Sleep Aid Toxicosis (Benzodiazepines) in Cats

Sleep aid toxicosis is a rare and serious condition that requires immediate medical attention. Benzodiazepines toxicosis can cause irreversible and potentially fatal hepatic damage in some cats.

The best way to ensure the animal's safety is to seek veterinary attention before the onset of symptoms.

On occasion, benzodiazepines can cause a paradoxical reaction characterized by

• Elevated heart rate
• Vocalization
• Excitation

Young cats may be more likely to develop paradoxical reactions.

Sleep aid toxicosis is caused by the ingestion of excessive amounts of benzodiazepines. Benzodiazepines are commonly used both in humans and veterinary medicine; toxicosis can be caused by either accidental ingestion of human medicine or accidental overdose of drugs intended for animals.

Benzodiazepines are a class of depressant drugs that, once in the system, bind to the animal's GABA receptor slowing down the central nervous system and decreasing excitation.

If the ingestion of sleeping aid medication is witnessed, the diagnosis is self-evident. Ingestion may occur without a witness, but it can leave evidence such as missing pills, bite marks left on sleep aid containers, or pills in vomit. A cat suspected of having ingested benzodiazepines generally undergoes the following diagnostics:

• Physical examination
• Blood test
• Urinalysis

If possible, the pill container or a photograph of the label should be presented to the veterinarian.

Once diagnosed, treatment options depend on the timing of ingestion and severity of symptoms.

If the animal receives medical attention prior to the onset of symptoms, gastrointestinal decontamination via induced vomiting may be sufficient. Note: Induction of vomiting or administration of activated charcoal should only be performed by a veterinarian. There is no safe way to induce vomiting or administer activated charcoal at home. If the amount of ingested benzodiazepines is very high, the animal may require the following:

• Activated charcoal
• Gastric lavage

If treatment is sought after the onset of symptoms, options include:

• IV fluid therapy
• Flumazenil: a benzodiazepine antagonist that inhibits benzodiazepine interaction with the GABA receptor. Flumazenil may cause seizures and is only used in severe cases of toxicosis.

Home care

• Rest
• Reduction of stimuli

With proper treatment, prognosis for acute sleep aid toxicosis is generally very good. The prognosis for acute overdoses is excellent with symptomatic care.

The majority of mildly affected cats do not need hospitalization and are able to recover with home rest; veterinary patients tend to have a higher tolerance for benzodiazepines than humans.

Cats that develop hepatic failure carry a guarded to poor prognosis.

Sleep aid toxicosis is not contagious and easily preventable by ensuring that pets do not ingest sleep aid pills and are not accidentally overdosed.

Prevention strategies include:

• Never administering human medicine to pets
• Never administering benzodiazepines to pets without discussing them with a veterinarian.
• Keeping sleeping pills out of reach of pets and children
• Keeping medications in original and tightly closed containers

Cats with underlying liver conditions may be at higher risk for developing hepatic failure. Cats living in a household where humans or other pets are prescribed benzodiazepines are at higher risk of accidental exposure.

• Gastrointestinal decontamination
• Induced emesis
• Minimizing stimulation
• Activated charcoal
• IV fluid therapy
• Flumazenil