cat inappropriate urination

Question
My four year old cat frequently urinates outside of litter box.  He does not have any medical problems and has been neutered.  He only goes on soft surfaces, does uses his litter boxes and now I have him on Elavil which does not seem to be working.  Does depo provera work or any other suggestions?  This has been going on for three years and is now getting worse.  It used to be infrequent.  we use enzyme cleaner.

Answer
Elavil works for some.  In a study done recently, however, Prozac (fluoxetine) has been shown to be most effective for inappropriate urination where there is no physical cause.  Following Prozac, Clomicalm (clomipramine) was second most successful.  Both drugs were proven more effective during treatment, and both were more likely to produce lasting results after the drug was discontinued than Elavil, Buspar and Valium.  I would definitely talk to your vet about switching to Prozac or Clomicalm.

Megestrol acetate is a synthetic progestin, along the lines of Depo Provera, which is sometimes successful for treating spraying or inappropriate elimination.  This is usually most successful with cats who had reached sexual maturity before neutering and have begun marking.  It is an option if antidepressants don't work.  However, be sure not to use this drug any longer than 2 months.  If used longterm, there is a tremendous risk of diabetes and mammary cancer, even in males.  One study I read suggested that, when used for 2 years, 96% of cats ended up with one or both of these complications.  And if the therapy is going to work, results should be evident in two weeks.