Animal Politics: The Use of Trazodone and Gabapentin in Shelter Animals

Balancing Relief with Responsibility

Animal shelters serve as havens for animals in need, providing care, shelter, and rehabilitation to countless animals each year. However, the shelter environment can be stressful for animals, leading to anxiety, fear, and behavioral challenges. To address these issues and improve the well-being of animals, some shelters have turned to pharmacological interventions, including the use of medications like Trazodone and Gabapentin. While these medications can offer relief for stressed animals, concerns over proper dosing, side effects, and overall effectiveness have surfaced.

Classification and Use:

Trazodone and Gabapentin are human medications adapted for veterinary use to treat conditions like chronic nerve pain. However, their use has expanded and they are now being used by some animal shelters to calm dogs down, particularly at or shortly after intake.

• Trazodone is a medication with sedative properties used to treat depression, anxiety, and restlessness. It is not subject to the Controlled Substances Act.

• Gabapentin is a medication used to help control seizures and nerve pain; it calms overactive nerves in the body. It is not subject to the Controlled Substances Act.

Trazodone and Gabapentin are sometimes used together to help animals relax and manage pain. This combination can have a sedative effect and ease any discomfort the animal may be experiencing, making it appropriate in certain situations, such as following surgery.

Reasons Given by Shelters for Use:

• Anxiety Management: Shelter animals often experience high stress and anxiety due to factors like separation from owners, unfamiliar environments, and the presence of other animals. Trazodone and Gabapentin are commonly prescribed to alleviate anxiety and promote relaxation in these animals.

• Behavioral Modification: Stress and anxiety can manifest in various behavioral issues, including aggression, destructive behavior, and excessive vocalization. By reducing anxiety, these medications can help mitigate behavioral issues, improving an animal’s adoptability and overall welfare.

• Facilitating Handling and Care: Animals in shelters may require medical examinations, grooming, and other necessary care. Administering Trazodone or Gabapentin can help facilitate these interactions by calming nervous or fearful animals, making it easier for shelter staff to provide essential care.

The Controversy

Despite the potential benefits, critics argue that the use of Trazodone and Gabapentin in animal shelters raises ethical concerns or pose risks to animal welfare. One concern is the potential for over-reliance on medication as a quick fix for behavioral issues, rather than addressing underlying causes or providing comprehensive behavioral support.

Critics worry about the long-term effects of these medications on animal health, particularly with prolonged or widespread use in shelter environments. They are also concerned about misdiagnosis or improper dosing, risking unintended side effects or ineffective treatment.

As a result of these concerns, there are calls for clear policies, protocols, ethical guidelines, and transparency around the responsible use of Trazodone and Gabapentin to ensure the welfare of shelter animals and maintain public trust.

The Role of the Veterinarian in Mitigating Controversy

Shelter veterinarians play a crucial role in ensuring the safe and effective use of medications in shelters. They assess individual animal needs, determine appropriate dosages, and monitor for adverse effects. Collaborating closely with shelter staff, their role is to guide the implementation of tailored treatment plans based on thorough evaluations of each animal's known medical history, behavior, and health status. Through this collaboration, shelter veterinarians can provide ongoing support and expertise in medication management, optimizing animal welfare and upholding the highest standards of care and ethical principles.

Side Effects and Safety Protocols

While Trazodone and Gabapentin are generally considered safe when used appropriately, they can produce side effects in some animals. Common side effects include drowsiness, sedation, neurological and gastrointestinal upset, changes in appetite, and aggression. It's crucial for shelter staff to be aware of these potential reactions and monitor animals closely after administration.

When Trazodone and Gabapentin are combined, they may have a synergistic effect on retinal function and pose an increased risk of serotonin syndrome. This syndrome can manifest as vomiting, diarrhea, decreased appetite, elevated heart rate, muscle tremors, restlessness, disorientation, and even seizures in severe cases. Therefore, shelter veterinarians must carefully assess each animal's condition and consider potential risks before prescribing these medications, especially in the absence of detailed medical histories.

Importance of Proper Dosing and Monitoring

Given the limited access to individual animals' medical histories in shelters, accurate dosing and vigilant monitoring become even more critical. While misdosing is typically less common under the supervision of trained veterinary professionals, human error, miscommunication, or inadequate monitoring can still occur.

To mitigate these risks, shelters must implement rigorous medication protocols and ensure clear communication among staff and veterinarians. Strict adherence to dosing guidelines, ongoing monitoring of animals receiving medications, and prompt reporting of any adverse reactions are essential components of medication safety in shelters. By prioritizing these measures, shelters can uphold the well-being of their animals and maintain trust within the community.

Considerations for Use in Shelter Animals

When using Trazodone and Gabapentin in shelter dogs, it is important to be aware of the specific contraindications and precautions for each medication, especially when the full medical history of these patients is often unknown.

Trazodone Contraindications and Precautions:

• Pets hypersensitive or allergic to Trazodone should not receive it. Risk: allergies may be difficult to identify in shelter animals.

• Trazodone should be used cautiously in pets with severe heart, liver, or kidney disease, as improper metabolism/excretion may occur. Risk: underlying conditions may go undetected in shelter animals.

• Pets with angle-closure glaucoma should not be given Trazodone, as it can increase intraocular pressure. Risk: glaucoma screening may not be routine in shelters.

• Trazodone is not recommended in pregnant pets. Risk: pregnancy status is often unknown for shelter animals.

• Trazodone should not be used with monoamine oxidase inhibitors (MAOIs), as this combination increases serotonin syndrome risk. Risk: shelter staff often lack full medication histories.

Gabapentin Contraindications and Precautions:

• Pets hypersensitive or allergic to Gabapentin should not receive it. Risk: allergies may be difficult to identify in shelter animals.

