This question was submitted during the webinar on Case Studies in Behavior: Aggression:
Paroxetine - is it typcial to dose this every 12 hours?
That depends on the clinician. I prefer to use paroxetine every 12 hours to maintain as steady a dose as possible to the patient. The pharmacokinetics of the SSRIs can vary widely from patient to patient. Paroxetine has a shorter half life than some of the other SSRIs. Dosing twice daily helps account for these issues. I hope that helps! Dr C
We currently have two cats - each weighing more than 6 kg. - that have been on a single daily dose of 5 mg. Paroxetine per cat for about a year, with unsatisfactory results. There is still a high level of intercat aggression that has actually increased over the past two months. Would you recomend increasing the dosage? going to a BID schedule and if so at what dosage? Thanks!
If paroxetine is not helping intercat aggression within 4-6 weeks at any dose, I'd be looking at the behavioral therapy plan, the separation plan for the cats, supplement/pheromone plans, and dosing/side effect profile of the paroxetine, as well as any underlying possible medical problems or environmental triggers that are preventing improvements.
So the short version of that is- it depends. It depends on what is happening with all of these parameters. Medication alone for severe intercat aggression is not likely to be a panacea no matter the dose.
I hope that helps!
Thank you E'Lise,
The two are part of a multicat household (8 adult to geriatric cats) . Environmental enhancements, behavioral program and manipulations, and Feliway are in place. The Pheromone therapy was instated a few days ago with limited improvement. There is no realistic way to do separation and reintroduction, without further increasing stress and wellbeing in the complex multi-cat home equilibrium... Being that the current dosage of Paroxetine seems to me on the low end (maybe insufficient) recomendation scale and given these two cats are quite corpulent :) I thought they may be underdosed. Reading your uptake on BID dosing I further thought they may benefit from a BID schedule. I will consult with the DMV treating them of course, but since he's not very profficient in behavioral therapies I wanted to present him with your oppinion.
Thanks again,
Marta Esterkin
Feline behavior and environment consultant
Israel.
Hi Marta,
Great to hear back from you!
It's really difficult when the cats exposures to each other can't be controlled. It allows so many negative interactions that it can be hard for other work to be successful. We often do complete separation and reintroduction, but it can be so helpful to do partial separation to give everyone a break.
Regarding the dosing of the paroxetine. In cats, I often use paroxetine once daily. In dogs, I split the dose. Cats metabolize medications incredibly differently from people and dogs, so they often get their own special dosing schedule.
In this type of case, if all other things were being addressed appropriately, then I might consider changing medications. However, I would need a lot more information. And, of course, I can't comment on these specific cats. Info I would be looking for would include any improvements in frequency, duration, intensity, distractibility, resiliency, etc of each cats total suite of behaviors (not just the ICA). Once I know about side effects and any improvement parameters, I would be able to move forward.
In general, 1 mg/kg of paroxetine per day is actually a pretty good dose for a cat. So other options may need to be explored. They may also need combination therapy.
And then, of course, there is the "square peg, round hole" issue. If one has two cats who are extremely distressed by each other, is it ethical to continue to encourage/attempt co-habitation in a species that would normally disperse if given the opportunity in this situation?
Cats with ICA can be difficult to rehome and obviously it's heart-breaking for the families, but sometimes it is absolutely the most ethical, humane choice.
And, of course, this is assuming all medical rule outs have been truly and completely assessed.
These are complicated cases that really require a lot of team work between very skilled people. The clients are lucky to have both you and the veterinarian on their side.
If you are in Israell, what about calling Noa and seeing if she can support the vet through telemedicine? Dr. Noa Harel.
Good luck!
ELise Christensen said:That depends on the clinician. I prefer to use paroxetine every 12 hours to maintain as steady a dose as possible to the patient. The pharmacokinetics of the SSRIs can vary widely from patient to patient. Paroxetine has a shorter half life than some of the other SSRIs. Dosing twice daily helps account for these issues. I hope that helps! Dr C
I really like what you said.
