Giving a dog or cat medication at home without a fight

Quick answer

The aim is not to win the struggle once. It is to give the tenth dose as easily as the first.

Most medication failures at home are not refusals. They are courses abandoned halfway, tablets spat out five minutes later behind the sofa, and animals that learn to disappear when they hear a foil blister pop.

Two technical points do more for success than any amount of technique. Find out before you leave the clinic whether the tablet can be crushed or hidden in food, because some cannot. And always follow a dry tablet in a cat with water or food.

• Ask at the appointment: can this be crushed, can it go in food, with or without a meal, what happens if a dose is missed, and is there a liquid, transdermal or long-acting version.
• Try food first. Direct pilling is the fallback, not the default.
• In cats, never give a dry tablet without a chaser of water or a lick of wet food.
• Never crush a tablet marked modified release, sustained release, enteric coated or similar, and never split a capsule, without asking first.
• Keep giving the medicine for the full course even when the animal looks better, unless the vet says otherwise.

:::danger
In cats, a dry tablet given with nothing to wash it down can lodge in the oesophagus and cause a stricture.

A cat's oesophagus is close to horizontal and moves things along slowly, so a tablet can stop partway, dissolve there, and ulcerate the lining. The scar that forms narrows the tube permanently, and the cat then cannot swallow properly. Doxycycline and clindamycin are the drugs most often implicated. The prevention is trivial: after any dry tablet or capsule, follow immediately with a few millilitres of water from a syringe into the cheek pouch, or a lick of wet food.
:::

Decide in 60 seconds

Before the first dose: the questions that prevent most problems

Ask these at the appointment, while the vet is in front of you.

Can this be crushed or opened?

Modified release, sustained release and enteric coated tablets are engineered to release the drug slowly or past the stomach. Crushing one delivers the whole dose at once, which can be an overdose, or destroys a coating that was protecting the stomach or the drug. Capsules may be openable or may not.

Can it be given in food, and with or without a meal?

Some drugs are absorbed much less with food, and a few are absorbed much more. A drug given in a way that halves its absorption is a wasted course.

How long is the course, and what happens at the end?

Antibiotics and many other drugs need to be finished. Stopping when the animal looks better is a common cause of relapse and of resistance.

What does a reaction look like, and what should I do?

Ask specifically what side effects are expected and tolerable, and what means stop and phone.

Is there another format?

Liquids, flavoured compounded suspensions, transdermal gels applied to the ear, chewable formulations and long-acting injections all exist for some drugs. What is available differs a great deal between countries, and compounding pharmacies are common in some regions and unavailable in others, so this is worth asking rather than assuming.

What if I miss one?

Get the rule now rather than at eleven at night.

Everything laid out before you start: the dose, the chaser, the reward, and something to write the time on. Fumbling for a treat afterwards is how a good session becomes a bad one.

The order to try things in

Work down this list. Each step is harder than the one above it, and most animals never get past the first two.

1. Hidden in a small, separate portion of something excellent.

Not the main meal. If a tablet is hidden in the dinner and the animal finds it, the dinner becomes suspect. Use a small ball of something the animal rarely gets, offered on its own.

2. A commercial pill pocket, or a soft food moulded around it.

Whatever holds together and hides the smell. Cream cheese, a soft treat, a piece of sausage, wet food shaped into a ball, or a purpose-made pocket.

3. The three-treat sequence.

The single most effective technique for a suspicious dog, and it works because it exploits rhythm rather than deception.

Prepare three identical treats. The second one contains the tablet. Give the first, and as the dog swallows, give the second, and as it swallows that, give the third. The dog is anticipating the next treat rather than examining the current one. Do it fast and cheerfully, and stop if the dog starts inspecting.

4. Direct administration by hand.

The technique below. Reserve it for when food has genuinely failed.

5. A different formulation or a different drug.

Phone the practice. An animal that cannot be medicated reliably at home is a medical problem, and vets would far rather change the plan than have a course go unfinished.

Giving a tablet to a dog

Sit or kneel beside the dog rather than looming over it, with the dog against your leg or in a corner so it cannot back away.

Place one hand over the muzzle from above, thumb on one side and fingers on the other, behind the canine teeth where the mouth naturally opens. Tilt the nose upward slightly. Most dogs release the lower jaw when the nose goes up.

With the other hand, use a middle finger to open the lower jaw and place the tablet as far back on the tongue as you can reach comfortably. Placing it at the front means the dog can push it out with its tongue.

Close the mouth, keep the nose slightly raised, and stroke down the throat or blow gently once across the nose. Both prompt a swallow. Watch for the lick of the lips that confirms it.

Then give water or a treat, and finish the interaction with something the dog enjoys.

Giving a tablet to a cat

Preparation matters more here than strength.

Work on a non-slip surface at waist height, with the cat facing away from you and its back end against your body or into a corner. A cat that can reverse will reverse.

Use the least restraint that works. A towel wrap is a useful tool for a cat that scratches, but it escalates many cats that would have accepted a lighter hold, so it is a second option rather than a first.

Hold the head from above, with your thumb and middle finger on the cheekbones just below the eyes, and tilt the nose towards the ceiling. The lower jaw drops open on its own when the head goes far enough back. Do not force the jaw.

Place the tablet at the base of the tongue, quickly. A pill giver is genuinely better than fingers here: it reaches further back, it is faster, and it keeps your fingers out of the mouth.

Close the mouth, lower the head to level, and stroke the throat.

Then give the chaser. Always.

A few millilitres of water from a syringe into the side of the mouth, or a lick of wet food, or a small amount of a liquid the cat likes. This is not optional politeness; it is what prevents oesophageal injury.

