Anxiety, and the behavior problems stemming from it, is increasingly common in our companion dogs. If you have one of these dogs, you know how heartbreaking and disruptive this can be. Anxious dogs are not comfortable. They can’t relax. Sometimes they are downright panicky. This can lead to dangerous destructive behaviors, house-soiling, and even aggression. Luckily, there are many safe and effective anti-anxiety medications for dogs that can help your quivering canine.
The trick is to find the right ones, at the right dose, and the right combination. Take detailed notes of your dog’s behaviors, and response or lack of response to any drugs and dosages tried. Your veterinarian will use this information to tweak your dog’s protocol until the desired result is achieved. It’s a process that can take some time, so be patient and work closely with your veterinarian.
What medication can and cannot do for your dog
It’s important to mention that medication alone is not likely to be a magic bullet, miraculously turning your anxious dog into a calm, confident, well-mannered one; however, it drastically enhances the effectiveness of desensitization to triggers and behavioral modification – the mainstay of treatment and long-term management of anxiety-associated behavior issues.
Many highly anxious dogs fail to show the kind of progress in training that is typical for dogs without anxiety; that’s because anxiety, fear, and panic impair a dog’s ability to focus and learn. Anxiolytic (anxiety-reducing) medications ease the symptoms of anxiety, fear, and panic, allowing your dog to absorb and learn during desensitization and behavior modification exercises. The combination of medication and behavior modification, under the direction of a force-free trainer and veterinarian or veterinary behavior specialist, is the gold standard for treating canine anxiety.
Types of Anti-Anxiety Medications for Dogs
There are several classes of drugs used for anxiety in dogs. Some are long-acting and meant to be used daily. Others are short-acting and meant to be used situationally as needed, although they can be used daily in combination with a long-acting medication.
Most of the drugs used for anxiety in dogs are prescribed off-label, meaning the U.S. Food & Drug Administration (FDA) has not determined the safety and efficacy of the medication for the intended purpose.
Don’t let off-label use be a deal-breaker for you. These medications have been used safely and effectively in veterinary medicine for decades. Your veterinarian should have a conversation with you regarding off-label drug usage so you can give informed consent, and you’re ready to get started.
When multiple medications are necessary to achieve the desired result, drugs from different classes can be safely combined. This enhances their beneficial effects without doubling up on side effects. Never use two drugs from the same class at the same time.
We’ll take a look at each of the main classes of drugs used for anxiety in dogs, which are:
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Tricyclic Antidepressants (TCAs)
- Benzodiazepines
- Serotonin Antagonist and Reuptake Inhibitors (SARIs)
- Alpha-2 Agonists
- Anticonvulsant/neuropathic pain relievers
Selective Serotonin Reuptake Inhibitors (SSRIs)
The drugs that belong to this class and are commonly given to dogs are:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Sertraline (Zoloft)
Serotonin is a neurotransmitter highly involved in mood and emotions. It is known to produce calm and lessen overactive responses to normal stimuli. SSRIs decrease the reabsorption of serotonin, resulting in increased amounts circulating in the brain, which helps manage anxiety, aggression, and obsessive-compulsive behaviors (e.g., self-mutilation by licking or chewing, flank sucking, tail chasing, pacing/circling, incessant barking) in dogs.
SSRIs are long-acting medications that are prescribed for dogs with generalized anxiety issues needing help on a daily basis. They generally take four to six weeks to reach full effect, so shorter-acting anxiolytic medications are usually prescribed with them in the beginning.
Never use an SSRI with a TCA, nor use two SSRIs at once, as this can result in serotonin syndrome (see sidebar). If you don’t see the desired result from the first SSRI medication you try, your vet should guide you through tapering your dog off the first medication before prescribing another.
Tricyclic Antidepressants (TCAs)
The drugs that belong to this class and are commonly given to dogs are:
- Clomipramine (Clomicalm)
- Amitriptyline (Elavil)
TCAs affect several different neurotransmitters, including serotonin, resulting in increased calm and dampened panic responses. They are long-acting medications given daily to help manage anxiety and obsessive-compulsive behaviors in dogs. They do not work for aggression. TCAs usually take three to four weeks to maximum effect. Do not use with an SSRI, and never use more than one TCA at a time. Do not stop abruptly. Always taper off these medications.
