The Compounding Pharmacy Problem: What Pet Owners Should Know

October 10, 2012

A rare form of human meningitis has recently been in the news. The outbreak, believed to stem from fungal contamination of a medication compounded to treat back pain, has resulted in several fatalities. The manufacturer of the implicated medication is not a big pharma or an overseas company; the medication was produced by a compounding pharmacy in Massachusetts. The Food and Drug administration has identified fungal organisms in a sealed vial of methylprednisone acetate produced by the compounding pharmacy.

Pets not affected

This outbreak is unusual since the fungi involved, aspergillus and exserohilum, live in soil and water. Exactly how they came to contaminate the medication is under intense investigation. Since veterinarians don’t treat back pain in dogs and cats with steroids like methlyprednisone acetate injected around the spinal cord, there are no reports of fungal meningitis in pets, but veterinarians do use compounded medications, and understanding their role in managing disease in your pet is important.

Compounding defined

Compounding is the alteration of the original drug dosage form for the purposes of ease of administration or because the original dosage form is unsuitable for the purpose intended. Translated for the pet owner, compounding is flavoring a medication to hide the bad taste, dissolving pills into a liquid to facilitate administration, or putting multiple medications into one capsule to help a pet owner comply with a multidrug treatment protocol. Without a good compounding pharmacy, my job would be impossible.

Compounding dangers

Compounding is not regulated by the FDA because it is a process initiated by prescription and on a case-by-case basis. In veterinary medicine, compounding rules have been stretched in an attempt to create cheaper medications. Some compounding pharmacies offer expensive medications at unbelievably low prices. I suspect these cheaper products are being produced by what is known as bulk compounding from raw materials. Just last week, I had to advise a pet owner against using the compounding pharmacy’s cheaper “house” brand of an expensive medication. That medication is not currently available as a less expensive generic. Although I am sympathetic to the financial burden of treating a pet with cancer, my overriding concern is for the patient and the efficacy and safety of the prescribed treatments. Prescribing an approved medication provides some assurance of efficacy and safety for my patients.

Medication safety

Listen to your veterinarian. If they believe a particular medication is better, ask why. If they are concerned about the safety and efficacy of a compounded medication, I recommend trying to make the standard formulation work for your pet.

Learn more about safely medicating your pet.


Streamlining a Specialist Consultation for Your Pet

March 8, 2012

I saw a nice new patient the other day. Angus Blue came to The Animal Medical Center for an evaluation of the tumor growing on the side of his chest.

When I tried to call his owner two days later with the biopsy results, the call would not go through. Fortunately, his family called me the next day and I was able to get their correct number. Turns out Angus’ owner was so upset and nervous about the tumor and about seeing an oncologist, she wrote down the wrong phone number on the registration papers.

Veterinary specialists are really nice people, but seeing one can be intimidating because you generally only consult a veterinary specialist when your pet has a big problem, and of course you are going to be upset.

The little snag in communication with Angus Blue’s family made me wonder how pet owners could make their consultation with a specialist go more smoothly. Here are my thoughts:

1. Find the right specialist. The Internet can help locate the specialists in your area since all the veterinary specialty websites have a search function, but your veterinarian is the best source to identify the best specialist for you and your pet. If you have seen a specialist previously with another pet or for another problem, call and ask them about the right specialist for the current problem.

2. Check the website of the specialty hospital. Like The AMC, many of them allow pre-registration online in advance of your scheduled appointment. Pre-registration removes one task from your list on the day of the specialist appointment. If you get lost or are running late, pre-registration will speed the check-in process along. The website may also have helpful information such as directions and parking information.

3. Ask your veterinarian or call the specialty hospital and determine what information about your pet should be sent in advance of the appointment. Most of the time, the specialist will want a copy of your pet’s complete medical record and copies of any diagnostic images. With computer radiography and electronic medical records, getting the information to the specialist may be as easy as sending an email or burning the images to a CD.

4. Bring a list or all the bottles of the prescription and non-prescription medications and supplements you administer to your pet. A list should include the name of the medication, the dose and frequency. Tablet color is not helpful to the specialist since not all brands of tablets are the same color.

5. Write down your questions for the specialist or your goals regarding your pet’s medical care. Putting your thoughts down on paper will help you focus on what is important to you during the consultation and you can refer to your notes to make sure all topics important to you have been covered during the appointment.

6. Take a friend. Having an extra pair of hands is invaluable when juggling papers, a pen and a leash or carrier. Two pairs of ears are better than one to help remember what was said and what the options are for your pet. Finally, having someone to get coffee or lunch with while you wait is priceless.

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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.


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