Check it actually went down.

Cats are expert at holding a tablet in the mouth until you look away. If the cat drools, foams or hides immediately, look for a wet tablet on the floor before you assume the dose was given.

Liquids, eye drops and ear drops

Liquids.

Draw the dose up, then insert the syringe into the pouch between the cheek and the back teeth, not into the front of the mouth. Deliver slowly, in small amounts, giving the animal time to swallow.

Keep the head level or only slightly raised. Tipping the head back and squirting is how liquid ends up in the airway, and aspiration pneumonia is a far worse problem than the one being treated.

Shake suspensions properly first. An unshaken suspension gives weak doses at the start of the bottle and strong ones at the end.

Eye drops.

Approach from behind and above so the animal does not see the bottle coming towards its eye.

Rest the heel of your hand on the top of the head so that if the animal moves, the bottle moves with it. Use the other hand to pull the lower lid down gently, and let the drop fall into the pocket that forms. Never touch the eye or the lashes with the tip, which contaminates the bottle.

If two different drops are prescribed, leave several minutes between them or the second washes the first out. Ointments go last.

Ear drops.

Warm the bottle briefly in your hand. Cold liquid in an ear canal makes some animals dizzy and most of them resentful.

Instil the drops, then, before letting go, massage the base of the ear firmly for twenty to thirty seconds. You should hear a squelching sound. An animal's ear canal is L-shaped, with a long vertical section before it turns, so drops that are not massaged in sit at the top of the canal and do nothing.

Then let the animal shake, and only wipe what you can see. Never push a cotton bud into the canal.

Handling the animal already accepts is the foundation. Practise holding the muzzle, lifting a lip and touching an ear during ordinary grooming, long before a tablet is prescribed.

The behavioural half, which is most of it

Do not poison the well.

If every time you approach, something goes in the animal's mouth, your approach becomes the warning signal. For every dose, create several handling and treat events that lead to nothing at all. Touch the muzzle, give a treat, walk away.

Never chase a cat out of a hiding place to medicate it.

You will get that dose and lose the next ten. Wait for the cat to come out, or make the routine happen at a predictable time in a place the cat chooses to be.

Be predictable rather than sneaky.

Same place, same order, same short cue word, then the reward. Animals cope well with unpleasant things that are brief, consistent and reliably followed by something good. They cope badly with ambush.

Practise before you need it.

The best time to teach a cat to accept a pill giver is when it is well and the pill giver is loaded with a lick of food. The worst time is the evening after a serious diagnosis.

Two people are not always better than one.

For dogs, a helper who feeds and talks while you dose is usually an improvement. For many cats, a second pair of hands means more restraint and more panic. Try alone first with a cat.

Never scold, and never end on a fight.

If it has gone wrong twice, stop. Feed the animal something nice, walk away, and phone the practice for a different plan. Forcing a third attempt teaches an association that will last for years.

Missed doses, vomited doses, and side effects

A missed dose.

Do not double up to catch up. For most drugs the rule is to give it when you remember unless it is nearly time for the next one, but the exceptions matter, particularly for insulin and for drugs with narrow safety margins. Get the rule for your specific drug from the practice.

A vomited dose.

If the animal vomits within a few minutes and you can see the tablet, phone for advice. If it vomits later, the drug may already be absorbed and re-dosing could be an overdose. Never re-dose insulin because a diabetic animal vomited its food.

Write it down.

A sheet on the fridge with date, time and initials prevents the two commonest household errors: a dose given twice by two people, and a dose everyone assumed the other one gave.

Stop and phone for:

Facial swelling, hives, or sudden itching. Repeated vomiting or diarrhoea. Marked lethargy or wobbliness. Loss of appetite that starts after the medicine did. Any bleeding, or black tarry stools, in an animal on anti-inflammatories.

Storage.

Refrigerate what says refrigerate. Shake what says shake. Do not decant tablets out of their original packaging, because you lose the name, the strength and the expiry. Never use a leftover medicine from a previous illness, and never give one animal's prescription to another, including from the same household.

The best outcome is a routine so ordinary that the animal keeps eating normally through the whole course.

What never to do

Do not crush or split modified release, sustained release or enteric coated tablets, or open capsules, without checking.

Do not give a cat any medicine prescribed for a dog unless a vet has specifically said to. Several common dog products, particularly permethrin-based flea treatments, are severely toxic to cats.

Do not give human painkillers. Paracetamol is lethal to cats and ibuprofen and aspirin cause ulceration and kidney injury in both species.

Do not tip an animal's head back and pour liquid into the mouth.

Do not push anything into an ear canal.

Do not stop an antibiotic course early because the animal seems better.

Do not double a dose to make up for a missed one.

Do not hide medication in the animal's staple food.

Do not keep fighting. Three failed attempts is information, not a reason to try harder.

When to get help

Contact the practice immediately if, after a dose, you see:

• Swelling of the face, muzzle or eyelids, or hives
• Difficulty breathing
• Collapse or severe wobbliness
• Repeated vomiting, or vomiting blood
• Black tarry stools, or blood in the stool, in an animal on anti-inflammatories

Phone the same day if:

• The animal has not managed a dose and the course is time-critical
• The animal has stopped eating since starting the medicine
• You gave the wrong dose, the wrong animal's medicine, or a double dose
• A cat is drooling, gagging, or reluctant to swallow after a dry tablet, which can be the first sign of oesophageal injury

Phone before the next dose if you cannot reliably give the medicine, if the animal has become frightened of you, or if you are unsure whether a dose went down. All three are common, all three are fixable, and none of them improve by being managed alone.