OTC casebook: Pet medicines

Alan Nathan answers a range of questions on animal health...

 


SCENARIO

A woman comes into the Casebook Pharmacy and asks to speak to the pharmacist. Pharmacist Eve comes out. The woman shows Eve a pack of Metacam (meloxicam) 2.5mg tablets and says, “I got these tablets from the vet for my dog’s arthritis, they were very expensive. I looked up Metacam on the internet and it said it was a drug called meloxicam. I looked that up and it said meloxicam was a ‘NSAID’. I looked up ‘NSAID’ and it said it was a group of pain relieving drugs and that ibuprofen was one of them. I bought a packet of 16 of ibuprofen off the shelf in here last week for under a pound. So, can I give them to my dog instead of Metacam?

 


QUESTIONS

Can ibuprofen tablets be given to a dog?
 
Can human OTC medicines be sold for use in animals?
 
What are the legal categories of veterinary medicines and, from a pharmacist’s perspective, what restrictions are there on their sale or supply?
 
What is the ‘cascade’?
 
What OTC medicines for human use could be used for animal treatment?
 
What are the two most common pet conditions for which customers might ask for treatment and which OTC treatments are available?

 


ANSWERS

1. Ibuprofen is not licensed for use in dogs or cats, and can be dangerous, and even fatal, if given. Note also that paracetamol is toxic to cats.

2. Human OTC medicines can be sold for use in animals, but this may only be on the prescription or recommendation of a veterinary surgeon, or prescribed under the cascade process (see below) if no suitable alternative medicine licensed for animal use is available.

3. There are four legal categories of veterinary medicines:

POM-V

Prescription-only medicines that can only be prescribed by a vet and supplied by them or by a pharmacist against a written prescription.

POM-VPS

Prescription-only medicines that can be prescribed and supplied by a vet, a pharmacist or a suitably qualified person (SQP) against a written or oral prescription. A written prescription is required only if the supplier is
not the prescriber. A SQP is a registered animal medicine supplier who is not a vet or a pharmacist, but who is trained and qualified to supply medicines for a specified group of animals, eg. companion animals. SQPs must operate from officially approved premises and POM-VPS medicines must be supplied personally or under their supervision.

NFA-VPS

Medicines licensed for use in non-food animals that do not have to be prescribed but may only be supplied by a vet, pharmacist or SQP.

AVM-GSL medicines

The animal equivalent of GSL medicines for human use, they may be sold from any retail premises with no restrictions on their supply.

4. The cascade process: If there is no suitable veterinary medicine licensed to treat a condition in a particular species, a vet may treat an animal under their care in accordance with the cascade, a risk-based decision process that allows them to use their clinical judgement to treat an animal with another medicine.
The steps, in descending order of suitability, are:

  • a veterinary medicine authorised in the UK for use for the same or similar condition in another animal species, or for a different condition in the same species.
  • if there is no such product available, either:

- a medicine authorised in the UK for human use, or a veterinary medicine not authorised in the UK, but

- authorised in another EU member state for use in any animal species.

If a prescription is issued for supply from a pharmacy, the vet must annotate the prescription with the words ‘prescribed under the veterinary cascade’, or similar.

5. The following medicines are generally safe to administer to a pet, but only on the recommendation of a vet, who should also suggest a suitable dose depending on the species and size of the animal.

 

Antihistamines

Diphenhydramine, loratadine and cetirizine can be used to relieve allergy symptoms and allergic reactions. They are usually safe for dogs, but may cause drowsiness or hyperactivity.

Gastrointestinal medications

  • Bismuth subsalicylate mixture is safe for dogs, but not cats, to treat diarrhoea, vomiting and upset stomach.
  • Loperamide is safe to use for most dogs and cats to relieve diarrhoea. It should not be used for more than 24 hours, and should not be used for collie-type dog breeds.
  • Ranitidine is generally effective and safe for dogs and cats.
  • Glucosamine and glucosamine in combination with chondroitin sulfate can be used as a long-term treatment for joint pain associated with arthritis.
  • Hydrocortisone cream can be used for skin irritation,

 

6. The two most common pet conditions for which customers might ask for treatment, are worms and fleas or ticks.

Gastrointestinal parasites

These include roundworms, hookworms, whipworms and tapeworms in dogs and roundworms and tapeworms in cats. Sign and symptoms which should alert owners to the possibility of infestation are: visible presence of worms or eggs in pets’ faeces, fur or vomit; persistent scratching around the anus; bloated stomach or belly; increased appetite; loss of vigour; weight loss; blood in stools; diarrhoea; bad breath. As one or more types of worm can be responsible for infestation in an animal, the most effective
treatments contain a broad spectrum combination of parasiticides: for dogs - febantel, praziquantel and pyrantel. For cats - praziquantel and pyrantel.
They are licensed NFA-VPS and various presentations are available. Adult animals should be treated on a prophylactic basis every 3 months, and puppies and kittens more frequently.

Ectoparasites

These include fleas, ticks, mites and lice. Flea infestation is more prevalent in cats (c.25%) than in in dogs (c.7%). Most dog infestations are from fleas passed on by cats. Signs of infestation are:

  • pets scratching or biting their fur.
  • bald patches caused by scratching.
  • flea droppings, visible as dark specks on a pet’s skin and bedding, on carpets and on upholstery.

Fleas and lice can be transferred from pets to humans.
There are several NFA-VPS and AVM-GSL licensed products available for treatment of ectoparasite infestation. Active constituents include: imidacloprid; fipronil; nitenpyram; lufenuron; imidacloprid; flumethrin. Garlic tablets are also marketed as a flea deterrent, although there is no evidence that it is effective.


Other available flea and lice treatments are licensed POM-V. Flea control treatments should be used every few weeks to prevent recurrence of infestation. Hygiene measures should also be taken, including regular washing of pet bedding and vacuuming in the home, including along edges of rooms and beneath furniture to remove eggs, larvae and pupae. The use of an insecticide spray (checked as not harmful to pets) around areas frequented by the pet is also advised.

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