Community pharmacists face a growing challenge: They are being asked to fill an increasing number of veterinary prescriptions. This trend is here to stay, and the challenges pharmacists face in filling pet prescriptions will be compounded if the Fairness to Pet Owners Act of 2015 is enacted as law. This Act would require veterinarians to provide a prescription, up front, for pet owners to fill either at their veterinary practice or at a pharmacy of their choice.
Is our pharmacy profession ready for this influx of veterinary prescriptions?
In 2013, the Food and Drug Administration issued a warning about a pattern of veterinary prescription mistakes. In 2014, the Journal of the American Veterinary Medical Association (JAVMA) printed an article about substitution errors made by pharmacists when dispensing veterinary prescriptions. In the JAVMA article, a startling 10% of veterinarians polled stated that their patients have been harmed when pharmacies made substitutions in filling pet prescriptions.
Recognizing the need for veterinary pharmacy education, the National Association of Boards of Pharmacy amended the Model State Pharmacy Act in 2015 to include the requirement of a veterinary reference, such as Plumb’s Veterinary Drugs, to reduce the risk for error when pharmacies fill prescriptions intended for animals.
Pets are not small humans. Medication doses and toxicities for pets may or may not correlate with human prescribing information. For example, a prescription for tramadol 50 mg TID would be reasonable for a 60-kg woman, but a 60-kg bitch (female canine, that is) would more likely be prescribed tramadol, 300 mg TID. Acetaminophen is toxic to cats, and xylitol (an excipient) is toxic to dogs.
There are other differences between human and veterinary prescriptions as well.
Abbreviations vary. For example, “SID” is used to denote “once daily” on veterinary prescriptions. Because most veterinarians provide handwritten prescriptions, there have been cases of “SID” being misinterpreted as “BID” and even “QID.” The result of such a misinterpretation can be devastating.
Further complicating matters, veterinarians do not write medication concentrations on their prescriptions as do their counterparts in human medicine. Veterinarians typically combine active ingredients for medications and dosing by the milliliter rather than by the teaspoon. For example, the following might be prescribed for a rabbit: “sulfamethoxazole/trimethoprim 48 mg/mL susp. Give 1.2 mL PO BID.” The pediatric suspension is labeled 200 mg/40 mg/5 mL. Veterinarians combine active ingredients so that “200/40/5” becomes “240/5” or simply “48 mg/mL.”
In order to avoid potentially tragic mistakes, a trusted veterinary reference must be available to pharmacists when dispensing prescriptions for veterinary patients. Dianna M. Black, RPh, FSVHP, states, “As a practicing veterinary pharmacist, I recommend Plumb’s Veterinary Drugs (plumbsveterinarydrugs.com). This online resource allows pharmacists to search quickly for drug dosing, interactions, and adverse effects. It is easy to navigate and covers multiple species.” Mistakes happen, but you can reduce your risk for error and negligence by investing in a trusted veterinary drug resource to protect yourself, your pharmacy, and your patients.
— Plumb’s Veterinary Drugs