Benzodiazepines
The drugs that belong to this class and are commonly given to dogs are:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Diazepam (Valium)
Benzodiazepines are fast-acting (60 to 90 minutes), short duration (4 to 12 hours), anxiolytic medications that promote calm by increasing the effects of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the central nervous system. They can be used alone or in combination with other classes of behavior-modifying drugs. They can be used “as needed” for situational triggers, or included as part of a daily multi-drug protocol.
Benzodiazepines are federally controlled drugs (meaning there are legal limits on their prescription). Physical dependence with increasing dose tolerance is unfortunately a possibility when benzodiazepines are used long-term. To avoid withdrawal symptoms (confusion, vocalization, tremors, twitching, seizures, and death), always slowly taper off these medications after long-term use.
Serotonin Antagonist and Reuptake Inhibitors (SARIs)
Only one drug belongs to this class that is commonly given to dogs:
- Trazodone
Trazodone is pretty much the only SARI used in veterinary medicine. SARIs keep more serotonin circulating by both decreasing its reabsorption and blocking its receptors. SARIs have both anxiolytic and sedative effects. They are rapid-acting (30 to 90 minutes), have a short duration (4 to 8 hours), and are non-addictive. They can be used alone, as needed for situational anxiety, or included daily as part of a multi-drug regime.
Trazodone has a wide dosage range so it will typically be started low and ramped up from there. Because SARIs increase serotonin, combining them with SSRIs and TCAs comes with a slight risk of serotonin syndrome. However, trazodone is routinely used together with SSRIs in dogs, with few reports of this.
Alpha-2 Agonists
The drugs that belong to this class and are commonly given to dogs are:
- Clonidine
- Dexmedetomidine (Sileo)
Alpha-2 agonists inhibit the release of norepinephrine (adrenaline) in the central nervous system. As inhibitors, they really work only if given before your dog gets upset. Once he’s upset, adrenaline has already been released along with its “fight or flight” response, and it’s too late.
Alpha-2 agonists are given prior to stressful situations known to invoke fear in your dog (such as veterinary visits or any situation that tends to trigger your dog’s separation anxiety, noise phobia, fear aggression, or leash reactivity). Onset is rapid (30 to 90 minutes), duration is short (2 to 4 hours), and they are safe to use with most other anxiolytic medications. As such, they can be added to a daily multi-drug regimen.
Anticonvulsant/neuropathic pain reliever
Only one drug belongs to this class that is commonly given to dogs:
- Gabapentin
Gabapentin is frequently used in combination with other anxiolytic medications for its mild sedative effect. It works by blocking certain biochemical channels in the brain, which calms overstimulated neurons, helping lessen feelings of anxiety. Gabapentin takes effect within 1 to 2 hours and lasts 6 to 8 hours. There is a wide dose range. Your veterinarian will likely start with a low dosage and increase the dose as needed. It can be used situationally, often in combination with trazodone, or it can be added to a daily multi-drug regime.
For more information about gabapentin, see “Gabapentin for Dogs: What You Should Know,” WDJ April 2021.
Be persistent when finding the right anti-anxiety medication for your dog
Finding the right medication (or combination of medications) and the right doses for your dog’s anxiety can be challenging. If a medication is not working well enough and maximum dose has not been reached, sometimes simply increasing the dose may work, assuming the side effects aren’t too bad. Other times a different drug from the same class will work better. Combining medications from different classes is often the ticket. And remember, SSRIs and TCAs take weeks to reach full affect, so adding a short-acting drug in the beginning is always helpful.
Here are some examples of how a case may be managed:
A dog with separation anxiety might be started on fluoxetine daily, with alprazolam as the short-acting medication for the first 4 to 6 weeks. If this isn’t working, the veterinarian may add gabapentin, or discontinue alprazolam and add trazodone. At 6 weeks, if the desired effect has not been achieved, the vet may increase the dose of fluoxetine and add clonidine. If this doesn’t work, fluoxetine may be tapered off and a different SSRI or TCA started as the long-acting daily medication.
A dog with generalized anxiety who is also reactive on leash (see “On-Leash Aggression)” may do well with a daily SSRI or TCA, and clonidine given an hour before going for walks.
Trazodone combined with gabapentin is frequently used for fear and anxiety associated with veterinary visits. If this isn’t enough, clonidine or dexmedetomidine may be added.
