Arthritis In Cats: Is Gabapentin A Good Choice?

By Dr Daisy A. May, MRCVS BVSc, Veterinary Surgeon

Cats with arthritis can be challenging to manage: they hide their pain exceptionally well (making it difficult to establish whether a treatment is or isn’t working); they are prone to kidney disease later in life, which means certain arthritis medications may not be safe for every feline patient; and no creature is more stubborn than the noble cat when it comes to taking a damn tablet! 

Any yet arthritis is perhaps the most common disease that I encounter in feline patients, period. Repeatedly, studies have shown that around 90% of cats in their teens (over about 12 years of age) have arthritis. In fact, one 2011 study even found that 60% of cats over the age of six have arthritis in at least one joint!

(Study can be found here:

https://pubmed.ncbi.nlm.nih.gov/20083417/ )

I know, right?

Not cool.

We can’t have 60% of our middle-aged and 90% of our teenage cats living life in pain! And remember, just because a cat is not showing pain, does not mean that they aren’t experiencing it. These guys are masters of deception!

Signs of arthritis in cats tend to be exceptionally subtle.

For the sake of this blog post, I’m going to be assuming you already know or strongly suspect your cat has arthritis, and that you have seen a vet about this.

We’ll be diving straight into discussing medications, and especially gabapentin, at this point. But, should you need a refresher of the signs of arthritis in cats, then I strongly recommend this page by icatcare:

https://icatcare.org/advice/arthritis-and-degenerative-joint-disease-in-cats/

OK so, without further ado…

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To set the scene, and for comparison’s sake, here’s an overview of the medications I most commonly see used either instead of or alongside gabapentin for feline arthritis (those who wish to, can skip ahead using the table of contents above).

Buprenorphine For Feline Arthritis

Buprenorphine is a fairly long acting (about 8 hours) opioid pain relief which tends to work well for cats. It can be given by injection in a clinic setting, or given under the tongue at home. It may cause nausea, constipation and – like all opioids – dependence/addiction.

Be aware that ANY patient who needs to stop taking opioids after being prescribed them for a prolonged period of time, must be weaned off gradually, under the supervision of a vet. Just because your cat can’t tell you they’re going through opioid withdrawal, does not mean they aren’t going through opioid withdrawal!

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Codeine For Feline Arthritis

Another opioid pain relief option. Effects only last about half as long as buprenorphine, and I find codeine is worse for giving my patients constipation. On the whole, there isn’t really any reason to go for codeine over buprenorphine, if you are going to reach for an opioid.

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Amantadine For Feline Arthritis

For some reason, poor amantadine often gets left on the shelf. I’m not sure why so many vets tend to forget about this option, because it’s actually a pretty good one!

Amantadine is a fairly safe, albeit moderately expensive medication with a variety of different uses, one of which is as a pain relieving agent in arthritic dogs and cats. It has been proven by studies to improve owner ratings of their arthritic cat’s quality of life.

Like gabapentin, amantadine causes a degree of sedation as a side effect, so cats who take these medications tend to have lower activity levels as a normal.

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Non-Steroidal Anti-Inflammatories (NSAIDs)

Only two NSAIDs are currently FDA approved for use in cats for pain relief purposes: 

Meloxicam (Metacam, Loxicom, Rheumocam and other trade names), and robenacoxib (the trade name in the UK is Onsior). 

In my experience NSAIDs provide excellent pain relief for arthritis cases, but they do have a flip side; they can cause vomiting, diarrhea or even stomach or intestinal ulcers in some patients.

And they may worsen any pre-existing kidney disease. Be aware that about one in three cats over the age of ten, suffers with chronic kidney disease, and that it can be a completely silent disease until the late stages.

For this reason, every geriatric cat should ideally have a blood test before being prescribed long-term NSAID treatment.

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Supplements for Feline Arthritis

Let’s be real: not all supplements are created equally, and it can be difficult to know whether you’re purchasing a helpful product or simply wasting your money when buying a supplement online, be that for yourself or for your cat.

