Think about the last time you swallowed a pill or a capsule. You
most likely took it with several swallows of something liquid to help
move the pill along its journey through the esophagus and into the
stomach. Most people would never dream of 'dry swallowing' pills,
having felt that awful sensation of a pill not 'going down' very
smoothly so why are we subjecting our animals to this illogical
procedure? When humans feel that a pill is 'stuck', we usually react by drinking
more water. It would be nice if cats and dogs reacted this way, but
Note: When I use the
word "pill", I am also referring to capsules which can cause even more
problems than pills, as shown in the study below.
Here is a quote from a
colleague of mine:
year, I was prescribed clindamycin (Antirobe) for a dental infection and
was instructed to take each capsule with a full glass of water.
One night, being lazy, I took the capsule with just a gulp of water.
What ensued was the worst case of heartburn/esophagitis I have ever had.
At first, the pain was so intense I thought I was having a heart attack.
This cured me of ever pilling a cat without a water or food chaser."
Given how humans take their medications and
vitamins (with a liquid in some form), we need to stop asking our cats and dogs to do something
we would never do.
The lining of the esophagus
is very delicate and it is not designed to have irritating medications
in contact with it for more than the short amount of time it should take
for the pill to pass from the mouth to the stomach when swallowed with
an adequate amount of liquid or food.
When a pill is in contact
with this tissue for a prolonged period of time, a painful irritation or
ulcer has the potential to develop. Some medications are worse
than others. For instance, doxycycline is a well-known antibiotic
that is extremely irritating. (More on that below from a human who
experienced very painful erosive esophagitis from taking this medication
without enough water.)
For this article, a "dry
swallow" refers to the administration of a pill or capsule to a cat or
dog without immediately following up with 4-5 milliliters (cc's) of
water, or tuna juice or meat broth given orally via a syringe, or the consumption of some canned food
by the patient. Offering canned food, tuna juice, meat baby food, or a meat broth for them to
lap up on their own are also very good
options and ones that are less stressful than syringing.
As noted on my
Feeding Your Cat: Know the Basics of
Feline Nutrition article, as well as in many other articles on this
website, I am strongly opposed to the feeding of dry food to cats. That
said, if you are dealing with a dry food-addicted cat, feeding a bit of
dry food or treats (such as 'Temptations' treats) after the pill will
also help 'chase' it into the stomach, but canned food - with its much
higher water content - is a much healthier choice.
Tip: You can
make your own tuna water by mixing a can of tuna with ~3 cups of water.
Mash it up and let it sit for ~10-15 minutes. Then pour the water off
covered ice cube trays to prolong the freshness. It is fine
if some tuna meat is included into the ice cube unless you will be
syringing this flavored water. If you are using a syringe to administer
the water - versus letting them lap it up - then I would strain the
water to remove any chunks of tuna that would clog the syringe.
As an alternative to pilling, I strongly urge people to
have their cat's medication made up into a
compound for ease of administration. That said, some people
state that their cat is not good about swallowing liquids and these
people prefer to use pills.
A third option is to use
Greenies Pill Pockets. If your
cat will eat these treats, they will provide a stress-free way of
administering medications especially if your cat still has a good
appetite and the pill is not too large.
Do not use a whole Pill
Pocket at a time. They are too big and most cats will bite
down on them. Instead, use just enough of the 'dough' to wrap around the
pill - being careful not to get any of the pill powder on the outside of
the Pill Pocket if you have broken up the pill into pieces.
A cat is going to be much
less apt to bite down on ~1/4 of a Pill Pocket than he will be if
offered a whole Pill Pocket. I break the Pill Pocket into 4 or 5
See this video showing how I broke a
Pill Pocket into 5 pieces and then rolled them into little balls. The first two pieces have 1/2 of Andy's
pill in each of them. The other 3 pieces are also fed.
Note how I quickly throw
down each piece. This is to get Andy to swallow the one that is in
his mouth which he does because he is anxious to gobble up the next
If your cat will not eat Pill Pockets, try
rolling them in crushed up treats such as Temptations treats or
FortiFlora. FortiFlora is a probiotic (beneficial bacteria) that
comes in a box with 30 small packets but I am not suggesting it for its
probiotic purpose. The reason why I love this product is because the
probiotics are contained in a very enticing animal digest powder.
This is what is sprayed on dry kibble to make it so palatable.
think that my cats would eat cardboard if I sprinkled FortiFlora on it!
I always keep this product in my home as a flavor enhancer to be used if
my cats don't want to eat for any reason or if I am trying to get them
to eat a new food. Think of it like salt and pepper for your own
food. You can use as little as 1/10 of a package or even less. Also,
don't worry if the product is outdated because we don't care if the probiotic bacteria have died since we are only using it for a flavor
Some cats also love parmesan cheese
so you can also try rolling the Pill Pocket in parmesan cheese.
