Back to home page

Effectiveness of dexmedetomidine in alleviating signs of noise-induced fear and anxiety in dogs

Clinical Scenario

Bobby is a 5 year old male neutered border collie who belongs to Miss Phipps. Miss Phipps has brought him in as her neighbours are having a party at the weekend which will include fireworks. You have seen Bobby a number of times as he is scared of loud noises and demonstrates significant anxiety-related behaviours which are upsetting for him and Miss Phipps. On previous occasions (e.g. bonfire night and New Year's Eve) you have tried ACP and benzodiazepines but Miss Phipps says the former 'knocks him out', she is frightened by the effects and the latter made no difference at all! She has an appointment in a month's time to see a behaviourist to try and sort out the problem. However she has great concerns for Bobby over the weekend and has found out about a gel ('Sileo') you can rub into his gums and she asks you if you think it is a good alternative. The drug is quite new so you have limited experience of it, you wonder if it will actually help reduce the signs of anxiety in Bobby.....

3-Part Question (PICO)

In [dogs with noise associated phobias] does [oromucosal application of dexmedetomidine compared to no treatment] [reduce the signs of fear and anxiety]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(fear$.mp. OR anxi$.mp. OR scared.mp. OR nervo$.mp. OR phobi$.mp. OR fright$.mp. OR exp Fear/ OR exp Anxiety/ OR exp Phobic Disorders/)

AND

(dexmedetomidine.mp. OR sileo.mp. OR exp Dexmedetomidine/)

CAB Abstracts 1910 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/ OR exp canis/)

AND

(fear$.mp. OR anxi$.mp. OR scared.mp. OR nervo$.mp. OR phobi$.mp. OR fright$.mp.OR exp phobias/ OR exp anxiety/ OR fearfulness.sh)

AND

(dexmedetomidine.mp. OR sileo.mp.)

Search Outcome

MEDLINE

  • 2 papers found in MEDLINE search
  • 1 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 9 papers found in CAB search
  • 6 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 2 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Korpivaara M; Laapas K; Huhtinen M; Schoning B; Overall K, 2017, Germany and Finland

Title:

Dexmedetomidine oromucosal gel for noise associated acute anxiety and fear in dogs - a randomised, double blind, placebo-controlled clinical study 

Patient group:

182 dogs - 89 received dexmedetomidine and 93 received placebo

Study Type:


A randomised, double blind, placebo-controlled trial

Outcomes:
  • Treatment success was measured as a composite variable of the behavioural signs, sedative effect, in the presence of the fear-provoking stimuli compared to the dogs behaviour at the previous New Year's Eve.
  • Behavioural signs (extent of fear and anxiety) were assessed subjectively by owners signs and included panting, trembling, vocalizing, pacing, seeking people, trying to hide, trying to escape, freezing, refusing to eat food/treats, inappropriate urination, inappropriate defaecation and salivating. The behaviour assessments were made in comparison to the previous year without treatment.
  • Local effects on the oral mucosa and alertness (on a subjective scale of 1 to 4) were also observed.
  • Number of doses given (up to five at ≥2 hour intervals).
  • The usability of the product (ease of application).
  • Clinical success of treatment (alleviation of acute anxiety and fear without clinical sedation in the presence of fear-provoking stimuli) or failure (no or some treatment effect, increased reactions or had good treatment effect but were sedated) was also recorded.
  • Adverse events
Key Results:
  • There was a significant overall treatment effect (compared to the previous year without treatment) for the dexmedetomidine compared to the placebo group with odds ratio of 3.4 (95% CI 1.95-5.99, p<0.0001).
  • A higher proportion of dogs in the dexmedetomidine group had some, good or excellent treatment effect compared to the placebo group (11, 55% and 17% in dexmedetomidine vs 39, 27% and 10%).
  • When the dogs who had signs of treatment failure were removed from the analysis, there was a significant anxiolytic effect (compared to last year without treatment) for the dexmedetomidine compared to the placebo group with an odds ratio of 3.25 (95%CI, 1.84-5.74, p<0.0001).
  • The behavioural scores were lower for the dexmedetomidine group compared to placebo, with a estimate difference over time of -2.16 (95% CI -3.87 to -0.45).
  • When analysed at individual time points the behavioural scores were significantly lower after dexmedetomidine than the placebo group after the second dose only (p=0.0003).
  • There was no significant difference between treatment groups in terms of alertness. Nine dogs were unable to stand up and walk when called, 7 in dexmedetomidine group and 2 in placebo.
  • Twenty one dogs (7 on dexmedetomidine and 14 on placebo) were removed prematurely from the study mostly due to a lack of efficacy.
Study Weaknesses:
  • The groups were not compared statitiscally prior to intervention though descriptive data is given.
  • No behavioural assessment was done on the previous New Year's Eve to compare these data to, the apparent treatment effect was based on recall from the owner only.
  • Subjective assessments of behaviours, firework exposure and alertness were used. Some of these scales had been used previously but extensive validation had not been done. 
  • The owners were asked to subjectively assess the firework exposure. The results of the exposure across the dogs in the trial were not given. No comparison of exposure in relation the the previous New Year's Eve was given.
  • No other noise exposures were measured, the environment was not controlled in any way.
Attachment:
Evidence appraisalEvidence appraisal

Comments

Only one study was found to answer this question. Whilst it was a relatively well designed and powered randomised controlled trial the measurements made may affect the reliability of the results. The owners were asked to subjectively compare their dog's behaviour to New Year's Eve 12 months ago which means all the results are subject to recall bias. The level of exposure to fireworks this year was not reported and no comparison was made to the previous year. It is unclear whether the dogs were exposed to any other noises to which they may have been fearful.

It is interesting how well the placebo appeared to work in the dogs in this arm of the trial. Over a third (37%) of the dogs demonstrated a good or excellent behavioural effect according to the owners and 3 dogs showed signs of sedation. This may be due to inaccuracies in the way the assesments were made or may be due to the positive effects of the increased attention by owners during the time of firework exposure regardless of treatment.

Bottom line

Oromucosal application of dexmedetomidine may reduce the signs of fear and anxiety in some dogs with noise-associated phobias.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Korpivaara, M. Laapas, K. Huhtinen, M. Schoning, B. Overall, K, (2017). Dexmedetomidine oromucosal gel for noise-associated acute anxiety and fear in dogs - a randomised, double-blind, placebo-controlled clinical study. Veterinary Record 180:356

About this BET

First author:
Rachel Dean
Second author:
Bree Merritt
Institution:

Centre for Evidence-based Veterinary Medicine, University of Nottingham

Shelter Medicine team, University of Nottingham

Search last performed:
2017-10-31 13:26:27
Original publication date:
2017-11-01 13:26:27
Last updated:
2017-11-01 13:26:27
About BETs?

A BET is a simple method of searching for and appraising evidence around a very specific clinical situation.

Read more …

Using BETs?

BETs don’t tell you what to do, they tell you about the evidence on a certain topic.

Read more …

Not a Vet?

This website has been designed to help vets use the best, most relevant, up to date science when they make decisions about their patients.

Read more …