Medication Mix-Ups

March 13, 2014
animal poison control image

Photo: aspca.org

Next week is Poison Prevention Week. According to ASPCA Animal Poison Control, the number one cause of poisoning in pets is prescription and over the counter drugs. The poisoning occurs because pets inadvertently consume either pet or human medications. To help raise awareness of potential sources of pet poisoning, here are some recent issues with medications reported to the veterinarians at The Animal Medical Center.

Name Swap
Most drugs have a brand name like Lasix® or Amoxi-tabs® and a corresponding generic name like furosemide or amoxicillin. I will admit I may use the brand name when speaking with pet owners but write a prescription for the generic medication because the generic brand is typically less expensive, though equally as effective. This dual naming system often creates confusion for the pet owner sometimes resulting in double medicating the pet. Oreo has heart failure and is being treated with Lasix. A second prescription of the same medication from a specialist said furosemide. The owner administered the new medication along with the old medication because she didn’t know the two were the same drug. Fortunately, the error was recognized and no harm came to Oreo.

Rainbow Roulette
Please keep in mind that your veterinarian usually doesn’t see the pills dispensed to your pet. Because I don’t see the pills, your description of “the oblong blue one” doesn’t help me determine the medication prescribed. Also keep in mind that generic medicines can be the same drug, but manufactured in different colors. If a medicine is dispensed and does not look like the last prescription for the same medicine, don’t hesitate to ask the pharmacist or someone at your veterinarian’s office to be sure the correct medication was dispensed.

A Pill for You and a Pill for Me
Last week one of our cat patients was inadvertently given one of her owner’s medications. Both pill bottles were sitting side by side on the counter. Even worse, the medication contained Tylenol® (acetaminophen), a human drug which is very toxic to cats. The owner quickly recognized the problem and successfully induced vomiting, but it could have been a disaster for the cat.

Yes, We Mean Three Times a Day
Three times a day does not mean, put all three pills in the food and hope your pet eats a bite of food containing a pill every eight hours. Don’t count on your pet to count the hours between doses. Give each pill separately at the prescribed intervals to avoid over- or under-dosing your pet.

Words to the Wise

  • Ask the prescribing veterinarian what each medication prescribed for your pet is meant to treat. If there are multiple medications to treat the same problem, ask if they are duplicate medications with different names on the labels.
  • If you see more than one veterinarian for your pets multiple problems, take all the medication bottles with you to each visit. Be sure each veterinarian knows what the other has prescribed.
  • Do not talk about the color of the pills with your veterinarian. We prefer the names of the medication to be read off the bottle. Even badly pronounced drug names are better than a description like “the white one, a little smaller than a dime.”
  • To avoid a medication mix-ups, store your medications in a different location than you store Fluffy’s.
  • Keep the toll free number of an animal poison hotline handy for an emergency:

- Pet Poison Helpline (800) 213-6680
- ASPCA Animal Poison Control (888) 426-4435


Drug Fright: Scary Medication Labels

April 3, 2013

Everyone has heard them: the rapid fire voiceovers on television advertisements for medications. They sound something like this, “Do not use this medication if you have serious heart disease, suicidal thoughts, liver problems or hangnails. Ask your doctor if this drug is right for you.” If you fast forward through commercials on your DVR and have missed the voiceover, then perhaps you have opened a bag from your pharmacy and found the accordion pleated paper, printed in size two font, containing drug information, warnings, contraindications, precautions, adverse reactions and risks.

Here is a portion of one for a commonly used human medication:

  1. General: Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of mouth, nose, and throat
  2. Cardiovascular System: Hypotension, headache, palpitations, tachycardia, extrasystoles
  3. Hematologic System: Hemolytic anemia, thrombocytopenia, agranulocytosis
  4. Nervous System: Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions
  5. Gl System: Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation
  6. GU System: Urinary frequency, difficult urination, urinary retention, early menses
  7. Respiratory System: Thickening of bronchial secretions, tightness of chest or throat and wheezing, nasal stuffiness

Here is a portion of a drug label for a canine chemotherapy agent:

Anorexia, lethargy, vomiting, lameness, weight loss, blood in stool/GI bleed/hemorrhagic diarrhea, musculoskeletal disorder, dehydration, dermatitis, pruritus tachypnea, localized pain, nausea, general pain, polydipsia, pyrexia, flatulence, pigmentation disorder, neutropenia, thrombocytopenia, increased alanine, aminotransferase, hypoalbuminemia, decreased hematocrit, hyperbilirubinemia, increased creatinine, urinary tract infection.