When administering pills or
capsules, some people use butter or oil
to coat the pill/capsule. This will
make swallowing the pill easier but it is not going to ensure rapid
passage into the stomach. Therefore, it is still very important to follow
a butter-coated pill with a liquid or food chaser to ensure that the pills or capsules
move immediately into
If a cat absolutely will not
allow water to be syringed after pilling, or he will not eat or drink
afterward, then you can put some butter or a product like Nutrical on
his paw. The licking of the butter/Nutrical from the paw (or even
the nose) has been shown to hasten the travel of the pill into the
stomach but it is not as effective as having the cat eat after pilling
or 'chasing' the pill with 4-5 cc of water or a flavored liquid.
The best size of syringe to
use for a cat - whether you are syringing the medicine or a water chaser
- is a 1 cc ("TB") syringe. The larger syringes do not
fit comfortably inside of a cat's mouth. Also, you do not want to
administer any more than 3/4 - 1 cc at a time. If liquid medications,
such as some of the commonly used antibiotics, are dispensed with an
eyedropper, ask your veterinarian for a 1cc syringe. Not only is
this a more accurate way to measure the dose, but your cat will be more
agreeable to this small syringe entering the side of his mouth rather
than the larger eyedropper that you have to squeeze a couple of times to
eject the medication.
If you have chosen the option
to pill your cat, I would suggest that before you get ready to
administer the pill, have a bowl of water (or tuna juice or broth)
readily available. See if your cat is interested in drinking it.
If not, you will then have to use your syringe. To administer a
liquid using a syringe, it is best to approach the cat from the side,
not from the front. Cats tend to be a bit worried when approached
head on. Slip the syringe into the side of the mouth at about a
45-degree angle being careful not to insert the syringe too far down the
back of the throat. You don't want the cat to panic, nor have him
aspirate the liquid.
Do not hold your pet's head up!
This is something that I commonly see people do. Try it yourself.
Lift your chin up and you will see how much harder it is for you to
swallow. You can hold his head level or his mouth slightly down,
but never raise his head upward.
understand that some of the readers will be saying "oh sure...I can
barely get the pill down my cat and now I am supposed to follow up with
the syringing of some liquid?!!?"
Another option is to see if the cat or dog will consume the pill if it
is hidden in canned food. This is obviously the least stressful
for all concerned but it works much better with dogs. Cats are
notoriously picky eaters and are suspicious of anything out of the
ordinary in their food and it would be very rare to have a cat eat a
whole pill when mixed into cat food.
Some drugs such as Clavamox
tablets and Baytril
TasteTabs are formulated to be fairly palatable and can be crushed
and put in canned food and this is a great way to go....if the cat will eat it.
I have had better luck with cats eating crushed Clavamox tablets
(tasteless) in food
than I have with the Baytril TasteTabs. I have treated many feral
(wild) cats with clavamox tablets crushed and mixed into food.
Please note the following
case study where another antibiotic, clindamycin (Antirobe),
resulted in severe injury - and some deaths - to the patients
when they were dry pilled.
Suspected clindamycin-associated oesophageal injury
in cats: five cases
Journal of Feline Medicine & Surgery, Volume 8, Issue
6, December 2006, Pages 412-419
Julia A. Beatty BSc(hons), BVetMed, PhD, FACVSc (Feline Medicine), MRCVS,
Nigel Swift BVetMed, Dip ACVIM (Small Animal Internal Medicine), MRCVS,
Darren J. Foster BSc, BVMS, PhD, FACVSc (Feline Medicine) and Vanessa
R.D. Barrs BVSc(hons), MVetClinStud, FACVSc (Feline Medicine)
Accepted 24 April 2006. Available online 18 July 2006.
The clinical findings, treatment and outcome of
suspected clindamycin-associated oesophageal injury in five cats are
reported. All cats were treated with one 75 mg clindamycin capsule twice
daily (dose range 12–19 mg/kg). Capsules were administered without food
or a water bolus. Dysphagia, regurgitation, choking or gagging were seen
3–9 days after starting clindamycin. On oesophagoscopy, three cats had
oesophagitis, one of which progressed to stricture formation. Two cats
had an oesophageal stricture at first presentation. This is the first
report of suspected clindamycin-associated oesophageal injury in cats.
It serves to further alert practitioners to the potential for
drug-induced oesophageal disorders (DIOD) in cats treated with oral
medications and to urge prevention by promoting a change in dosing
Personally, I have dealt with 3 cats
that have died post-pilling with
clindamycin (Antirobe) tablets.