The main joint supplement to aid in management of arthritis for senior cats that I currently recommend to pet owners in my consult room is YuMOVE. Whilst I’m fairly sure this exact product isn’t easily available in the USA, there seem to be plenty of similar options.

A very key ingredient in this supplement is green lipped muscle, which has a triple-action: soothing joints and relieving pain; supporting the structure of the joints; and aiding your pet’s mobility. YuMOVE use a special, sustainably sourced and patented variety of green lipped muscle that contain as much as 8 times the quantity of omega-3 as ordinary green lipped muscle (used by other brands), and is up to 30 times more powerful.

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Frunevetmab (Solensia) For Feline Arthritis

This monthly injection contains a relatively new drug called frunevetmab, which works by blocking pain signals at nerve cell level. Solensia can be thought of as being a newer, safer, but unfortunately much more expensive replacement for NSAIDs. It’s also fab being able to completely avoid the need to get a fussy cat to take oral medication daily.

Solensia works phenomenally well in my experience, and has a lower risk of gastrointestinal side effects compared to NSAIDs. It’s also a lot safer than NSAIDs for cats with kidney disease.

But, like I said – it is very expensive; around £130/$160 in my experience, maybe a little more or a little less depending where you go.

Solenisa is typically administered by a vet or vet nurse, but I have certainly also taught many owners to administer the drug themselves at home if they are confident and able to do so.

This has the downside of meaning the cat sees a vet less frequently and is less closely monitored, but the upside that things can be kept significantly cheaper for any owners who may be cost concerned.

I actually have a whole blog post specifically focusing on Solensia, for those who are interested:

Cat Arthritis Injection – Everything You Need To Know

Don’t worry, my slightly impatient friend. I’ve not lost sight of the end game. I was just setting the scene for y’all.

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What Is Gabapentin?

Gabapentin is a prescription-only medication used in both human and veterinary medicine as an anti-seizure medication, a pain reliever, and sometimes as a sedative. It also has a few additional uses in the human medical field, for example, the treatment of restless leg syndrome.

Gabapentin exerts its effects by reducing the excitability of nerve cells; ie, it calms your brain – and certain pain signals – down. It also produces mild muscle relaxation, by the same mechanism. 

In cats, we typically use gabapentin at doses of 5-10mg/kg, twice daily for management of long-term pain, such as that associated with arthritis.

I do use higher doses than this as a one-off to achieve sedation in fractious cats prior to vet appointments, provided their medical history does not contraindicate this. I can’t tell you how much easier it is to take a blood sample from an angry cat who has had a gabapentin 60-90 minutes before their appointment, than one who has not. And it makes the whole ordeal much nicer and less stressful for the kitty cat, too. 

Last but not least, I find gabapentin exceptionally useful for cats with stress cystitis (aka feline lower urinary tract disease, ‘FLUTD’), because it does a fantastic job of calming that irritating nerve input on the bladder. But let’s stick to arthritis, for now (bladders can be a separate blog post). 

Gabapentin is available in tablet, capsule and liquid form, although be warned that the liquid form has a bitter taste (which cats hate) and is exceptionally expensive when compared to the capsules and tablets, which are relatively cheap.

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How Effective Is Gabapentin For Cats With Arthritis?

Speaking anecdotally, I find that it works quite well in most of my patients. It is definitely not as good as the NSAIDs or Solensia….but the beauty is, you can use gabapentin in combination with an NSAID or Solensia to achieve really good pain relief for most patients. 

Speaking as a scientist of course, the evidence supports the claim that gabapentin is somewhat effective at relieving arthritis pain in cats. For example, in a relatively small 2018 study owners felt that their cats were less painful and with a better quality of life on gabapentin compared to a placebo. 