Fortunately, no matter what your dog’s issues are, there are many possible medications and medication combinations available to try, with the simple goal of finding what works best for your dog with the least amount of side effects.
Serotonin syndrome is what happens when there is too much serotonin floating around in the brain. It can happen either by accidental overdose of one serotonin-enhancing medication or inadvertently when two or more serotonin-enhancing medications are used together. It is potentially life-threatening so it’s important to recognize the early signs.
Initially, the dog may seem overly sedate. This is followed by panting, confusion, disorientation, agitation, vocalization, vomiting, and diarrhea. Without intervention, next comes rigid muscles, tremors, seizures, coma, and death.
If you have any feeling this may be happening, seek veterinary attention right away. Give your veterinarian a list of all medications and supplements your dog is on, along with dosages. Treatment is mostly supportive and usually requires hospitalization for 12 to 48 hours.
Here are medications/supplements most commonly involved in serotonin syndrome in dogs:
SSRIs (fluoxetine)
TCAs (clomipramine)
SARIs (trazodone)
MAO inhibitors (selegeline)
Opioids (tramadol)
Tryptophan (found in over-the-counter [OTC] supplements
Chlorpheniramine (an OTC antihistamine)
Dextromethorphan (present in some OTC cough suppressants)
St. John’s Wort, ginseng, griffonia seed extract (herbal)
Some owners prefer a more natural approach to their dog’s health, avoiding long-term prescription medications if at all possible. Here’s a list of things that are worth trying, either alone or in combination:
- Choose a Fear Free Certified veterinary clinic
- Dog Appeasing Pheromone (DAP)
- Alpha-casozepine (a hydrolyzed milk protein with calming properties, such as Zylkene
- Purina ProPlan Calming Care
- Melatonin (See whole-dog-journal.com/health/melatonin-is-safe-for-dogs)
- Supplements containing l-theanine, such as Solliquin, yuMove Calming Support Soft Chews, or Zesty Paws Calming Bites
- Supplements containing l-tryptophan, such as Quiet Moments Calming Drops or Zesty Paws Calming Bites
- Thundershirt
Most Commonly Prescribed Medications for Dogs with Anxiety
| Class | Sample Medication | Onset | Duration | Indications | Contra-indications | Cautions | Side Effects | Used |
|---|---|---|---|---|---|---|---|---|
| SSRI | Fluoxetine | Slow, 4-6 weeks | Long, 24-48 hours | Aggression, anxiety, phobias, compulsive behaviors | Seizures, liver disease | Diabetes, bleeding disorders; taper off | Anorexia, vomiting, diarhea | Once daily, alone or in combination |
| TCA | Clomipramine | Slow, 3-4 weeks | Long, 24-48 hours | Anxiety, compulsive behaviors | Thyroid disease, seizures, MAO inhibitors, male breeding dogs | Cardiac disease; taper off | Vomiting, diarrhea, or constipation | Once or twice daily, alone or in combination |
| Benzodiazepine | Alprazolam | Rapid, 30-60 minutes | Short, 2-6 hours | Anxiety, phobias, fear | Liver disease, glaucoma | Kidney disease, physical dependence; taper off | Sedation, wobbliness | Two to four times daily as needed, alone or in combination |
| SARI | Trazodone | Intermediate, 1-2 hours | Short, 2-8 hours | Anxiety, sedation | MAO inhibitors | Cardiac disease, kidney disease, liver disease, bleeding disorders | Increased appetite, mild GI upset | Two to three times daily as needed, alone or in combination |
| Alpha-2 agonist | Clonidine | Rapid, 30-90 minutes | Short, 2-4 hours | Anxiety, fear, panic | If already agitated | Cardiovascular disease, kidney disease | Sedation, dry mouth, constipation, low heart rate | One to four times daily as needed, alone or in combination |
| Anti-convulsant, neuropathic pain reliever | Gabapentin | Intermediate, 1-2 hours | Intermediate, 6-8 hours | Anxiety, fear | None | Kidney disease; taper off | Sedation, wobbliness | Two to three times daily, usually in combination |
I speak from firsthand experience. Meds should not be considered as a “last resort”. You can’t help a dog that is over threshold therefore has no brain. Meds are not a cure all. It takes education on your part so you know the anxiety signs from your dog as well as training coping mechanisms for the dog (and you). A Vet Behaviorist is your best bet and typically has more experience in this area than a regular vet. VB are expensive, but worth it in the long run because they can produce results faster than trial and error. My anxiety rich rescue lived a happy controlled life once we had a plan and worked on it. Good Luck and take a lot of deep calming breaths. Anxiety travels down the leash.