Please note this excerpt from
the study quoted below:
"After 5 minutes 84% of capsules and 64%
of tablets are still sitting in the esophagus."
This is referring to pills and capsules that were dry swallowed.
It really is amazing that
cats and dogs are as good as they are about pilling but one has to
wonder about the pets that panic and/or gag when their owners try to
pill them. I know that I would not be very happy about being asked
to dry swallow a pill.
A Very Interesting Study
The following is a summary of a very
interesting article that appeared in a veterinary journal entitled Evaluation of the Passage of Tablets and Capsules Through the
Esophagus of the Cat. It is from a paper presented at the 2001
College of Veterinary Internal Medicine Forum. (They do note at the end
of the paper that the principles outlined also make good sense for
dogs.) This paper was submitted to one of the lesser-read journals
so a lot of veterinarians may not have seen it. This is extremely
unfortunate for all cats and dogs.
Purpose of the study:
The goal of the study was to determine the length of time that it took
for pills or capsules to enter the stomach after 1) dry pilling and 2)
pilling and then giving a 6 cc water chaser immediately following the
administration of the pill or capsule - referred to as a "wet swallow".
30 cats were used. Fluoroscopy was used to evaluate the pill/capsule
passage at 30, 60, 90, 120, 180, 300 seconds.
For the dry swallows:
No pills were in the stomach at 30 and 60 seconds. Only 6% of the
pills were in the stomach at 90 seconds. Only 13% of the pills were in
the stomach at 120 seconds. And at 5 minutes only 36% of the pills were
in the stomach.
For the wet swallows: (i.e., the pill was followed by 6 cc of
At 30 seconds, 90% of the pills were in the stomach. All pills were in
the stomach by 120 seconds.
The statistics were even worse for capsuleswhen dry
swallowed.By 5 minutes, only 16% of the capsules had made it
to the stomach. 100% of capsules followed by water chasers, were in the
stomach by 60 seconds - faster than for pills probably due to the
smoother surface of a capsule versus a pill.
"This is an interesting study that has considerable practical impact.
Although veterinarians have a huge arsenal of mediations and treatments
available to us, we still have a very poor understanding of some of
the most basic aspects of everyday practice. We routinely prescribe
oral medications in the form of tablets or capsules to cats.
It has been our assumption that when it was possible for the owner to
actually give the pills or capsule to the cat, it would make it into the
stomach reasonably rapidly. It turns out that this is inaccurate.After 5 minutes 84% of capsules and 64% of tablets are still sitting
in the esophagus. Similar results were published in another study by
JP Graham (American Journal of Veterinary Research 2000).
The main concern with this information is that if tablets and capsules
sit in the esophagus for a prolonged period of time, this can cause
damage to the tissues in this area. This damage can lead to
esophagitis, which can lead to nausea, vomiting and megaesophagus. At
times, the esophagus can also respond by developing an ulcer or
stricture. The latter is a very serious complication requiring
aggressive therapy, preferably with balloon dilatation.
In addition, we probably have all had that uncomfortable feeling when a
tablet we have taken has gotten stuck on the way down. This could be the
cause of vomiting in some cats that are medicated. It is quite
frustrating to win the battle to get the pill or capsule down a cat and
then have it vomited up several minutes later.
Both this abstract as well as the study published by Graham et al.
clearly point to the need to administer either water or food after a cat
has been pilled with a tablet or a capsule. This will hasten the
movement into the stomach and cut down on the chances of the tablet or
capsule remaining in the esophagus for a prolonged period of time.
Although comparable studies have not been done in dogs, this advice is
sound in dogs, as well."
(End of quoted study)
The following is an anecdotal report from a person who ended up with a
very painful case of an ulcerated esophagus after a capsule became
lodged in her esophagus:
know the pain of an ulcerated esophagus personally and it is a living
hell. I was on doxycycline capsules (due to a cat bite) last year
and one got stuck in my esophagus. I did not think it was a big deal
and went to bed figuring it would eventually work it's way down. Several
days later I had suffered so much that I took myself to the ER. I had
to drink this horrible tasting cocktail with liquid lidocaine to get
relief. It worked, temporarily, but I had to drink a tsp of the
lidocaine 3x a day just to be able to swallow for about 30 minutes each
time. Forget eating. I lost 10+ lbs in less than 2 weeks. I couldn't
eat at all and could not swallow without the lidocaine. I laid in the
bed with a cup to spit in because it was too painful to swallow. It was
a great diet, but not one I'd recommend. Please take every
precaution you can to make sure this does not happen to your pet."
As an alternative to using pills and capsules to administer medications,
certain pharmacies can compound the medications into flavored liquids.
