April 2016 CE — Therapeutics for Pet Aggression (Plumb, 2015) if they have not been previously informed of the difference. Therapy for one to two months may be necessary in order to determine whether seizure control is adequate. Levetiracetam (Keppra®), an antiepileptic and anti-anxiety drug for people, also has become a popular alternative for treatment of dogs with seizures that are resistant to phenobarbital and/or KBr. The popularity of levetiracetam has increased since it became available as a generic. As with zonisamide, it can be employed as a monotherapy or as an adjunct with phenobarbital or KBr. Clients may be forewarned that, as with several other human anti-epileptic agents, a “honeymoon” effect often occurs in which a period of high efficacy may be followed in four to eight months by the development of tolerance (Plumb, 2015). The adverse effect profile for levetiracetam is excellent and sedation is uncommon. However, one disadvantage that a pet owner should be made aware of is a three-times daily dosing schedule (Volk et al., 2008) and, even as a generic, the cost of levetiracetam treatment is greater than phenobarbital. Summary Pet behavior disorders and seizures are very disquieting to their owners and the successful use of pharmacologic agents can therefore benefit both pets and owners. Pharmacists who possess knowledge about both the disease condition in pets and the effects of the drugs can provide reassuring counseling on drug use and safety. Aggression in dogs and cats can be treated with SSRI or TCAs, but typically not with benzodiazepines. Compulsive disorders also are treated with SSRIs or the TCA, clomipramine. Owners should be made aware that the full effect of SSRIs or TCAs in behavioral management may not be achieved for three to four weeks or longer; however, some effects could be noted as early as the first week. The underlying anxiety or social stress generally at the root of housesoiling (urine marking and toileting concerns) by cats can be treated with SSRIs, TCAs, as well as with buspirone, or even a benzodiazepine. Mirtazapine is a tetracyclic molecule that in part antagonizes pre-synaptic alpha (2) receptors promoting increased norepinephrine and serotonin release in the CNS. It is used in pets for medically-related anorexia and as an antiemetic. MAOIs inhibit neurotransmitter oxidation sparing dopamine, norepinephrine and epinephrine. In veterinary medicine, the most commonly prescribed MAOI, selegiline, is used to treat cognitive dysfunction syndrome. Seizure disorders can be treated with phenobarbital, KBr or more recently, zonisamide or levetiracetam. Adverse effects that are most relevant to clients during counseling are listed in Table 1, and include anorexia, vomiting and diarrhea for SSRIs, TCAs and selegiline, with additional anticholinergic effects with TCAs. Sedation and ataxia are to
March/April 2016 be expected with use of phenobarbital, the benzodiazepines and zonisamide. Pharmacist and pharmacy technicians should freely consult with the referring veterinarian to exchange ideas such as compounding that may enhance chances for successful therapy or to inquire about any concerns or questions that they or their clients have about a pet prescription. References AAFP; The American Association of Feline Practitioners. (2004). Feline Behavior Guidelines. Retrieved from Catvets.com: http://www.catvets.com/public/PDFs/ PracticeGuidelines/FelineBehaviorGLS.pdf Accessed Nov. 5, 2015. AVMA.org. (2015). Retrieved from https://www.avma.org/ News/JAVMANews/Pages/140901a.aspx Accessed Nov. 5, 2015. Barann, M., Stamer, U. M., Lyutenska, M., Stüber, F., Bönisch, H., & Urban, B. (2015). Effects of Opioids on Human Serotonin Transporters. Naunyn Schmiedebergs Arch Pharmacol., 388(1): 43-9. Barahona-Corrêa J.B., Camacho M., Castro-Rodrigues P., Costa R., Oliveira-Maia A.J. (2015) From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder. Front Psychol. 6:1798. Crowell-Davis, S., Murray, T. (2006) Veterinary Psychopharmacology, First ed., Blackwell Pub., Ltd. Oxford, UK. Drugs.com. (2015). Retrieved from http://www.drugs.com/ Accessed Nov. 5, 2015. Hsu, W. H. (2013). Handbook of Veterinary Pharmacology, 2nd ed. 2013. Seoul. Republic of Korea.: Shinilbooks. Yin, J., Song, J., Lei, Y., Xu, X., Chen, J. (2014). Prokinetic effects of mirtazapine on gastrointestinal transit. Am J Physiol Gastrointest Liver Physiol. 306(9): G796-801. Landsberg, G., Hunthausen, W., Ackerman, L. (2013) Behavior Problems of the Dog and Cat. (2013) 3rd Ed., Elsevier, Edinburgh UK. Merckvetmanual.com. (2015a). Retrieved from http:// www.merckvetmanual.com/mvm/behavior/ normal_social_behavior_and_behavioral_problems _of_domestic_animals/behavioral_problems_of_cats.html? qt=buspirone&alt=sh Accessed Nov. 5, 2015 Merckvetmanual.com. (2015b). Retrieved from http:// www.merckvetmanual.com/mvm/behavior/normal_social_ behavior_and_behavioral_problems_of_domestic_animals/ behavioral_problems_of_dogs.html?qt=aggression&alt=sh Accessed Nov. 5, 2015.
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