Study can be found here:

https://avmajournals.avma.org/view/journals/javma/253/5/javma.253.5.579.xml)

The same study showed that cats on gabapentin actually moved around less than their placebo-taking counterparts, but this is very likely due to the sedation that we know comes as a side effect of gabapentin. Personally, I would rather be a little sedated and lacking in pain, then super alert and painful, and I’m sure my cat would agree. So frankly, this wouldn’t put me off. 

Overall, gabapentin is not a cure-all or a miracle drug. Used alone, it will probably not completely remove arthritis pain for most cats, and certainly not for those who have advanced arthritis and a visibly abnormal walk. 

It’s best used in combination with a NSAID or Solensia, and alongside a holistic arthritis management plan, including weight management, a good quality joint supplement, and environmental adjustments to make the home an easier place for your arthritic cat to abide in.

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Is Gabapentin Safe To Give My Elderly Cat?

The general consensus amongst the veterinary community is that yes, gabapentin is a pretty damn safe drug for the vast majority of older cats, especially when compared to NSAIDs. I would however use gabapentin with more caution, or in some cases avoid it altogether, in patients whose liver is not functioning optimally.  

Ideally every geriatric cat should have a blood test at least yearly to screen for conditions that may not be instantly apparent to the pet parent or the vet. This is even more important to do before embarking upon any daily long term medication, gabapentin included. 

However, blood tests can get expensive, especially if done regularly. And I strongly believe that pain relief for painful pets should not be considered optional. We owe it to them, to relieve any pain.

For this reason, if owners cannot afford blood tests but we know or strongly suspect their cat to be painful with arthritis, I still tend to recommend gabapentin. It’s probably the safest medication we have for arthritis in cats, where a blood test cannot be carried out prior to deciding upon a treatment protocol.

A blood test just makes things a little safer because it allows us to tailor medications and doses to the patient, and to treat any other health conditions we may unearth.

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What Side Effects Should I Expect?

Well, we’ve already touched on this a little bit, but the major side effect you almost certainly will see in a cat on gabapentin is sedation. This is completely normal, with this medication. Remember how we said gabapentin works? It calms the brain and pain signals down, and causes your muscles to relax a little. Of course if your brain is calm and your muscles are nicely relaxed, you’re going to feel a little dozy. 

I don’t consider this a bad thing, to be honest, and nor do I think it bothers the cats. Your average cat sleeps for 12-16 hours per day anyway, and the majority of elderly arthritic cats sleep for a damn sight more than this – frequently about 20 hours – in my experience.

If I were an arthritic little old cat, I can tell you for sure that I’d much rather be pain-free and comfortably dozy most of the day, then painful and awake. 

Likewise, because of the calm brain and relaxed muscles, some cats (mine included) will appear a little drunk when taking gabapentin. Usually this is worst at the start of treatment and subsides a fair bit once treatment has been ongoing for a while and the body has adjusted to it. 

Gabapentin can also cause tummy upset – inappetance, vomiting and/or runny stools – in a minority of individuals. I typically advise owners to try and persist with giving the medication, in all but the most extreme of cases. Sometimes I prescribe anti-nausea medication alongside the gabapentin for a while whilst the patient’s body adjusts to it. Usually the upset tummy settles and the cat is able to continue taking gabapentin.

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Interactions With Other Medications

Gabapentin can be and often is used alongside other types of pain relief to get good control of arthritis pain in cats. In fact, unless there is a reason not to give NSAIDs, my preferred first line treatment plan for arthritic cats involves metacam plus gabapentin, or even better if the owner is able to afford it, Solensia and gabapentin. It is completely, perfectly safe to use gabapentin in combination with NSAIDs and/or Solensia. 

There are plenty of medications that do interact with gabapentin, however, so it’s important to always make your vet aware of any and all medications that your pet is taking, including those acquired over the counter. Just as one example, care should certainly be taken when giving other medications that produce sedation, such as opioids.

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I hope you guys enjoyed this overview of gabapentin use for feline arthritis, and found it useful. Please feel free to drop any questions in the comments, and I’ll be sure to get back to you.

Daisy xx

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