Thanks to a mention of Sileo two or three years ago in Whole Dog Journal I was able to ask my veterinarian to prescribe it for my noise-phobic dog. My vet had not heard of it, but now prescribes it for dogs who are terrified of thunder or fireworks. It isn’t as much of a sedative as some of the older drugs which would make my dog catatonic. My Roxy is awake and calm, and can take a treat, go outside for a potty break, wag her tail, walk around, etc. Sileo seems to put up a barrier between the noise and her fear. In my book it is a wonder drug.
Although the reader can appreciate the thorough listing of drugs and other options, it seems typical causes (of anxiety, depression, separation issues) was left out of the article. That being everyday needs of beloved canines: walks, games/running, petting, fresh air, attention and enrichment. Imagine if humans never stepped foot outside the home. Ramifications would not be positive. Let’s focus on providing our dogs with what they need, each and every day. Perhaps some issues might just dissipate.
My beagle/BC mix gets a long daily sniffing walk, petting/recall games/fresh air/car rides/toys and tons of love and attention. I play calming music in the house all day. I don’t work, so I am home with my animals, and my husband just retired. So, Josie, what else am I supposed to provide her with? She is the most anxiety ridden dog I know. T-storms, fireworks, wind, gunshots all put her in a real panic. Shaking, panting, drooling, hiding. I took her to my regular vet, then to a veterinary behaviorist. She was put on a daily anti anxiety med, and two meds that can be used as needed. They do help, but not a lot. It is easy for people to come up with all kinds of criticisms of people who chose to medicate their dogs. But unless you have watched an animal that you adore turn into a terrified mess, you have no right to give advice on how to make these issue “dissipate”.
Excellent article. The medications mentioned are pretty much the same as those used for humans.
My two Havanese do pretty well with most challenges, but are somewhat high-strung. When an new person walks in the house, they bark for a minute or two (I’ve worked with them to get it down to that!) A walk on a tandem leash is fun for all three of us unless/until we encounter another dog, and then they go ballistic, barking away and pulling hard to get to the other dog. Yes, I’m sure these issues could be conquered with training, and I’ve tried to do so with little success. My vet basically shrugs and says, “Little dogs bark.” While I’ll continue to try training, I do believe they are so high-strung that they need some sort of anti-anxiety medication if they are ever going to get beyond this behavior.
Our breeder, who is an absolute angel, dog whisperer, and expert on Havanese, has suggested VetriSCIENCE COMPOSURE, daily chews containing Thiamine, Colostrum Calming Complex Biopeptide blend, and L-Theanine. These seem to be helping a little, but not a lot.
I notice CBD was not mentioned in the article. I have heard of its successful use in dogs for this purpose. Dr. Fatcheric, could you comment? Thanks!
I’ve got an American Eskimo Dog, Kyah (gong on 10), who runs for the bathroom as soon as one drop of rain falls or one fireworks goes off. She has never been food-motivated and hates me going anywhere near her mouth. She also scratches the carpet and sometimes the walls like a cat (her toenails are regularly trimmed so I assume it’s just anxiety). On top of that she has lost most of her sight.
I’ve tried a few of the few drugs but it’s more stressful trying to dose her than any relief she might get from it and I hate the idea of medicating her. For the past year I’ve been using Melatonin with some success but after giving CBD a try this summer I’ve committed to it (Honest Paws). I’m using a low end dose unless I know a storm or fireworks are coming and then I dose a little higher.
The CBD Calm is not a cure-all (she still runs for the bathroom) but it’s taken the edge off of her triggers enough that she doesn’t lay there panting, and redirects usually curb her scratching. It’s subtle enough that I wasn’t convinced it was helping until I ran out of the CBD oil at one point and could actually see her anxiety ratcheting up. She won’t let me put it directly in her mouth but she likes it with her food and that’s saying a lot for her.
It remains to be seen how long this is effective for her, if she develops a tolerance for it, etc., but for now I feel like it’s a win!