Pre-Visit Pharmaceuticals for Dogs

What is a pre-visit pharmaceutical?

A pre-visit pharmaceutical (PVP) is a medication or combination of medications given before a veterinary visit to reduce fear, anxiety, or stress associated with a veterinary visit.

People use PVPs routinely for fear of flying or fear of the dentist. Incorporating PVPs with training (behavior modification), special handling techniques, and environmental changes in the clinic can help ease your dog’s anxiety during their veterinary visit. 

See handouts “Reducing Fear of Veterinary Visits for Dogs” and “Fear of Places in Dogs” for more information on how you can help your dog with clinic anxiety.

Why did my dog’s veterinary team recommend a PVP?

Your dog’s veterinary team may recommend a PVP if they notice your dog’s level of fear or stress in the clinic is causing them emotional distress. Dogs show fear and stress in different ways. Some may freeze and not take an offered treat, some may try to hide behind you, and others may growl or bite.

"Fear and stress can prevent your dog’s veterinary team from completing 
a true assessment of your dog’s health."

Fear and stress can prevent your dog’s veterinary team from completing a true assessment of your dog’s health. These emotions can cause your dog to “hide” the limping you noticed at home or may not allow your veterinarian to get close enough to perform a physical exam.

If your pet allows a physical examination, their stress may cause a falsely elevated temperature or heart rate, and increased or decreased reactivity to touch – interfering with an accurate and complete physical examination, and causing the loss of valuable clues about their health status.

Are PVPs just sedatives?

Many medications used as PVPs cause sedation, but they also have additional beneficial effects, depending on the medication used, including calming and reducing anxiety, as well as reducing pain.

Use of PVPs at every visit can stop or reverse the ongoing cycle of fearful memories that cause heightened anxiety at subsequent visits. PVPs may allow pets to learn that the clinic is not as scary as they expect it to be – potentially leading to fewer PVPs in the future.

Why does the timing of the PVP matter?

Dogs are very intelligent and know they are going to the clinic well before they arrive – especially if they fear a veterinary visit. To reduce anxious feelings before they start, the medications need to reach full effect before your dog realizes a veterinary visit is coming.

Your veterinary team will let you know when to administer the prescribed medications. In some cases, it may be one or more hours before your visit, or even the night before a visit.

What medications are used as PVPs?

Many medications are available to help dogs with veterinary visit anxiety. These medications may be used as single agents or used in combination. Your veterinarian will recommend the best PVP plan for your dog based on their health and behavior. For more information on how these medications help, see handout “Behavior Counseling: Medications”.

• Trazodone increases serotonin levels in the brain and reduces anxiety. It is commonly used as a short-term, anti-anxiety medication.
• Gabapentin is commonly used to manage chronic pain and may be helpful in reducing anxiety induced by short-term triggers such as vet visits or thunderstorms.
• Acepromazine works as a tranquilizer and can reduce anxiety-induced rapid heart rate. It is not generally recommended to be used alone in fearful situations, as it can increase noise sensitivity.
• Alprazolam, lorazepam, and diazepam are some of a group of drugs known as benzodiazepines that have sedative and mild anti-anxiety effects on the brain. They also act to relax muscles. 
• Clonidine is commonly used to treat phobias, including clinic anxiety, storm phobia, and hyperarousal on walks.
• Phenobarbital is a common anti-seizure medication, but it has a similar effect on the brain as benzodiazepines and has been used for short-term sedation prior to stressful events.
• Oral transmucosal dexmedetomidine (Sileo®) reduces excitement and can have a sedative effect.

These medications often have a wide dose range, meaning the exact dose that works best for your dog may need to be determined through trial and error.

As with many medications used in veterinary medicine, many of these drugs are used off label in dogs and should only be used at the direction of your dog’s veterinarian.

What is the chill protocol?

The chill protocol is a combination of medications given before a veterinary appointment that work together to reduce anxiety in the animal. The chill protocol was developed at Tufts University School of Veterinary Medicine, which recognized that using a multimodal protocol increased the effectiveness of anti-anxiety medications. Multimodal means using multiple treatments/medications to achieve a better and more balanced effect.

The chill protocol combines gabapentin, melatonin, and acepromazine. Melatonin is a hormone normally produced when it becomes dark and may have a relaxing effect. A study published in 2023 demonstrated reductions in signs of stress, fear, and fear-based aggression during veterinary visits when the chill protocol was used.

If I use PVPs, does that mean my pet won’t need additional medication for a veterinary visit?

Sometimes oral PVPs, training, and stress-reducing handling techniques aren’t enough, and injectable sedation may be needed to provide care without creating a bad experience for a dog. Injectable sedatives are generally considered safe and doses can often be lowered when a PVP has been used prior to administration. Your veterinarian can discuss additional in-clinic medication for your dog.

Is there a “natural” treatment I could use instead?

Some supplements may help reduce the fear response, including theanine, tryptophan, and casozepine. Supplements may help manage mild stress responses, but they are unlikely to be effective as a sole therapy in more fearful responses.

Supplements are not regulated as stringently as medications and few supplements and herbs have been subjected to rigorous scientific trials to determine if they are truly effective. Additionally, just because a product is natural, does not mean that it is safe; it could interact negatively with other medications or supplements your pet is already taking.

Talk to your veterinarian about any supplements before administering them to your dog. For more information about behavioral supplements, see handout “Behavior Counseling: Complementary Treatments”.

Pre-visit pharmaceuticals play a vital role in making veterinary visits less stressful for dogs. By recognizing the signs of fear, anxiety, and stress, and administering these medications at the appropriate time, we can ensure our pets receive the care they need in a calm and controlled manner. Always consult with your veterinarian to determine the best approach for your pet's specific needs.