Oral diazepam in the cat: acute hepatic necrosis
4-year-old spayed queen receiving oral diazepam for 7 days for urine marking. She is now anorexic, lethargic and jaundiced, with ALT of 1,850 U/L (reference < 100) and a prolonged prothrombin time.
What is the interpretation and the most appropriate approach?
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A. Stress-induced hepatic lipidosis: feeding tube and continue diazepam
Lipidosis does not explain such a high ALT in such a short time nor the link with the drug. Continuing diazepam may be fatal.
B. Expected enzyme induction: reduce the dose
Benzodiazepines do not cause this kind of induction in cats. Jaundice, coagulopathy and very high ALT indicate severe hepatocellular injury.
C. Idiosyncratic hepatic necrosis due to diazepam: stop it and give intensive supportive care
Correct. Repeated oral diazepam can cause unpredictable, often fatal acute hepatic necrosis in cats. Stop it and provide fluids, glucose monitoring, vitamin K1, antioxidants (N-acetylcysteine, SAMe) and nutrition.
D. Neutrophilic cholangitis: antibiotics and continue diazepam
Without fever or biliary findings, and with a recently started hepatotoxic drug, the most likely cause is diazepam. Continuing it worsens the injury.
lightbulb Key takeaway
Avoid oral benzodiazepines in cats for behavioural problems; safer alternatives exist. If they are used, measure ALT before and a few days after starting. In any acute liver disease, always review recent medication.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.