Drug compounding is not new, but there have been some recent high profile events, both in the human and the veterinary world, that have brought the issue back into prominence. These include the 2009 deaths of 21 polo ponies at the U.S. Open Polo Championship in Florida after an error was made when mixing a compounded medication for the ponies, and most recently the 2012 outbreak of human fungal meningitis, when contaminated medication was dispensed to physicians around the country from New England Compounding Center. These events may lead to legislative changes that affect the compounding of medications in veterinary medicine and those changes could impact the prescribing of medications for cats.
What exactly is ‘compounding’? My recent involvement on the American Veterinary Medical Association’s (AVMA) Clinical Practitioners Advisory Committee has taught me a lot about the ins and outs of compounding. The AVMA is working hard to educate veterinarians and pet owners about compounding by posting information on their website, www.avma.org, as well as holding educational webinars for veterinarians. Much of the information that I am including in this blog article came from the AVMA. Below are some compounding facts:
What exactly is ‘compounding’? My recent involvement on the American Veterinary Medical Association’s (AVMA) Clinical Practitioners Advisory Committee has taught me a lot about the ins and outs of compounding. The AVMA is working hard to educate veterinarians and pet owners about compounding by posting information on their website, www.avma.org, as well as holding educational webinars for veterinarians. Much of the information that I am including in this blog article came from the AVMA. Below are some compounding facts:
- Compounding is the manipulation of a drug beyond that stipulated on the label. Examples include mixing, diluting, concentrating, flavoring, or changing a drug’s dosage form, in order to tailor the drug for a specific patient. In the cat world, compounded medications are widely used. Why?
- Many of the drugs that we prescribe are not available in a strength that is appropriate for a cat. Thus manipulation of that drug is the only way we can dose it correctly for a feline patient
- Knowing that cats can challenge the best of us when it comes to being medicated, unless we can somehow manipulate a drug to make it more acceptable to the cat (‘if it’s tuna flavored, I’ll consider it’), we run the risk that some of our patients simply will not get needed medication.
- In other cases, a patient may resist oral medications altogether, no matter how the medication is manipulated. In these cases, there are some medications that can be made up into a gel that can be applied topically on the inside of the cat’s ear (known as a ‘transdermal’ or ‘across the skin’ application of drug). A very limited number of drugs have been studied and shown to work when given by this route, but one that is used commonly to treat overactive thyroid conditions in cats (methimazole) usually works quite well when given by the transdermal route.
- Compounding is regulated by both the federal government (FDA, or Food and Drug Administration) and state governments.
- Compounded drugs are not the same as generic drugs! A generic drug is a non-brand-name version of a drug. Generic drugs are approved by the FDA.
- Compounded drugs are not FDA approved drugs. Even though compounding involves manipulating or tweaking already approved FDA drugs, when a drug is compounded, the new form may or may not perform in the same way as the approved drugs.
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