Evaluating panicolytic dosing and response

Keep in mind with benzodiazepines that there's a huge amount of variation in response within any population, so adequate dosing becomes a matter of trial and error. Side effects can include serious sedation or paradoxic excitement. Clients don't want dogs so sleepy that they fall down stairs or drown in their water dishes—or so excited that they run through a glass door.

When clients are going to be home with their dogs for at least four hours, they should give their medium-sized or larger dogs at least 0.25 mg; small dogs should receive half that dose. If a dog is so sedated it cannot function or is uncoordinated (ataxic), this dose is too high. Halve the dose the next time it is administered. If the dog is still sedated, you may need to help the clients find another medication.

When a client is going to be home with a dog, he or she can dose the animal as discussed above. If there's no provocative stimulus, the dog should seem normal. It may sleep more deeply but should awaken on request and not seem at all sedated. That is, the client shouldn't be able to tell the animal was given medication, except that the dog may be hungrier than on days when the drug was not given.

To learn if a dose will help a dog, clients should follow these steps:

• For a week, try the baseline dose.
• If after that time there's still no effect, double the dose.
• After another week, double the dose again.

If the dog is not large and is getting 2 to 4 mg and there's no effect, it's unlikely the dog will respond to this medication. It may, however, respond to other benzodiazepines alone or in combination with tricyclic antidepressants (TCAs) and selective serotonin-reuptake inhibitors (SSRIs) or an anticonvulsant medication such as gabapentin. The same pattern of dosage testing can be used with other drugs or drug combinations.

If you discover the dog responds to alprazolam but needs a longer-acting benzodiazepine, clonazepam (0.5 mg/kg every eight to 12 hours) may be beneficial, since it has a long half-life. Clonazepam is often used for some types of seizures and for sleep disorders. Dosing should start low and increase as needed; in some dogs, small amounts can have a huge effect.

The key to getting these medications to work is to give them to the dog before behavioral, physical or physiologic signs of distress develop. For storm-related phobias, clients must learn what the trigger is for the dog, because it may not be the noise per se. Triggers can include such things as light flashes, noise, atmospheric pressure changes or changes in ozone levels. Many weather programs can be downloaded to laptops or handheld devices and set to alert clients to certain atmospheric cues. Regardless of the dog's cue, the client must give the drug to the dog before the animal begins to react to the stimulus.

Benzodiazepines can be terrific medications, but they vary hugely in effect from one individual to the next. This lack of predictable effect is one reason benzodiazepines are not used as often as they once were.

Alternatively, numerous anecdotal reports seem to recommend melantonin or beta-blockers such as propranolol to treat noise reactivity. Without controlled studies, it's difficult to evaluate these claims or dosage ranges. An open-label trial of clonidine1 suggests this alpha-2 agonist, typically used as an antihypertensive agent in human medicine, may help in such situations. The recommended initial dose is 0.01 mg/kg once or twice a day orally, with an interdose interval of at least six hours. Stepwise increases up to 0.05 mg/kg or 0.9 mg/day have been used.