Does imepitoin reduce signs of fear and anxiety in dogs frightened by loud noises?

PICO question: In adult pet dogs with a sensitivity to sudden loud explosive noises, does treatment with imepitoin, compared to no medical treatment, reduce levels of fear and anxiety? Clinical bottom line: Category of research: Treatment. Number and type of study designs reviewed: Two papers were critically reviewed. Both were double blind randomised placebo-controlled clinical trials. Strength of evidence: Moderate. Outcomes reported: Imepitoin given orally twice daily to adult dogs who were sensitive to loud noises such as fireworks or thunderstorms reduced owner rated levels of fear and anxiety responses when compared to placebo. Owner satisfaction with imepitoin treatment was mostly good, but a proportion of dogs developed mild-to-moderate side effects including ataxia, appetite changes, lethargy, and emesis during treatment. Conclusion: In adult pet dogs with a sensitivity to sudden loud noises, treatment with imepitoin, compared to no medical treatment, may reduce owner-rated levels of fear and anxiety responses in their dogs. Imepitoin appears to be generally well tolerated by dogs, is considered easy to administer by owners and can positively improve the welfare of dogs who show fear and anxiety in response to loud noises including fireworks and thunderstorms. Whilst no serious adverse effects were noted, a high prevalence of side effects were observed in the reviewed studies which were carried out using the manufacturer's recommended dose for noise phobia. These side effects were shown to be unacceptable to some owners, resulting in reduced compliance and satisfaction with treatment. Clinicians should proactively discuss potential side effects of imepitoin with owners, particularly if used at the manufacturer's recommended dose, and consider starting at a lower twice daily dose of 10 mg/kg and titrating up to 30 mg/kg as required. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient's circumstances and owners' values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.