Electrocardiographic assessment of antianxiety medication in dogs and correlation with serum drug concentration

Veterinary Psychopharmacology

The stress response affects the central nervous system and multiple other systems in the body. Chronic mental and behavioral pathologies are associated with inflammation, dysfunctions in the immune response and an increased risk for other chronic inflammatory and metabolic diseases. Psychiatric treatments alleviate fear, stress and anxiety, increase the qualify of life and lifespan for dogs and cats. Multiple safe psychoactive medications that can be used in association are available to help veterinary patients. Clinicians should understand the function of neurotransmitters and hormones on emotional processing, cognition and behavior, and drug mechanism of action so medication selection is appropriate for each individual patient.

Effect of body position on electrocardiographic recordings in dogs

OBJECTIVE

To determine whether body position (standing vs right lateral recumbency) altered the quality of the electrocardiogram (ECG) and value of ECG variables in dogs when the ECG was recorded using American Heart Association guidelines for frequency response.

DESIGN

Crossover study using a convenience sample.

METHODS

ECGs were recorded twice in 65 sled dogs in random order with each dog standing or placed in right lateral recumbency. Lead II and three semi-orthogonal leads (I, aVF, and V10 ) were recorded and muscle tremor artefact was assessed.

RESULTS

Lead II ECGs obtained from dogs in right lateral recumbency had less muscle tremor artefact and consequently a shorter QRS duration than ECGs obtained with the dogs standing. The P, Q, R and S wave amplitudes differed in selected leads and the mean electrical axis was shifted 20° to the right when dogs were in right lateral recumbency.

CONCLUSIONS

Right lateral recumbency improves the quality of ECG recording in dogs by decreasing muscle tremor artefact, alters the amplitude of P, R and S waves in specific leads and results in a rightward shift in the mean electrical axis, relative to standing.

Therapeutic options for the treatment of chronic pain in dogs

Chronic pain is a widely recognised problem in humans and is being increasingly recognised as a significant problem in dogs. Whilst a large number of therapies are described and utilised to treat chronic pain in dogs, there is a severe shortage of evidence to guide practitioners in selection of treatments. Until more evidence becomes available, practitioners should adopt a cautious approach, utilising licensed treatments first when possible. Non-pharmacological therapies should be incorporated into the chronic pain management plan whenever possible. Given the probable prevalence of chronic pain in dogs there is an urgent need for research to identify effective treatments.

hERG-related drug toxicity and models for predicting hERG liability and QT prolongation

BACKGROUND

hERG K(+) channels have been recognized as a primary antitarget in safety pharmacology. Their blockade, caused by several drugs with different therapeutic indications, may lead to QT prolongation and, eventually, to potentially fatal arrhythmia, namely torsade de pointes. Therefore, a number of preclinical models have been developed to predict hERG liability early in the drug development process.

OBJECTIVE

The aim of this review is to outline the present state of the art on drug-induced hERG blockade, providing insights on the predictive value of in vitro and in silico models for hERG liability.

METHODS

On the basis of latest reports, high-throughput preclinical models have been discussed outlining advantages and limitations.

CONCLUSION

Although no single model has an absolute value, an integrated risk assessment is recommended to predict the pro-arrhythmic risk of a given drug. This prediction requires expertise from different areas and should encompass emerging issues such as interference with hERG trafficking and QT shortening.

The effects of clomipramine hydrochloride in cats with psychogenic alopecia: a prospective study

A double-blind, placebo-controlled clinical trial was conducted to determine the efficacy of clomipramine hydrochloride in cats with psychogenic alopecia. Twenty-five cats were randomly assigned to receive clomipramine hydrochloride (0.5 mg/kg orally q 24 hours) or placebo for 56 days. Eleven cats in each group completed the trial. The results of this study showed that clomipramine hydrochloride failed to demonstrate significant changes in the number of grooming bouts, hair regrowth, and the area of alopecia in cats with psychogenic alopecia when compared to a placebo. It was uncertain whether these results reflected a lack of drug efficacy, insufficient treatment duration, or an insufficient number of cases enrolled.

The hERG K+ channel: target and antitarget strategies in drug development

The human ether-à-go-go related gene (hERG) K+ channel is of great interest for both basic researchers and clinicians because its blockade by drugs can lead to QT prolongation, which is a risk factor for torsades de pointes, a potentially life-threatening arrhythmia. A growing list of agents with "QT liability" have been withdrawn from the market or restricted in their use, whereas others did not even receive regulatory approval for this reason. Thus, hERG K+ channels have become a primary antitarget (i.e. an unwanted target) in drug development because their blockade causes potentially serious side effects. On the other hand, the recent identification and functional characterization of hERG K+ channels not only in the heart, but also in several other tissues (e.g. neurons, smooth muscle and cancer cells) may have far reaching implications for drug development for a possible exploitation of hERG as a target, especially in oncology and cardiology.

