5-3-17
NMVMA listserve Veterinary Behavior Tip #26
Canine Separation Anxiety

I invite you to peruse and use any of the information from this and past nmvetlist missives. You will find the entire archive on the For Veterinarians page of my website, drjeffnichol.com/

Jeff,

I have a patient, Noah, who is an 8yr neutered toy poodle.  He will cry incessantly when the owner leaves her apartment.  She recently moved in to the apartment and Noah’s crying when the owner leaves has gotten worse since the move.  The owner is working to break the cycle of anxiety by doing short trips out, signaling when she is going to leave frequently (and then not leaving), but he still cries whenever she leaves the apartment.  He is an 11.5# dog and we started him on Clomipramine 10mg PO q24 hours about a month ago.  The crying has gotten less but he will occasionally have whole days where he cries.  The owner has gotten a few complaints from neighbors and is concerned about being able to keep him.

My question, could we add either Trazadone or Clonidine in to help?  People seem to be back and forth about whether these drugs are safe to be used together.

Any help would be greatly appreciated!

Nick Hopkins

 

Hi Nick-

This question is important because separation anxiety is so common in dogs. Cats, by the way, can also have this problem but their symptom is more commonly urine soiling in their owners’ absence.

I agree with Clomicalm (clomipramine) as a good primary anxiolytic. It is palatable and is usually effective. It is currently the only drug that is FDA approved for this indication. At 5.3 kg your patient is getting about 1.9 mg/kg once daily. While this is in line with package recommendations, in the behavior specialty we usually start twice daily and raise the dose after the first 2 weeks to 3-4 mg/kg bid. To make this economical for the client I recommend giving Noah ¼ of an 80 mg Clomicalm tablet bid.

Trazodone is an excellent adjunct anxiolytic for dogs like this. It is safe when added to clomipramine or fluoxetine. Trazodone is best dosed on a m2 basis. For simplicity, we use the following chart.

Dogs:

  • <10 kg: < 25 mg. q 12-24 h for 3 days, then < 50 mg. q 8-24 h.
  • 10-20 kg: 50 mg. q 12-24 h for 3 days, then 100 mg. q 8-24 h.
  • 20-40 kg: 100 mg. q 12-24 h for 3 days, then 200 mg. q 8-24 h.
  • >40 kg: 100 mg. q 12-24 h for 3 days, then 200-300 mg. q 8-24 h.
  • Available in 50, 100, 150, & 300 mg tablets.

Over time (usually after 3-4 consecutive days) many dogs develop a tolerance to trazodone and require increasing doses 50-100%, as noted above. Trazodone is best given 2 hours prior to an owner’s departure so that it’s on-board as she exits her apartment.

If Noah still struggles you can add a benzodiazepine to the above. Since most of those in common clinical use are pretty short acting (3-4 hours duration of effect) I usually go with clonazepam.

  •  0.1 – 1 mg/kg PO up to 2-3 times per day, but some recommend up to q6h dosing or dosages up to 2 mg/kg PO q12h.
  • Clonazepam tablets: 0.5 mg, 1 mg, & 2 mg.

You could add clonidine but it is usually not indicated for separation anxiety.

All drugs have the potential for side effects. Moderate sedation is part of the bargain with trazodone. I explain to clients that it isn’t a bad thing for a dog whose anxiety is significantly controlled to doze off and relax until its person returns.

It can be hard to know when to add one adjunct anxiolytic and then maybe one more. Simply asking neighbors if the dog is vocalizing isn’t good enough. One recent study of a large number of dogs believed by their owners to have no behavioral issues found that 30% of them showed clear indicators of distress when they were home alone. This was determined by leaving a video camera (smart phone, iPad) aimed at the exit door following the owner’s departure. The first 10 minutes of an owner’s absence will show a lot.

I always recommend this for these clients. We can monitor progress pretty accurately.

I would also give this dog a healthy canine-specific activity to engage his brain and the rest of his body when he is home alone. Tell your client to eliminate the dog food bowl and provide all of Noah’s sustenance from food-dispensing toys and puzzles. These should be dropped on the floor as she departs and picked up when she returns home. If she purchases a whole bunch of them they can be rotated. I advise hiding some of them under the furniture or cushion so the dog has to scavenge, much as he wound if he were free-living.

The point of this structure is for the dog to see the owner preparing to leave home and learn to anticipate eating rather than wringing his little hands in despair as he anticipates the inevitable. On days when the owner will be home all day she can drop the food toys on the floor at about the time that she would otherwise leave.

Finally, this client’s well-intentioned “graduated absences” is an older behavior modification technique that is, frankly, seldom helpful. We occasionally add it to other methods. While desensitization to predeparture cues, independence training, and other structures of teaching a dog that life is OK when the owner is gone are often part of treatment, it’s controlling the anxiety itself that makes the biggest difference. This dog needs to be relaxed when the owner walks out the door in order to succeed.

There is much more that many afflicted dogs need. If video monitoring shows Noah pacing, yawning, lip licking, and fidgeting when he is alone I would encourage you to refer the client to me for a consultation.

All the best,
Jeff

I have added a For Veterinarians page to my website (drjeffnichol.com). You will find all of my past missives and answers for your reference. I hope you find this information helpful.