brain chemicals to reduce excessive grooming.		1 day* or 2 – 3 weeks	1.6 mg/kg once daily’ or 0.5 mg/kg once daily
Primidone (Neurosvn”*, Mysoline)		Sedation		Not documented	12.5 – 25 mg once to three times daily
Amitri tvline (Elavil}p		Sedation, alters brain chemicals to reduce excessive grooming; anti-itch.		. – 4 weeks	5 – 10 mg once or twice daily
Megestrol Acetate (Ovaban**, Megace)		Anti-itch		Not documented	2.3 – 5 mg every other day for one week and then once per week
* Only one case noted ** Approved for use in animals (canine only)
	MEDICATION                                                      POSSIBLE SIDE EFFECTS
	Diazepam (Valium)		Fatal liver effects; increased appetite; irritability, depression.
	Phenobarbital		Harmful liver effects; anxiety and agitation at the start of therapy; depression; increased appetite; increased urination; increased thirst.
	Clomipramine (Anafranil)		None documented in cats. Humans and dogs: dry mouth, constipation, nausea, decreased appetite, dizziness, nervousness, fatigue.
	Primidone (Neurosvn**, Mysoline)		Harmful liver effects; increased appetite, increased urination; increased thirst.
	Amitriptyline (Elavil)		Dry mouth, constipation, urination problems, vomiting, heart problems, decreased appetite, increased excitability.
	Megestrol Acetate (Ovaban**, Megace)		Decrease in certain hormones, diabetes (elevated blood glucose), increased thirst, increased urination, personality changes, increased weight, cancer, rare liver problems.