The United States Food and Drug Administration has strict regulations governing drug labels. Drug labels should be accurate and not promotional. The list of possible side effects is comprehensive to help prescribers, like me, alert their patients, like your pet, to possible problems that might arise while the medication is being taken. Without this critical information, you might keep giving a medication that is actually making your pet worse. The information on a drug label helps me to weigh the risk of not treating a disease with benefits of a medication used to treat the disease.

The warning labels for both the commonly used human drug and the canine chemotherapy agent sound moderately frightening and yet these drugs are critical to improving a patient’s quality or quantity of life. What the drug labels can’t substitute for is experience. Once your veterinarian or physician has used a drug on many patients, we know what to expect and what to tell you to expect. Reading the drug label is a good thing since it helps you to recognize any adverse reactions to medications early. Not giving a drug to your sick pet because the drug label is frightening is foolish, unless you tell your veterinarian about your concerns and together you decide the best course of action for your pet. Remember, we love to talk about sick pets and about medications; it’s what we do every day!

Oh, by the way, the human drug with the seven body system long list of adverse effects was Benadryl.


Pet Medications: 6 Tips to Keep Pets Safe

August 30, 2012

All of us want to give the best and safest medications to our pets. Here are my tips to make sure your pet gets the medications he needs.

1. Approved is easy

Some of the work of selecting safe medications for your pet has already been done for you. The United States Food and Drug Administration (FDA) approves medications for use in pets by a similar process used for human drugs. Animal vaccines receive approval from the United States Department of Agriculture and treatments to prevent ectoparasites, also known as flea and tick preventatives, by the Environmental Protection Agency. Approved medications help you ensure you are administering drugs that have met standards for both safety and efficacy.

2. Don’t play veterinarian and give your own medications to your pet.

Certain human medications can be lethal to pets. For example, acetaminophen (a common brand is Tylenol) in cats, ibuprofen (a common brand is Advil) in dogs. The leading phone call to animal poison control experts is about accidental or owner administered human medications.

3. Human pharmacies

Like nearly all veterinarians, I too prescribe human medications for my patients. I do this for convenience when the pet owner is far from The Animal Medical Center or because there is not a veterinary-approved version of the drug. Human medications are most often a solution for dogs over 40 or 50 pounds, since tablet and pill sizes are too big for cats and little dogs. So if it is Saturday night and your veterinarian tells you to come to the clinic to pick up medication, it is because nothing but a doggie drug or kitty capsule will do.

4. Legal drugs

The law requires all veterinarians to prescribe medications only in the context of a valid veterinarian-client-patient relationship. Translated from the legalese, the statement means I have to examine your pet in order to prescribe a medication. This is all about safety –Fluffy’s safety. Although you are sure she has the same skin condition as last year, I need to be sure you are correct in order to prescribe the medication with the best chance of fixing the problem with the least risk of an adverse reaction.

5. Custom compounding

Veterinarians rely on compounding pharmacies to convert pills and tablets into chicken-flavored liquids, to place multiple medications into a single capsule to simplify medicating the pet with bear trap-like jaws, or to scale down a large tablet for a tiny terrier. Regulations govern compounding like they do for any prescription. Prescriptions for compounded medications can only be written on a case-by-case basis and must be made specifically for an individual pet. Compounded medications may mean the difference between therapeutic success and failure, but because compounded products are not regulated, products may be of variable quality as demonstrated in a recent scientific study of compounded trilostane. Using a pharmacy certified by the Pharmacy Compounding Accreditation Board assures you of a compounding pharmacy that adheres to established principles, policies and standards.

6. Internet pharmacies

The challenge in using an internet pharmacy is finding the right one. Although the prices offered by electronic drug stores are attractive, high-quality service may be lacking. Red flags in online reviews include companies who fill email boxes with spam, distribute counterfeit products, or never ship product at all. I spoke with the CEO of PetCare Rx, Jonathan Shapiro, about how his company ensures the quality of medications they ship. “PetCare Rx purchases product directly from the manufacturer or veterinary purchasing groups to protect our customers from counterfeit products. Consumers should look for an internet pharmacy accredited by the Veterinary Verified Internet Pharmacy Practice Sites (Vet-VIPPS). This accreditation ensures the pharmacy complies with regulations and laws governing pharmacy practice.”


