Sunday, March 24, 2013

Compounding Pharmacies and Drug Shortages--Veterinary Blog by LauraMc

ou’ve probably heard of the outbreak of fungal meningitis in people caused by contaminated methylprednisolone acetate from a compounding pharmacy in the northeast. The outbreak, associated with a weird fungus called Exserohilum rostratum, has caused 370 meningitis cases and 39 deaths. The contaminated product was distributed to various states and was used for anti-inflammatory injections into joints as well as the spine.According to the CDC, the total number of fungal infections from the product is 656 (as of 12/28/12), including infections in and around the spine and in joints.

A compounding pharmacy is a pharmacy that obtains the raw ingredients for a drug and formulates them into a useable medication, whether an oral, topical, or injectable product. They tend to operate “below the radar” of the FDA, which can lead to problems. As well as the contamination issue, a few years ago a number of polo horses died from a dosage error in a compounded injection.

NPR did a great piece on the fungal meningitis outbreak this week. They interviewed physicians and asked why anyone would use a compounding pharmacy if there is risk of the product being improperly formulated or contaminated. The answer: “Dr. Bill Greene says St. Jude Children's Hospital in Memphis depends on compounding pharmacies for smaller dosages or preservative-free products. In a growing number of instances, it's a matter of national shortages with FDA-approved versions.”

In veterinary medicine, we also rely on compounding pharmacies. In some cases, it’s to provide a medication which is not commercially available, such as ophthalmic tacrolimus for dogs with dry eye. In other cases, it’s to provide a formulation of a commercially available medication in a lower dose or more palatable form for pets. For example, we use a lot of gabapentin for chronic pain in cats and dogs. The human-size pills and capsules are too high of a dose for most pets, and although a liquid solution is available for humans, it contains the sweetener xylitol, which is toxic for dogs. Therefore, we have gabapentin compounded into a chicken-flavored, lower-dose, xylitol-free liquid for pets.

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