Treatment

As there is currently no cure for cats with FIC, treatment options are aimed at keeping the clinical signs to a minimum and increas­ing the disease-free intervals. Because FIC can be a chronic condition in some cats, excellent client communication in conjunc­tion with MEMO (multimodal environmen­tal modifications) and dietary therapy and possibly pharmacologic agents, may be ben­eficial for managing FIC.

As environmental stressors can exacerbate clinical signs of FIC, MEMO therapy has been shown to be successful in most cats with FIC (Buffington et al. 2006). However, placebo controlled trials are difficult when evaluating cats with FIC due to the waxing and waning nature of the disease as well as the numerous variables that one encounters in a home environment. After the diagnosis of FIC is made, a thorough environmental history (including any inter-cat conflict), as well as notation of all other comorbidities present, needs to be obtained so the clinician can begin to tailor a plan to address all the needs of each individual cat. Helpful modifi­cations can then be recommenced to the cli­ent. Key resources to consider include water, food, litter boxes, interaction with humans and other animals, and hiding or resting areas (Herron and Buffington 2010).

Diet

Cats with FIC fed a canned diet tend to show a significant reduction in the clinical signs. (Markwell et al. 1999). Increasing water intake by feeding canned food — or other methods, such as broths or automatic water dispensers, may also be beneficial for cats with FIC. It is hypothesized that added water may help dilute the potential “noxious” stimulants in the urine such as urea and potassium chloride. One should also consider that for some cats, canned food or added dietary moisture in the forms described above may actually serve as a form of environmental enrichment (e.g., increased contact with humans who provide the food or differences in mouth feel/ texture for the cat), which might have a positive impact on the cat's clinical signs (Westropp 2014).

Recent clinical studies have supported nutritional management with L-tryptophan and alpha-casozepine (Beata 2014). This may be especially as the daily administration of treatments can be potentially difficult or even stressful. As stated previously, stress may contribute to anxious behavior and it appears to play a key role in the pathogenesis of FIC. Use of dietary supplements or therapeutic foods may therefore be helpful to decrease anxiety and stress, however, clinical studies are needed with the final product showing that the expected efficacy is present.

Pheromones

Feliway^e is the synthetic F3 fraction of the natu­rally occurring feline facial pheromone. Treatment with this pheromone has been reported to reduce the amount of anxiety expe­rienced by cats in unfamiliar circumstances, a response that may potentially be helpful for FIC cats (Westropp 2014). In a pilot study eval­uating Feliway® in cats with FIC, a decrease in the number of days they exhibited clinical signs was reported, although this finding was not significant (Gunn-Moore and Cameron 2004).

Drug Therapy

A variety of drugs has been used in cats with FIC, including amitriptyline and glycosami­noglycans. Unfortunately, prospective, rand­omized, properly masked, placebo-controlled studies are lacking to confirm their clinical efficacy (Westropp 2014). If MEMO and die­tary (and possibly pheromone) therapy fails to control signs, these medications can be con­sidered. It must be emphasized that these drugs should not be used for cats on initial presentation for care of FIC; they should be considered only for cats after their environ­mental and dietary needs have been addressed, and should not be discontinued abruptly.

Amitriptyline (2.5-7.5 mg/cat PO SID), a tricyclic antidepressant appears to help clini­cal signs in some cats with severe, refractory FIC (Chew et al.

Pentosan polysulfate sodium is a semi­synthetic carbohydrate derivative similar to glycosaminoglycans that are approved for humans with IC. A multi-centered, placebo- controlled, masked study in cats with FIC reported no significant differences when comparing pentosan polysulfate sodium with placebo (Chew et al. 2009). However, all groups had clinical benefit, suggesting a strong “placebo” effect. All medication was provided to the cat in a food treat; the authors of this study hypothesized that improving the interaction and environmental needs of the cat may inadvertently have contributed to the positive outcomes noted in all groups. Similar findings were reported in two other studies evaluating GAG replacers in cats with FIC (Westropp 2014).

Analgesics to reduce pain during acute episodes are advocated, although studies evalu­ating their use have not been reported. Current management includes opioid analgesics (butor­phanol or buprenorphine) and/or NSAIDS.

Glycosaminoglycans, pheromones, seroto­nin modulating drugs, or salt supplementa­tion have been shown to be no better than a placebo but can be considered in difficult, highly recurrent or chronic cases of FIC.