Avoiding Veterinary Hospital Mistakes

July 9, 2012

Much has been made lately about a new book highlighting the commonalities between human and animal diseases. Because we share similar diseases with our animal companions, we may also share similar risks for hospital mistakes.

In the spirit of Zoobiquity, here is an adaptation to the veterinary setting of the recommendations made by Prevention magazine on avoiding human hospital mistakes.

  1. Check your veterinarian’s experience. You can confirm your veterinarian is fully licensed to practice medicine by checking the professional license bureau in your state. Unlike doctors for humans, veterinary interns have completed all their training and are fully licensed to practice veterinary medicine. Veterinarians selected for internships get training beyond that required for licensure. Board certified veterinary specialists are common, especially in urban areas, and can be identified through their specialty website. For a searchable list of specialties with links to each of the specialty websites, click here.
  2. BYOB — medication bottles that is! I can’t tell you how many times a pet owner forgets to mention a medication prescribed for their pet by their regular veterinarian or gives the name of a similar sounding medication instead of the one their pet is taking. Help avoid a prescription mistake by bringing medication bottles with you when you visit your veterinarian.
  3. Avoid a close call with a close shave. Stay with your pet while a small amount of fur is clipped over the lump to be surgically removed or the knee to be repaired. The shaved area will serve as a reminder to the surgeon regarding the specific site where surgery is to be performed.
  4. There’s safety in numbers. Bring a friend or family member with you when you visit your pet in the hospital. You and your pet will be thrilled to see each other and it will be hard to absorb all the information your veterinarian wants to communicate about your pet’s health and medical care. Your friend’s job will be to listen, take notes, and ask any questions you forget to ask the veterinarian. Once you return home, you will have the notes as a reference.
  5. Use the services of the veterinary hospital’s social worker. For many years I relied on The Animal Medical Center’s social worker to help pet owners make difficult treatment decisions. I could supply detailed medical information about treatment and prognosis, but needed reinforcement when families were struggling with decision making. For additional counseling resources, click here.
  6. Smile! You don’t have to smile at the veterinarian or veterinary technician taking care of your pet; your pet is so darn cute we can’t help but be attentive to every need of your favorite feathered friend or fluffmonster. Still, it makes our day to be appreciated with a smile or a thank you!

A Compounding Pet Pharmacy Can Be a Lifesaver

September 20, 2011

Tracey required eye drops in a special bottle. Sapphire refused pills she desperately needed. Bailey turned from a fluffy, gray kitty into a man-eating lion every time he needed a thyroid pill. The medication list for Rufus was so long, I was worried about a dosing mistake.

Fortunately for the veterinarians and our patients at The Animal Medical Center, there is a creative group of pharmacists just up the street from us — Best Pet Rx. This week alone, the group solved the medication problems of all four pets above and more.

Not the typical chain drug store you see on every corner or in every strip mall, a compounding pharmacy has specialized equipment to take an existing medication and formulate it into a patient-friendly “compound.”

Tracey has a water fetish, and at one time drank eight liters a day. In humans, this problem is treated with a nasal spray that comes from a special bottle. Dogs do not think nasal sprays are fun. With a water guzzler like Tracey, we take the human nasal spray and use it as an eye drop, except the bottle doesn’t drop, it sprays. The compounding pharmacy has a special sterile area where the medicine can be removed from its spray bottle and be put in an eye drop bottle to facilitate administration. Two drops a day has brought Tracey down to three liters of water a day, which is 50 percent less than she was drinking.

Sapphire is very smart, very beautiful and avoids pills like the plague. The solution to her medication problem was quite simple: Turn the pills into a beef-flavored liquid, easily squirted into the side of her mouth and readily swallowed because of the tasty beef flavor.

Bailey needed a different solution to his medication problem. Lucky for him, his prescription was for thyroid pills. These pills can be compounded into a gel and applied to the inside of the ear, transporting the medication across the skin and into the bloodstream. Not all medications can be compounded into a transdermal gel, but when they can it is a life saver.

The solution to Rufus’ multi-pill problem is my favorite. The pharmacists took his morning and evening pill allotments and placed them into a gelatin capsule. Each capsule delivered an entire morning or evening dose of all medications. Clearly this was much simpler than giving four pills at a time.

