Gabapentin has a variety of indications in cats, and the key recognition here is that dose differs with indication. We've taken a look at the literature here to assess the most useful doses for each indication.
For our subscribers, you can listen to our podcast on this topic here.
Acute pain
An early case report by Vettorato and Corletto reported the benefits of gabapentin used in trauma cats where NSAIDs were contraindicated.
A subsequent study by Steagall et al reports the use in an acute model of pain - ovariohysterectomy. The doses and groups are detailed in the table. The need for rescue analgesia was used as an outcome measure - but the rescue was based on a non-validated pain scale - but these authors did use the Glasgow pain score so not sure why that validated method was not used to indicate the need for rescue.
This study shows that buprenorphine alone really does not provide adequate analgesia for 50% of cats and underscores our knowledge of the importance of a multimodal approach. If meloxicam is added in a multimodal fashion, we see an increase in comfort and this group had the lowest need for further analgesia. Where we can't use NSAID, adding gabapentin to the opioid is seen as more effective as the opioid alone so this is a useful take home. We do have to bear in mind this was a really small study and further numbers are required to prove a statistically significant difference. The dose used was 50mg per cat. What would be really interesting is to see the benefit of the combination - opioid, NSAID and gabapentin.
52 cats (ace, bupr, propofol, is
Group | Dose | Need for rescue | |
Buprenorphine | 0.02 mg/kg IM | 50% | Inadequate as a sole analgesic |
Bupr & meloxicam | 0.02 mg/kg IM /0.1 mg/kg SC | 13% | Improved cf buprenorphine alone |
Bupr & gabapentin | 0.02 mg/kg IM /50mg PO | 26% | Better than buprenorphine alone |
Chronic pain
An alarming statistic, as highlighted by Gwen Covey Crump in her excellent webinar on gabapentinoids, is that the number one prescription for feline musculoskeletal pain in a survey on VIN, was gabapentin. This is difficult to understand when we have the NSAIDs and frunevetmab as licensed and effective options for feline MSK pain. You may appreciate this fact more when we tell you that the only study looking at gabapentin as a chronic analgesic in cats is this one.
In a study of 20 cats (Guedes et al), a dose of 10 mg/kg q 12hrs was used, compared to placebo. The outcome measures used were client-specific outcome measures (CSOMS), mobility assessment and owner assessed quality of life (QoL). Cats received either gabapentin or placebo for 2 weeks and then switched groups for a further two weeks. In the cats receiving gabapentin, owner assessed QoL was improved. With mobility assessed using an accelerometer placed on the cat's collar, a decrease in activity was noted which was attributed to sedation.
So we have some small-scale work that suggests there could be a benefit to gabapentin - but we need to work out the dose to avoid sedation. Advice here is to start lower - at 5 mg/kg BID and titrate upwards. Also bear in mind the huge placebo effect we see in feline studies. With that note of caution, and with other licensed options available we would be careful with relying on gabapentin as a sole analgesic for cats. In this webinar (How to manage chronic pain in cats) we review analgesic options for cats prior to the launch of frunevetmab - and cover NGF in this webinar here (New Options in Feline OA).
Anxiolysis
There are two studies examining the use of gabapentin in healthy cats as an anxiolytic. The first by Van Haaften et al used a 100mg capsule for all cats in the study. This equated to a wide dose range given the weight of the recruited cats. These authors concluded a dose of 20 mg/kg given 1-2hrs prior to the vet visit was the most effective dose. This forms the basis of our recommendations.
Another study by Pankratz et al evaluated the benefit of gabapentin to reduce stress in a trap, neuter, return programme. These authors also used a wide dose range of 9-47 mg/kg as a result of using a set size capsule across a range of cat size. They noted the greatest effect at 2 hours post administration.
With use of a liquid gabapentin we can dose our cats really accurately with that optimal dose of 20 mg/kg.
In a recent study (Gurney et al) we evaluated the efficacy of 20mg/kg gabapentin in hyperthyroid cats, given 1-2hrs before coming to the clinic. This was a placebo controlled study and the cats in the gabapentin group were significantly more relaxed during transport to the hospital, and more amendable to examination (exam, blood sampling, blood pressure).
It's important to recognise adverse effects - most important here is the duration of action of this dose of gabapentin. This higher dose is really only designed for one off treatment for anxiolysis - the sedation can last up to 8 hrs. If you are sending the cat home you must instruct the owner to keep the cat inside and avoid jumping.
Dose Summary
Acute pain 5-10mg/kg BID.
Chronic pain 5mg/kg BID, increasing to 10mg/kg if required.
Anxiolysis 20 mg/kg 1-2hrs before required. One off dose.
References
Guedes AGP, Meadows JM, Pypendop BH, Johnson EG, Zaffarano B. Assessment of the effects of gabapentin on activity levels and owner-perceived mobility impairment and quality of life in osteoarthritic geriatric cats. J Am Vet Med Assoc. 2018 Sep 1;253(5):579-585. doi: 10.2460/javma.253.5.579. PMID: 30110208.
Gurney M, Gower L. Randomised clinical trial evaluating the effect of a single preappointment dose of gabapentin on signs of stress in hyperthyroid cats. J Feline Med Surg. 2022 Jun;24(6):e85-e89. doi: 10.1177/1098612X221091736. Epub 2022 Apr 28. PMID: 35481442; PMCID: PMC9160945.
Pankratz KE, Ferris KK, Griffith EH, Sherman BL. Use of single-dose oral gabapentin to attenuate fear responses in cage-trap confined community cats: a double-blind, placebo-controlled field trial. J Feline Med Surg. 2018 Jun;20(6):535-543. doi: 10.1177/1098612X17719399. Epub 2017 Jul 18. PMID: 28718700.
Steagall PV, Benito J, Monteiro BP, Doodnaught GM, Beauchamp G, Evangelista MC. Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy using two pain-scoring systems: a randomized clinical trial. J Feline Med Surg. 2018 Aug;20(8):741-748. doi: 10.1177/1098612X17730173. Epub 2017 Sep 18. PMID: 28920534.
van Haaften KA, Forsythe LRE, Stelow EA, Bain MJ. Effects of a single preappointment dose of gabapentin on signs of stress in cats during transportation and veterinary examination. J Am Vet Med Assoc. 2017 Nov 15;251(10):1175-1181. doi: 10.2460/javma.251.10.1175. PMID: 29099247.
Vettorato E, Corletto F. Gabapentin as part of multi-modal analgesia in two cats suffering multiple injuries. Vet Anaesth Analg. 2011 Sep;38(5):518-20. doi: 10.1111/j.1467-2995.2011.00638.x. PMID: 21831060.ag
This post was written by Matt Gurney.
Matt sees referrals in the pain clinic at Anderson Moores Veterinary Specialists. You can also receive telemedicine advice from us here if you have a pain case where you need a helping hand.
Matt & Carl established Zero Pain Philosophy to provide educational resources & telemedicine to veterinary professionals enabling optimal management of pain.
Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is President of the European College of Veterinary Anaesthesia & Analgesia.
Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists.
The intended audience for this pain update is veterinary professionals. This pain update is based on clinical experience and independent opinion. all P.V. et al. 2017. Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy using two pain-scoring systems: a randomized clinical trial. Journal of Feline Medicine and Surgery gall P.V. et al. 2017. Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy using two pain-scoring systems: a randomized clinical trial. Journal of Feline Medicine and Surgery