Diagnosis of rapid eye movement sleep disorder with electroencephalography and treatment with tricyclic antidepressants in a dog

A 9-month-old, female Labrador retriever mix was presented for two types of seizure-like episodes, one of which occurred only during sleep. The two types of episodes were morphologically distinct. An electroencephalogram (EEG) demonstrated that the sleep-associated episodes occurred during rapid eye movement (REM) sleep, supporting a diagnosis of a REM behavior disorder. Based on their morphology and response to antiseizure medications, the waking episodes were diagnosed as seizures. The animal was also diagnosed with an obsessive-compulsive and generalized anxiety disorder. The REM behavior disorder and anxiety-related behaviors improved with tricyclic antidepressant therapy.

Evaluation of six-lead electrocardiograms obtained from dogs in a sitting position or sternal recumbency

OBJECTIVE

To compare 6-lead ECG traces in clinically normal conscious dogs in a sitting position and sternal recumbency to that of right lateral recumbency.

ANIMALS

31 healthy dogs with no history of cardiac disease.

PROCEDURE

Six-lead ECGs were recorded for dogs in right lateral recumbency, a sitting position, and sternal recumbency. Q-, R-, and S-wave amplitudes as well as QRS-complex duration were measured in all leads. Additionally, P-wave amplitude and duration, PR interval, ST-segment elevation or depression, and OT interval were measured in lead II.

RESULTS

Compared with measurements in right lateral recumbency, the sitting position resulted in increased Q-wave amplitude (lead III), increased R-wave amplitude (leads I and aVL), decreased R-wave amplitude (leads III and aVF), increased S-wave amplitude (lead aVR), decreased S-wave amplitude (lead aVL), increased P-wave amplitude (lead II), and a leftward shift in the mean electrical axis. Compared with measurements in right lateral recumbency, sternal recumbency resulted in decreased Q-wave amplitude (leads I, II, and aVF), increased R-wave amplitude (leads 11, III, and aVF), decreased R-wave amplitude (lead aVR), increased S-wave amplitude (lead aVR), increased P-wave amplitude (lead II), and decreased ST-segment depression (lead II). Compared with right lateral recumbency, the sitting position or sternal recumbency did not result in significant differences in PR interval, QT interval, or QRS-complex duration.

CONCLUSIONS AND CLINICAL RELEVANCE

Significant changes are found in ECG measurements in the sitting position and sternal recumbency, compared with right lateral recumbency. In dogs, many ECG reference range values for right lateral recumbency are not valid for ECGs obtained in the sitting position or sternal recumbency.

Effects of Clomipramine on Cats Presented for Urine Marking

Twenty-five cats exhibiting at least four episodes of vertical urine marking per week were assessed. Following a medical workup, a 4-week clomipramine trial was instituted, using a mean dose of 0.54 mg/kg per os q 24 hours. No concurrent behavioral or environmental modifications were applied. There was a statistically significant (P<0.0001) decrease in urine spraying when the cats were on clomipramine, with 20 of 25 cats having a ≥75% reduction in spraying within 4 weeks. Side effects were mild. Twenty cats were followed for an additional 5 months. Fifteen cats required medication to control the spraying, often at a reduced dose.

Paradigms for pharmacologic use as a treatment component in feline behavioral medicine

Veterinary behavioral medicine remains an under-supported, under-appreciated, and under-taught specialty within veterinary medicine. Neuropsychopharmacology is the aspect that has provided the field with the most scientific legitimacy, but is also one of the most hotly debated. Paradigms for use of pharmacologic intervention include firstly ruling out any underlying medical cause. If a behavioral diagnosis can be made, treatment with psychotropic medication may be considered, although their use is most effective as part of an integrated treatment program that includes behavior modification. Used without an understanding of the mechanism of action, pharmacologic intervention may only blunt or mask behavior without altering processes or environments that produced the behavior. This paper reviews specific drugs, mechanism of action of those drugs, and relevant uses are reviewed for cats. Future advances in treatment in veterinary behavioral medicine will be pharmacological and neurophysiological. As the field of veterinary behavioral medicine expands, its paradigm will enlarge to include routine combination therapy and the implementation of neuropharmacological intervention as a diagnostic tool.

Pharmacologic management in veterinary behavioral medicine

As our knowledge expands, behavioral pharmacology plays an increasingly important role in behavioral medicine. Drugs traditionally categorized as anxiolytics, antidepressants, anticonvulsants, and hormones may be used to help manage a range of animal behavioral problems. Knowledge of how these agents act in the body and interact with other agents is imperative for safe and efficacious use.

Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 cases (1989-2000)

OBJECTIVE

To determine clinical features and outcome in dogs and cats with obsessive-compulsive disorder (OCD).

DESIGN

Retrospective study.

ANIMALS

103 dogs and 23 cats.

PROCEDURES

Records of patients with OCD were analyzed for clinical features, medication used, extent of behavior modification, and outcome.

