Saturday, September 15, 2012
Equine Chronicle » Veterinary Compounding
Equine Chronicle » Veterinary Compounding
September 15, 2012
By Heather Smith Thomas
Compounding is the manipulation of a drug product to produce a dosage or formulation tailored to meet the needs of a specific patient. This can be done by mixing two drugs together, or creating a more palatable oral product by adding flavoring, creating an oral suspension by crushing tablets and mixing them with fluid, etc. Compounding can be done by a licensed pharmacist on the prescription of a licensed veterinarian, or by the veterinarian.
Scarlet Thomas, director of Pharmacy at Hagyard Equine Medical Institute in Kentucky, says compounding can legally be performed only when there’s no approved drug available in correct dosage, form or concentration to appropriately treat the patient. It is not legal to create something that merely duplicates an already existing product.
“There are a number of instances in which compounding could be beneficial or necessary There are a limited number of drugs commercially available for horses. There are more commercial options for small animals, due to the greater number of cat and dog owners,” explains Thomas.
“When there is not an appropriate commercially available product, or when a certain medication is discontinued or unavailable from pharmaceutical companies, compounding becomes necessary. Some medications get dropped by the manufacturer, perhaps due to profitability issues,” she says.
“When products are pulled off the market, for whatever reason (as long as it’s not a safety issue), this might be an appropriate instance to compound that medication. The owner and veterinarian must have some way to obtain these medications, to continue the therapy,” she explains.
In some instances equine patients are allergic to certain preservatives, dyes, fillers, and carriers that exist in commercially available products, and something else must be used. Some patients require tailored dosage strengths to meet a unique need. “If you’re using a human product or small animal product for a horse, and it’s geared toward a 25 pound dog or a 150 pound human and you are treating a 1300 pound horse, this can be challenging,” says Thomas. Compounding the product to appropriately tailor it for that horse is a logical solution.
“In some instances the horse may not be able ingest the medication in its commercially available form. It may be a human product that is not palatable, or it may not be feasible to give the horse 200 tablets of human medication. In those instances it may be necessary to manipulate the drug into a different formulation or dosage, or add flavoring so it could be given orally.”
Legal compounding requires a valid veterinarian-client-patient relationship. “Veterinarians should limit the use of compounded drugs to specific needs in specific patients, when there is no other method or route of drug delivery that is practical for that patient. If there’s a commercial product available that can be given to that horse, that’s the first choice,” says Thomas.
Compounded medications would be the next option, but require a valid prescription from a veterinarian, and must be patient specific. The veterinarian would have to have seen or know the animal and diagnose the condition to be treated. If there’s nothing commercially available to treat that case or there’s something unique about the patient that makes it impossible for the commercial product to be appropriate, then a compounded product would be considered.
“Talk with your veterinarian if a compounded product is necessary for a certain animal. Ask about the source of that compound, making sure it’s a reputable pharmacy that your veterinarian has confidence in and trusts,” she says. Ask which FDA approved drug(s) will be used to compound the prescribed medication. You want to know that the ingredients and potency of the compounded product are reliable
Commercial products that are already on the market should not be compounded. “If medications are compounded in the same dosage formulation as a patented product, it’s usually not for the health and welfare of the horse, but to offer a less expensive product,” she explains. The horse owner may choose a compounded substitute because it’s cheaper, but may be getting something less effective (or even dangerous) if obtained illegally.