If you are having trouble medicating your pet, ask your veterinarian to work with a compounding pharmacy to develop a custom solution to your pet’s medication problem. No veterinary clinic should be without one.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Medication Madness

February 18, 2011

Several months ago, I blogged tips for getting your sick pet to eat and take his medications.

This week, I thought I would give tips for the pet owner to help safely and correctly administer medications.

Prescribing medications starts at the scale. At The Animal Medical Center (AMC), we weigh pets in kilograms, a great frustration to many pet owners who carefully monitor their pet’s weight in pounds. We do this because most drug dosages are given in mg/kg and weighing in kilograms eliminates one step (and one potential place for error) in the calculation of a drug dosage.

If you multiply the weight in kilograms by 2.2 you get the weight in pounds or ask the staff at your veterinarian’s office to weigh your pet in pounds for you. Most scales have a switch you flip to toggle between pounds and kilograms.

Liquid medications are commonly prescribed for cats and small dogs. Most liquid medications have a short shelf life and you will be called upon to reconstitute a second bottle if your pet needs a long treatment. If you have to reconstitute the medication, read the directions carefully. At the AMC, we include the correct sized syringe to measure the water accurately into the bottle. Make sure you know exactly how much water to add so the medication is neither too weak nor too strong.

Before you leave the veterinarian’s office, make sure you have the answers to the following questions regarding your pet’s new prescription.

  • If you have never given your pet medications, ask the veterinarian or the veterinary technician (nurse) for a lesson.
  • Should the medication be given with, without food or in no particular relationship to feeding?
  • Can the medication be given with any other prescriptions your pet is taking?
  • If your pet is very difficult to medicate, ask which are the most important medications to administer. Give the most important medications first, in case your pet becomes resistant and you become unsuccessful at medicating.
  • If you pet is very difficult to medicate, ask if the medication is available in any other form, i.e., liquid, not pills, injections, not liquids, or even a transdermal gel.
  • How should the medication be stored and if it is a liquid, does it need to be shaken?
  • If you miss a dose or find a pill under the sofa cushions, what should you do?
  • What would a medication reaction look like and how should you respond?

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.

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For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Medication Toxicity

August 3, 2010

Late last week, the United States Food and Drug Administration issued a warning to women who use the drug Evamist®, made by Ther-Rx Corporation to treat the symptoms of menopause. Exposure to this medication can have negative affects on both children and pets.

Evamist is sprayed on a woman’s arms to reduce hot flashes. Two cases of toxicity have resulted in female dogs and ingestion of the spray was the result of licking or being held in their owner’s arms. Signs of toxicity are not immediate. If contact between the sprayed skin and a pet cannot be avoided, women should cover their skin with clothing.

The Evamist problem is just the tip of the iceberg when it comes to medication toxicity and pets. VPI (Veterinary Pet Insurance) reports nearly 20,000 claims for poisoning of pets during the 4 years between 2005 and 2009. The number one cause of pet poisoning, you guessed it, is accidental exposure to human or pet medications. The average policyholder claim was $791 dollars per poisoning episode.

Medications poisoning can occur a variety of ways. Pet owners may simply want their sick or painful pet to feel better and administer their own medications. This commonly occurs with owner-administered non-steroidal, anti-inflammatory drugs such as ibuprofen and naproxen. Acetaminophen is another potentially deadly pain reliever. Cats are very sensitive to its effects and can develop anemia, but dogs develop liver problems. Pills are easily dropped unnoticed, but if your pet jumps on every dropped object like it is a tasty morsel, down goes the pill. I’ve seen pets ingest their owner’s antidepressant medications this way and end up in the AMC ICU.

Because pets are superbly clever, they always find new ways to cause trouble. Some inquisitive dog got into trouble by prowling in the bathroom trash. He found a cotton swab used to apply a skin cancer drug. According to Animal Poison Control, the residual drug on the cotton swab was enough to cause severe toxicity, even death. Cats are also sensitive to this drug.

Animal Poison Control is a 24 hour a day, seven day a week service, available to pet owners and veterinarians. The $65 fee provides medical advice to veterinarians and peace of mind to the pet owner. Once the fee has been paid for an episode of poisoning, additional calls related to the poisoning incident can be made without additional charges. The Animal Poison Control number is (888) 426-4435.

The Animal Medical Center is open 24 hours a day, 7 days a week for emergency, routine and specialty care: (212) 838-8100.

The Animal Medical Center
For 100 years, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


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