Please be aware that compounded medications may be more expensive than
medications dispensed by your veterinarian, but the use of these liquid medications can alleviate a great deal of stress
for both the pet and the human.
I am very involved in rescue work
and often deal with extremely frightened and painful animals whose trust I am trying
Pilling a sick cat/kitten who is feral or traumatized/frightened/painful, or has
severe upper respiratory disease
and can hardly breathe as it is, does not exactly make for a fast
friendship and development of trust.
When an animal is ill or injured, the last thing we want to do is add more stress
to the situation. I adopted a 9 year old cat
out to a really nice woman many years ago. Toward the end of Caliban's
life, the lady called me in tears
because Caliban was now in congestive heart failure and she was having a
hard time pilling him and was going to put him to sleep since he could
no longer receive his necessary medications. She felt so guilty for
failing Caliban by not giving him the medications that he desperately
needed but was also feeling guilty for
stressing the heck out of him in his final days with the pilling. This stress was
alleviated by using compounded, flavored liquid medications.
The most common flavor used for cats is 'triple fish' and if dealing
with a very bitter medication, this flavor is the best one to use.
Another flavor that is used is chicken and some cats do better with this
milder flavor than the very strong triple fish.
Please note that some drugs are so bitter that even compounding will
not hide the awful taste. An example of this type of drug is
amitriptyline which is often used for anxiety and inappropriate
elimination problems. Fortunately, this medication is formulated
into a small, coated pill but a food or liquid chaser still needs to be
administered if the cat is pilled.
Or, Pill Pockets can be used.
In cases where I have deemed medications necessary, I have had good luck
with Prozac for inappropriate elimination (marking) problems and it is
easier to give than amitriptyline. I have one patient that was
scheduled for euthanasia for constantly urinating on the owner's bed.
I put the patient on a small dose of Prozac that is fed to her every
night in a Pill Pocket. The owner splits the Pill Pocket into
three pieces and only one piece has the tiny pill piece in it but the
kitty gets all three treats each night. No stress to either the
owner of the patient....and the kitty
has not (knock on wood....) urinated on the bed for the past 8 months.
2/24/11 update: The patient
discussed above decided that she did not want to eat Pill Pockets
anymore but she is now readily eating them if they are rolled in
Since we all know that every
cat is different, I will mention again that some people state that they have
much better luck pilling their cats than trying to get liquids into
them. Some cats throw a fit if given liquid medications. The
problem with these cats, however, is that if you do pill them
successfully, they are not apt to take the water chaser very well.
This presents a bit of a problem and the hope is that they will eat some
canned food or drink some tuna juice or meat broth after being pilled.
Another favorable aspect of using a compounding pharmacy is that you can
pick the drug concentration so that the necessary dosage volume is not
I try to have the medication mixed in a
concentration that enables me to give 3/4 of a cc or less. This is an easy volume to administer to a cat.
Occasionally you may run across a drug that can't be compounded but I have yet to run into this situation.
preparations are medications that are formulated into a gel or ointment
that can be applied to the inner ear of the cat. That said, the
only frequently used medication that has shown to be adequately absorbed
by this route is methimazole (Tapazole) for
here have shown that the use of
transdermal methimazole is an effective way to administer this drug
and results in fewer gastrointestinal upsets.
Unfortunately, many veterinarians are under the mistaken impression that
other medications like steroids, antibiotics, and behavior-altering
drugs are adequately absorbed through the skin when they are not.
The goal of this article is to prevent the silent suffering that our
pets often go through when medications are administered without
appropriate precautions. I have outlined several options above:
1) Administer the pill or capsule and follow up immediately with a
chaser of a 4-5 cc of a liquid
using a syringe.
2) Administer the pill or capsule and follow up with the feeding of
canned food, baby food, tuna juice or a meat broth. Dry food or
dry treats can also be used but a higher moisture 'chaser' is preferred.
3) Use compounded, flavored liquid medications.
4) Use transdermal preparations. (Tapazol only)
5) Try Pill Pockets. If the patient will not eat Pill Pockets, try
rolling them in parmesan cheese, FortiFlora, or crushed Temptations or
6) Or...be lucky enough to have your cat eat the medication in canned
Please pass this
information on to anyone whose pets may benefit from the information.
It is my hope that the information will help to save some of our non-speaking
friends from a painful esophagitis and their caretakers from the stress of
pilling some hard-to-pill cats.
Information on this site is for general informational purposes only
and is provided without warranty or guarantee of any kind. This
site is not intended to replace professional advice from your own
veterinarian and nothing on this site is intended as a medical diagnosis
or treatment. Any questions about your animal's health should be
directed to your veterinarian.