RESULTS

Most dogs affected with OCD had been obtained from breeders. Male dogs significantly outnumbered females (2:1). Female cats outnumbered male cats by 2:1 in a small sample. Most affected dogs lived in households with 2 or more humans and other dogs or cats, and had some formal training. Client compliance with behavior modification was high. A combination of behavior modification and medication resulted in a large decrease in intensity and frequency of OCD in most animals. Clomipramine was significantly more efficacious for treatment in dogs than was amitriptyline. Only 1 dog and 1 cat were euthanatized because of OCD during the study.

CONCLUSIONS AND CLINICAL RELEVANCE

OCD in dogs does not appear to be associated with lack of training, lack of household stimulation, or social confinement. In cats, OCD may be associated with environmental and social stress. Obsessive-compulsive disorder appears at the time of social maturity and may have sporadic and heritable forms. With appropriate treatment (consistent behavior modification and treatment with clomipramine), frequency and intensity of clinical signs in most dogs and cats may decrease by > 50%. Success appears to depend on client understanding and compliance and the reasonable expectation that OCD cannot be cured, but can be well controlled.

Safety of non-antiarrhythmic drugs that prolong the QT interval or induce torsade de pointes: an overview

The long and growing list of non-antiarrhythmic drugs associated with prolongation of the QT interval of the electrocardiogram has generated concern not only for regulatory interventions leading to drug withdrawal, but also for the unjustified view that QT prolongation is usually an intrinsic effect of a whole therapeutic class [e.g. histamine H(1) receptor antagonists (antihistamines)], whereas, in many cases, it is displayed only by some compounds within a given class of non-antiarrhythmic drugs because of an effect on cardiac repolarisation. We provide an overview of the different classes of non-antiarrhythmic drugs reported to prolong the QT interval (e.g. antihistamines, antipsychotics, antidepressants and macrolides) and discusses the clinical relevance of the QT prolonging effect. Drug-induced torsade de pointes are sometimes considered idiosyncratic, totally unpredictable adverse drug reactions, whereas a number of risk factors for their occurrence is now recognised. Widespread knowledge of these risk factors and implementation of a comprehensive list of QT prolonging drugs becomes an important issue. Risk factors include congenital long QT syndrome, clinically significant bradycardia or heart disease, electrolyte imbalance (especially hypokalaemia, hypomagnesaemia, hypocalcaemia), impaired hepatic/renal function, concomitant treatment with other drugs with known potential for pharmacokinetic/pharmacodynamic interactions (e.g. azole antifungals, macrolide antibacterials and class I or III antiarrhythmic agents). This review provides insight into the strategies that should be followed during a drug development program when a drug is suspected to affect the QT interval. The factors limiting the predictive value of preclinical and clinical studies are also outlined. The sensitivity of preclinical tests (i.e. their ability to label as positive those drugs with a real risk of inducing QT pronglation in humans) is sufficiently good, but their specificity (i.e. their ability to label as negative those drugs carrying no risk) is not well established. Verapamil is a notable example of a false positive: it blocks human ether-a-go-go-related (HERG) K(+) channels, but is reported to have little potential to trigger torsade de pointes. Although inhibition of HERG K(+) channels has been proposed as a primary test for screening purposes, it is important to remember that several ion currents are involved in the generation of the cardiac potential and that metabolites must be specifically tested in this in vitro test. At the present state of knowledge, no preclinical model has an absolute predictive value or can be considered as a gold standard. Therefore, the use of several models facilitates decision making and is recommended by most experts in the field.

Pharmacological treatment in behavioural medicine: the importance of neurochemistry, molecular biology and mechanistic hypotheses

Psychopharmacology has become a popular, and sometimes mandatory addition to treatment regimes for canine and feline patients with behavioural problems; however, clients and practitioners should be dissuaded that behavioural drugs are 'quick fixes'. Veterinarians should only prescribe psychotropic medication when they have a specific idea of how the mechanism of action of the drug will affect the target behaviours associated with a specific diagnosis. The diagnosis must be treated rather than non-specific signs. Newer psychotropic medications demonstrate the extent to which truly abnormal behaviours are dysfunctions of neurochemistry; synaptic or cellular metabolism; or genetic encoding and 'learning', or LTP, hence there is a clear role for the interaction of neuropharmacology and behavioural and environmental modification.Future advances in treatment in behavioural medicine will be pharmacological and neurophysiological. As the field of behavioural medicine expands, its paradigm will enlarge to include combination therapy and the implementation of neuropharmacological intervention as a diagnostic tool. At present, the veterinary practitioner can effectively aid many common behavioural problems using extant drugs to treat animals with true behavioural pathology. Rational pharmacological therapy requires complete medical and behavioural histories, requisite laboratory work, complete client understanding and compliance, and an honest and ongoing dialogue between the client and veterinarian that includes frequent follow-ups and re-examinations.