Drugs commonly used in treatment of feline elimination disorders

For fear and anxiety:
   1. Alprazolam (Xanax)
   2. Oxazepam (Serax)

For inter-cat aggression- given to the "victim cat":
   Buspirone (Buspar)

For cystitis and mild anxiety:
   Amitriptyline (Elavil)

For mild anxiety (less sedating):
   Nortriptyline (Pamelor)

For obsessive/ compulsive disorders and significant anxiety:
   Clomipramine

For social phobias/social anxieties and related urine marking:
   Paroxetine (Paxil)

For panic, anxiety, intercat aggression and marking:
   Sertraline (Zoloft)

For aggression and social anxieties and related urine marking:
  Fluoxetine (Prozac)

For cognitive dysfunction:
   Selegeline (Anipryl)

Side Effects and Treatment Challenges

Depending on the drug, side effects may include weight gain, sedation, urine retention, cardiac arrhythmias, and liver problems. There is no one medication that will work for every cat. Most of the medicatins used take some time to take effect, and it may be up to six weeks for the full effects of the medication to be seen. Some cats will respond beautifully to the first medication used, others may require several medication changes. Some cats do not appear to improve their urine marking  on any medication. Some cats are difficult to medicate. Some cat owners are unable or unwilling to give the medication consistently and the therapeutic blood levels are never reached. Some cats experience significant enough side effects that treatment needs to be discontinued. Some cats will require treatment for their entire life while others may be able to stop their medication after a certain stressful event is over or acclimated to,  for example a move or a new pet or baby in the household.

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"Isn't there some medicine we can give so my cat will never miss the litter box again?"

Anti Anxiety

Well, yes and no to that simple question. In addition to treating any underlying medical conditions such as cystitis or inflammatory bowel disease directly, additional therapy with anti-anxiety medications can also be helpful. Currently none of these drugs are approved for use in cats, and consequently are used off label. These are prescription drugs and all have significant potential side effects. Use of most of these medications require blood tests at regular intervals to evaluate for these side effects. Sedation is often seen as a side effect especially when the medication is first started. The goal of treatment is to reduce the stress, anxiety, and fear that the cat is experiencing in order to stop urine marking and eliminating outside of the litter box. Sometimes not only the cat who is missing the litter box but also another cat in the household (usually the dominant cat) will require medication to reduce negative interactions that trigger the marking. These medications must be used under your veterinarian's supervision- DO NOT give any of your own anti-anxiety medications to your cat!