QUARTERLY BEAT
APRIL 2026
FAST-ACTING MEDICATION AS A BRIDGE The onboarding time for the long-lasting medication (typically 4-6 weeks) may feel too long for a dog with an urgent issue — whether because their behavior is dangerous to others or themselves or because there are significant welfare concerns due to fear and anxiety. In this case, a short- acting medication can act as a bridge to help the dog while you are waiting to see what the long-lasting medication is going to do for them. A common question is, "How will I know which medication is helping, the fast-acting medication or the long-lasting medication?" If both drugs end up working well, you will typically see obvious timing of clinical response associated with the fast-acting medication — the owner can tell when they are due for the fast-acting medication and can tell if they have missed a dose. After a few weeks, and especially getting towards the 4 to 6-week mark of initiating long-lasting medication, the owner no longer typically sees these big swings in relation to the fast-acting medication timing. They also may be late to administer or forget a dose and not realize it. At this point, it is reasonable to start weaning the fast-acting medication.
EXAMPLE: A 4-year-old dachshund with global fear significantly improved with a combination of sertraline 2 mg/kg twice daily and lorazepam 0.2 mg/kg every 8 hours.
Dosing should similarly start low and typically start twice daily for a bridge. Further adjustments in dosing and timing depend on the pet’s response.
FAST-ACTING MEDICATION LONG TERM, IN CONJUNCTION WITH LONG-LASTING MEDICATION Some dogs benefit from long-term polytherapy - meaning the long-lasting daily medication the dog takes is helping but not enough to maintain adequate control over the anxiety. In these cases, even once the long- lasting medication has taken full effect, you still have the dog on one or more fast-acting medications. The goal with this daily use of fast-acting medication is to help further reduce anxiety and fear without causing sedation. In this case, weaning the fast-acting medication results in increased behavioral concerns, but you still want the baseline medication doing most of the heavy lifting. You do not want to see wild swings of behavior associated with the fast-acting medication’s timing — this likely indicates that the baseline medication is not doing enough. USING A FAST-ACTING MEDICATION LONG TERM WITHOUT THE PRESENCE OF A LONG-LASTING MEDICATION In some cases, fast-acting medications are used daily on a longer-term basis without any long-lasting medication. This is a common practice for recovery from an orthopedic surgery (e.g., giving a dog gabapentin every 8 hours during a multi-week recovery window). Another scenario would be if a dog had a temporary stressor spanning more than one day (e.g., a dog may benefit from a calming medication for the first week or two following a move or following the death of a close housemate). However, if a dog has generalized anxiety or suffers from long-term fear or hyper-arousal that warrants long-term medical management, using a fast- acting medication in the absence of a long-lasting medication is not ideal for the following reasons: 1. You can have a dog whose behavior seesaws throughout the day depending on the timing of the medication. 2. If you miss a dose or are late on a dose, it is typically obvious. 3. Repeated use can lead to less significant efficacy (i.e., the effects may wear off after time). 4. These medications can cause sedation, especially at higher doses. Pet parents (and we!) do not want dogs sedated daily.
EXAMPLE #1: An owner looks at you with deep exhaustion as you explain that the Clomicalm® (clomipramine hydrochloride; Virbac) will take 4-6 weeks to take effect to help his Doodle, who is currently doing a mixture of pacing, barking and destroying your exam floor 30 minutes into the appointment. Give this owner the option of a bridging medication, such as clonidine twice daily. Help him today.
EXAMPLE #2: A 6-year-old female spayed Australian Shepherd was started on fluoxetine two years ago. You have slowly increased the dose to 2 mg/ kg. The medication has been very helpful for generalized anxiety, but her appetite has taken progressive hits with dose increases and has not rebounded after 1 full month at the current dose. Previous dosing of 1.5 mg/kg daily was not enough to maintain adequate control of anxiety. In this case, transitioning to a new medication is indicated since she does not tolerate 2 mg/kg and 1.5 mg/kg is not effective enough. This transition will likely be somewhat bumpy due to fluoxetine’s positive influence on her overall anxiety, so utilizing a fast-acting medication such as trazodone during the swap from fluoxetine and a new long- lasting medication would be beneficial.
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 13
Made with FlippingBook - Online Brochure Maker