How combining pet drugs can be like playing pin the tail on the donkey
I have a great gift idea for someone who wants to make their favorite veterinarian very happy. Find them a ginormous, computerized, veterinary drug interaction program. Best yet, make it one that can fit both in the palm of her hand (ideally on her iPhone) and tie into her office’s computerized invoicing function.
Anything to keep her from making mistakes. Please. Something to make it easy for her to question the use of two or more drugs in combination. A method that means she can have this info readily available instead of how it works now: time-consuming emails to veterinary pharmacists, phone calls to drug companies, visits to the specialty hospital for detailed discussions that almost always end in I-don’t-knows, etc.
It’s not easy, you know, making sure your once and future polypharmacy patients get the help they need when it comes to taking more than one medication at a time. God knows we have plenty of patients who do take multiple meds for one or more specific conditions.
As you might expect, this population of pets is more than keeping pace with our ability to keep them alive longer. Problem is, they can’t yet reach what we believe might be their potential for even greater comfort and longevity without the significant risk of adverse drug interactions.
The truth is that we don’t yet understand how all the drugs we now use in dogs and cats work when used in combination with one another. It’s this uncomfortable reality that’s emerging as a very real barrier to greater success in long-term pet care.
Sure, there’s plenty of information out there. Veterinarians and pet owners who work hard to find it can access the basics. But it shouldn’t be so hard! As I intimated in my opening paragraph, veterinary drug interaction information is currently not well organized.
Think Medscape. This Internet behemoth for human healthcare education offers a simple plug-in-your-drugs function to determine whether your meds might be giving you trouble. No such sophisticated functionality exists, anywhere, for pets. For the top-twenty pet meds, yes. For the vast majority of what’s now available? Only in my dreams. And that’s a problem.
Consider yesterday’s patient. Seven ear old shepherd mix. He’s an allergic skin disease sufferer who’s been successfully treated with Atopica (cyclosporine)...as long as he takes a big, expensive daily dose. After a stint at the ophthalmologist’s place for corneal surgery last week, his eyes are doing great.
The problem? The eye doc put him on a low dose of Rimadyl (carprofen) for a week to control his post-operative pain. Now he’s feeling sluggish. Does his belly hurt from the Rimadyl? Is the cyclosporine taking its toll on his kidneys now? Did the specialist even realize this dog was on a high-ish dose of Atopica before starting the Rimadyl?
So I call the eye doc (gone for the day). I call Pfizer (the drugs’ manufacturers). It’s late. I hold and get no one. I fire off an email to my favorite Veterinary Information Network clinical pharmacologist. And wait. My favorite local internal medicine specialist suspects a problematic interaction and confirms my recommendation to stop both meds for the moment.
This process is typical. 20 minute of digging online and another 20 minutes of phone calls and I have nothing to show for it aside from the same sneaking, but unconfirmed, suspicion I had when I started. And these are among the garden-variety of drugs we prescribe. Nothing too fancy, really.
Sure, I can hazard guesses...and I do (often). Because I have to. There’s no hard and fast data revealing the commoner complications we see with the drug reactions. No chart helping us decide how much to taper one dose to reduce the risk of X effects when administered with another.
So here’s where I ask....
...if anyone knows of a drug interaction resource more complete than the 12 by 12 chart currently hanging in my lab and the only slightly better veterinary practice management software plug-ins.
If so, please, please tell me. Because until someone in the veterinary clinical pharmacology arena decides to build me the drug interaction application of my dreams I might as well be playing pin the tail on the donkey with some of my drug selections. And none of us wants that.