There have been reports in the news that the use of a pharmacy compounded combination of toltrazuril and pyrimethamine may result in severe adverse side effects or even death in equine patients. Investigation into the exact cause is still ongoing but these incidences appear to be associated with two compounded formulations, and this is the purpose of the alert.
According to recent reports, two incidences have resulted in the death of four horses along with the acute onset of severe neurologic disturbances in an additional six horses. These resulted from two different forms (paste and suspension) of compounded products, and both contained toltrazuril and pyrimethamine. All ten horses were being treated for equine protozoal myeloencephalitis (EPM) with a non FDA approved combination drug formulated at a veterinary compounding pharmacy. The exact cause of the toxicity has not been established.
It is our understanding that the FDA is working closely with the state boards of pharmacy and several state health departments to investigate the cause of these deaths. Out of an abundance of caution, the AVMA PLIT wanted to make you aware of these incidents.
For the most current information, rules, and regulations, you can monitor the FDA website. Equine practitioners are encouraged to report adverse events or side effects related to the use of any products to the FDA's Veterinary Adverse Event Voluntary Reporting Program.
Links to Recent Industry Articles
http://www.thehorse.com/articles/33870/compounded-drug-eyed-in-thoroughbred-deaths http://equimanagement.com/article/horse-owner-alert-bad-epm-drug-16578
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