Ace refused tablets.

By his final year, his gabapentin came as a liquid we gave him by mouth.

Between Ace and Queen, our poodle with heart disease, we have managed ten-plus medications at different times. Pill pockets, treats with a pill tucked inside, and a morning routine we could do in our sleep.

So if your dog has figured out the pill pocket, you are in very good company. Here is what veterinary teams recommend, from the easiest approach to the more hands-on ones.

Start with a small treat, and make it a game

The easiest way is still to hide the pill in food. Use only enough to cover the pill, so it goes down in one bite, and hide one medicine per treat.

Cornell’s canine health center suggests turning it into a game: a plain treat, then the treat with the pill, then another plain treat right away. Ohio State’s veterinary behavior team calls a version of this the 1-2-3 method. Your pet is happily expecting three bites in a row, and the pill rides along in the middle one.

A few things to check first:

• Ask your veterinarian or pharmacist whether the medicine should be given with food. Some work better with a meal, and some need an empty stomach.

• Not every medicine mixes with every food. Cornell’s pharmacy notes that some don’t combine well with cheese, so ask before you reach for it.

• Don’t cut, crush or break a tablet, or open a capsule, unless your veterinarian tells you it’s okay.

• If you use peanut butter, read the label. Some peanut and nut butters contain xylitol, a sweetener that can be poisonous to dogs.

When hiding it stops working

Some dogs will eat around a pill no matter what you wrap it in. When that happens, it may be time to give it by hand. Veterinary pharmacists at Cornell describe it like this:

1. Relax first. As Cornell puts it, your dog will reflect your emotions.

2. With one hand, hold the top of your dog’s muzzle and gently tip the head back so the chin points up.

3. With the other hand, open the lower jaw and place the pill as far back in the mouth as you can.

4. Close the mouth and hold it gently, with the head level, until your dog swallows.

5. A gentle rub or a soft blow on the nose can help start the swallow.

6. Finish with a treat or some praise, so it ends on a good note.

If you’ve never done this, ask your veterinary team to show you at your next visit. It’s a completely normal thing to ask.

Giving a cat a pill

Cats need one extra step, and it matters.

A tablet or capsule given dry can stay in a cat’s esophagus instead of reaching the stomach. In a study at Colorado State, tablets given without water still hadn’t reached the stomach a minute later. With a little water after them, more than nine in ten had. A few medicines, including the antibiotics doxycycline and clindamycin, have been linked to injury of the esophagus in cats.

Cornell’s pharmacy recommends this:

1. Hold the top of your cat’s head and gently tilt it back so the chin faces up.

2. Open the mouth by pressing gently on the front of the lower jaw.

3. Place the pill as far back in the mouth as you can.

4. Gently rubbing the throat, or blowing softly on the face, can help your cat swallow.

5. Right away, give about a teaspoon (5 to 6 mL) of water from a dropper or syringe. If water is a struggle, ask your veterinarian or pharmacist whether a little tasty liquid or a small bite of food is okay with that medicine.

Pill pockets made for cats are another good option.

Other things to ask your veterinarian about

• A pill gun or pill popper. It holds the pill on a soft tip and places it at the back of the throat, so your fingers stay out of your pet’s mouth. Ask your veterinary team for a quick demonstration.

• A different form. Some medicines can be made into a flavored liquid or a chewable by a compounding pharmacy. Compounded medicines are not FDA-approved, so ask your veterinarian whether an approved option would work first.

• Another approach, if it has become a struggle. If your pet is fighting every dose, stop and tell your veterinary team. They can look for something your pet tolerates better.

If it comes back up

If your pet spits out a pill or vomits after a dose, call your veterinarian before you give another one. Whether to repeat it depends on the medicine, and a second dose can mean too much.

On the hard mornings

Some mornings the pill goes down in a pill pocket and you never think about it again. Some mornings it takes three tries and a kind of patience you didn’t know you had.

Both mornings count. You showed up, and your pet is lucky to have you.

If the routine has started to wear on you, you’re not imagining it. We wrote about that in The Caregiver Nobody Sees.

You don’t have to figure it out alone, either. Care Circle is a free place to talk with other people caring for a sick pet, and the NurturedPet app is the companion we built for days like these. It’s in free beta now.

Sources

We’re arranging a veterinary review of this article. Until it’s done, here are the sources behind it.

• Cornell University Hospital for Animals Pharmacy: Giving Your Dog Oral Medications

• Cornell University Hospital for Animals Pharmacy: Giving Your Cat Oral Medications

• Cornell Riney Canine Health Center: How to medicate your dog

• Ohio State University Veterinary Medical Center: Conditioning Your Pet to Take Medication

• Colorado State University Veterinary Health System: How to give a cat a pill

• University of Illinois College of Veterinary Medicine and Fear Free: How to Pill Your Pet with Kindness

• Texas A&M School of Veterinary Medicine: Tips for Feline Medi-cat-ion Administration

• U.S. Food and Drug Administration: Medications for Your Pet, Questions for Your Vet

• U.S. Food and Drug Administration: Veterinary Medication Errors

• U.S. Food and Drug Administration: Paws Off Xylitol; It’s Dangerous for Dogs

• U.S. Food and Drug Administration: FDA-approved and pharmacy-compounded drugs for pets

• Westfall DS et al. Evaluation of esophageal transit of tablets and capsules in 30 cats. Journal of Veterinary Internal Medicine, 2001

• German AJ et al. Oesophageal strictures in cats associated with doxycycline therapy. Journal of Feline Medicine and Surgery, 2005

• Beatty JA et al. Suspected clindamycin-associated oesophageal injury in cats: five cases. Journal of Feline Medicine and Surgery, 2006

This article shares general information from veterinary sources. It isn’t a substitute for advice from your own veterinarian, who knows your pet and their medicines.