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