• Gabapentin should be used cautiously in pets with kidney impairment, as it is primarily eliminated through the kidneys. Risk: renal function assessment may be limited in shelter settings.

• Pets with a history of pancreatitis should be monitored closely when receiving Gabapentin, as it may exacerbate this condition. Risk: pancreatic disease may be undiagnosed in shelter animals.

• Gabapentin may cause sedation and ataxia, especially at higher doses. Risk: adverse effects may impact an animal's ability to adapt to shelter life and interact with potential adopters.

Given these considerations, extra care and diligence is required when using Trazodone and Gabapentin in shelter animals. Thorough screening and close monitoring are essential to ensure safe and effective use in this vulnerable population.

Effectiveness:

The effectiveness of Trazodone and Gabapentin in managing anxiety and stress in shelter animals has been examined in various studies and anecdotal reports:

• Trazodone has been shown to help mediate transitional stress in shelter dogs. A study conducted at the Animal Care Centers of NYC found that administering low doses of trazodone (5 mg/kg) to dogs within 48 hours of arrival at the shelter resulted in a significantly higher adoption rate compared to dogs that did not receive trazodone. The study suggested that trazodone may be able to help reduce stress and prevent immune system suppression, leading to lower rates of contagious respiratory illness in the shelter.

• A review article on the use of pre-appointment medications to reduce fear and anxiety in shelter animals noted that trazodone has been used as an "as needed" medication to help manage intermittent or acute anxiety in dogs, such as during veterinary visits or other stressful events. The article states that while few scientific studies have evaluated trazodone's efficacy as a single agent, the available evidence suggests it may be a promising intervention for improving shelter animal welfare.

• Regarding Gabapentin, an AKC Expert Advice article states that while the use of Gabapentin to calm dogs is mostly anecdotal, it has been used as an adjunctive therapy, or secondary treatment, paired with other medications like Trazodone to provide additional sedating effects and pain relief. The article notes that Gabapentin and Trazodone can be safely used together in dogs.

• A case report on the use of Gabapentin and Trazodone to treat separation anxiety in a dog with fear-based behavior highlights how these medications can be combined to manage anxiety in shelter and rescue animals.  The report suggests that the short-acting nature of these drugs makes them useful for addressing acute stress, while longer-lasting maintenance medications are also needed to treat the underlying condition.

Alarming Trend in NYC:

Recent reports from the Animal Care Centers of NYC indicate a concerning trend in the increased use of Trazodone and Gabapentin in shelter animals. According to a source within the organization, the use of these drugs has expanded alarmingly, suggesting a potential risk of over-reliance. Furthermore, dogs presenting with side effects from these medications have reportedly been euthanized for manifesting drug-induced side effects. This development highlights the urgent need for further investigation and oversight to ensure the responsible use of medications in shelter environments.

Reliance on Available Studies Risky

While the available studies and reports suggest that Trazodone and Gabapentin can be effective in managing anxiety and stress in some shelter animals, it is prudent to exercise caution in relying on these findings. The existing research in a shelter environment is limited, small in scale, and may not fully represent the diverse population of shelter animals. Larger, more comprehensive studies are needed to conclusively establish the effectiveness of these drugs across a broader range of shelter animals and environments.

Additionally, individual animal responses to Trazodone and Gabapentin can vary significantly, influenced by factors such as age, health status, and underlying behavioral issues. Relying too heavily on "average" or "typical" responses seen in the research may overlook the nuances of individual animal needs and experiences.

Furthermore, the long-term impacts of using these addictive medications in shelters are not yet fully understood. Concerns have been raised about over-reliance on pharmacological interventions. Prolonged or widespread use of Trazodone and Gabapentin may have unforeseen consequences on animal welfare that require further investigation.

Shelter staff and veterinarians should carefully consider the unique circumstances of each animal, monitor responses closely, and be prepared to adjust treatment plans as needed. Ongoing research, transparent communication, and a commitment to evidence-based practices will be essential to ensuring the responsible and effective use of these medications in the shelter setting.

Conclusion:

The use of Trazodone and Gabapentin in animal shelters may represent a valuable tool for alleviating stress, anxiety, and behavioral challenges in shelter animals. However, controversies surrounding their use underscore the importance of further studies, addressing concerns, and promoting transparency within the shelter community.

Important Follow Up to the Article:

Troubling Allegations of Medication Misuse at NYC Animal Care Centers

Addendum

Having managed the three largest animal control programs in the U.S., Maricopa County; New York City; and Los Angeles, I have firsthand experience with the vital role shelters play in caring for vulnerable animals. Often operating under challenging conditions with limited resources, high caseloads, and staffing shortages, ensuring for the safety and well-being of shelter animals, particularly regarding medication administration, remains essential.

Shelter management must prioritize comprehensive strategies to mitigate risks, uphold the highest standards of care, and create a culture of safety and excellence. This includes implementing rigorous protocols for drug dosing and administration, training staff in safe medication practices, establishing detailed procedures, maintaining effective communication with veterinarians and stakeholders, and implementing systems for audits, inspections, and adverse event reporting.

By prioritizing these recommendations, shelter management can safeguard the health and welfare of all animals in their care, even in the face of the significant operational challenges they often confront. Shelter leaders play a pivotal role in ensuring the responsible and compassionate treatment of vulnerable animals entrusted to their facilities.

Ed Boks is a former Executive Director of the New York City, Los Angeles, and Maricopa County Animal Care & Control Departments. He is available for consultations. His work has been published in the LA Times, New York Times, Newsweek, Real Clear Policy, Sentient Media, and now on Animal Politics with Ed Boks.