Example of a Treament Plan

If the cat is not causing significant self-mutilation, treatment with 50 mg/cat Gabapentin (Neurontin ®) PO once daily in combination with 0.5-2 mg/kg Amitriptyline PO once daily could be used initially. If there is no effect in two to three days, increase the dose of Gabapentin (Neurontin ®) to 50 mg/cat PO twice daily. The dose of Gabapentin (Neurontin ®) can be increased again to 50 mg/cat PO three times daily if required. As described above under medical management, pharmacokinetic studies of Gabapentin have not been done in cats. Therefore it would be wise to not increase the dose of Gabapentin any further and to discontinue the drug if any adverse effects occur. If remission is achieved, discontinue the Gabapentin and Amitriptyline after four weeks by tapering the dosages over several weeks. Some cats may require lifelong treatment – use the lowest possible dose that maintains remission. Renal parameters (serum biochemistry and urine specific gravity) should be measured prior to commencing treatment with gabapentin as lower doses are required in renal compromise (NEURONTIN® data sheet, 2007).   

If the cat is causing significant self trauma which requires immediate relief, start treatment with 2-3 mg/kg of phenobarbitone alone or in combination with 50 mg/cat of Gabapentin (Neurontin ®). As described above, measure serum phenobarbitone levels after 2 – 3 weeks of treatment, and discontinue the drugs after four weeks after remission is achieved by tapering the dosages over several weeks.