Gabapentin, melatonin, and acepromazine combination prior to hospital visits decreased stress scores in aggressive and anxious dogs in a prospective clinical trial in: Journal of the American Veterinary Medical Association Volume 261 Issue 11 (2023)

Introduction

Veterinarians and technicians often interact with aggressive, fearful, and anxious dogs and are at risk for suffering animal-related physical harm. Historically, forceful restraint has been used to provide care to fearful and aggressive animals. However, repeated use of restraint in a fearful animal increases the patient’s fear and consequent risk of aggression in the future.1 Dogs may express fear by attempting to escape, hide, or bite. Low-stress handling, behavior modification such as desensitization and counterconditioning, and sedation are management options to prevent patients from experiencing their care as traumatic.2-6

Studies evaluating specific drugs or drug protocols to facilitate procedural management of animals displaying signs of fear and stress have the potential to improve animal welfare, work safety, and client experience. Gabapentin, a gabapentinoid with anticonvulsant and analgesic properties, appears to provide anxiolysis and dose-dependent sedation in veterinary species.5,7-12 A recent study6 in dogs reported decreased lip-licking, a sign of stress, after 50 mg of gabapentin/kg was administered PO 2 hours prior to the veterinary visits. Exogenous melatonin is another agent that could facilitate management of anxious and fearful animals. In people, PO melatonin has been shown to reduce pre- and postoperative anxiety.13 In dogs, melatonin provided calming effects during thunderstorms and minimized excitement levels.14,15 Oral melatonin doses of 3 to 9 mg for dogs have been recommended by some authors to decrease anxiety levels in older animals.16-18 Studies evaluating anxiolytic and sedative properties of gabapentin and melatonin in dogs are still scarce. Acepromazine is a widely administered drug in veterinary medicine. It elicits behavior-modifying effects such as tranquilization and sedation. Albeit not an anxiolytic agent, acepromazine works synergistically with other sedatives, opioids, and anxiolytics to produce calming effects.19

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Although an increasing number of veterinary practices are administering PO sedatives or anxiolytics for chemical restraint when dealing with aggressive or anxious dogs, data on treatment reliability and consistency of results are lacking. A case report5 described reliable sedative effects with at-home administration of PO gabapentin, PO melatonin, and oral-transmucosal (OTM) acepromazine. The protocol, known as the chill protocol, was administered by the owners prior to hospital arrival to facilitate the management of a fear-aggressive dog. The authors’ clinical experience suggests that this 3-drug protocol facilitates procedural management of animals that exhibit signs of anxiety and/or aggression. However, no prospective study evaluating the safety and reliability of this protocol has been published.

This study aimed to evaluate the behavioral and sedative effects of a client-administered preappointment protocol with PO gabapentin (20 to 25 mg/kg), melatonin (3 to 5 mg/dog) and OTM acepromazine (0.05 mg/kg; GMA protocol). On the basis of clinical experience, it was hypothesized that the GMA protocol would reduce stress scores during a hospital visit in over 70% of anxious and aggressive dogs.

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