Finding the cure for drug delivery ills in veterinary medicine
Getting pets to pop their pills is a huge issue. So huge, in fact, that a drug's delivery method often informs veterinary decision making, sometimes more than the drug’s other properties. Side effects, for example, matter far less when the alternative is no treatment at all.
The "drug delivery" issue is getting more play recently, what with the growing list of drugs we're now prescribing for our patients. This, coupled with issues of accessibility, availability and price fuels a sizable niche industry created specifically to meet the needs of pets who won’t — or can’t — tolerate drugs and supplements designed to treat and/or prevent their ills. After all, pets can be picky about what we put in their mouths or mix into their meals. And you would be too if you didn’t understand why you needed to take that multivitamin, glucosamine, or fatty acid gelcap on a daily basis.
This is why compounding pharmacies exist. For the modern veterinarian, being able to access our favorite compounding pharmacy’s expertise in the formulation of new versions of the same-old drugs that line our shelves is a boon to our profession. But few veterinary clients fully understand what it is our compounding pharmacies do for us. To help unmuddy the waters, here's a brief list of how these places help us bring better care to our patients:
1. Delivery, delivery, delivery
As for the real estate and location truism, so too does the veterinary drug industry rely on the "D" word.
As a pet owner, you know how it is. We try everything to get meds into our pets. Some of us hide our pets’ pills in foodstuffs or treats: cream cheese, peanut butter (chunky works best, IMO), ham, chicken breast, pill pockets, filet mignon …
As veterinarians, we also do whatever it takes to get the meds into our patients. And, yes, sometimes it takes a lot of trial and error.
More than anything else, what we all want is a cure that requires no daily discomfort, wriggling, stressing, in-the-towel-burrito-ing or the potential for biting, scratching or generalized inter-species strife. This is where the compounding pharmacy comes in with their ability to turn...
a. chalky to chewy
b. bitter to tasty
c. oral to topical
Yes, topical. So it is that sometimes compounding pharmacies can manage the seemingly impossible.
Is your drug on back-order? Discontinued? Supply chain hassles? Never fear. You don't have to compromise your pet's care if you can find a compounding pharmacy willing to make it for you. That’s what lots of veterinarians are doing now with drugs like ophthalmic cyclosporine. When the supply goes dry, compounding pharmacies' production ramps up.
I'm not big on doing chemotherapy in-house. I'd always rather send my patients to the specialists where the required drugs are more safely housed. Yet I have plenty of clients who prefer that I administer these drugs personally, citing their pets' greater comfort in a place they already know well.
This is where compounding pharmacies come in. They'll ship pre-measured doses to me, already in their syringes and ready to inject. Safer for me, my staff, and my patients.
Want your meds shipped directly to you? Your vet can arrange for that. Pharmacies will ship monthly, on cue, if that's what you need.
It’s hard to quantify, but we suspect that non-compliance resulting from an inability to administer meds is among the biggest drivers of poor clinical outcomes in veterinary medicine (if not the biggest). Then there’s the issue of antibiotic resistance to deal with when antibiotics are started. The pill is found under the sofa … started again … spit out again … repeat …
Given this setup, is it any wonder that compounding pharmacies are finding veterinary medicine a lucrative place to invest their time and money?
But the take-home message here is not about building new businesses with our pet-dedicated dollars; it’s more about the willingness to meet our pets’ needs by making medications work through any means necessary.
Trouble is, clients don’t always inform us when the meds aren’t going down the gullet. Not every pet owner is educated enough about drug choices to know they can ask us for alternatives. And, truth be told, we don’t always pointedly ask whether an unhappy outcome might be the result of poor drug compliance. (It just seems kind of rude to ask, you know?)
However, now that you’ve read this, you know what you need to do. When you come across a tidy stack of tablets your dog has hidden under the bed, or your cat drools for hours after taking her pill, consider asking for another method. No one needs to suffer when so many other options are available.
Dr. Patty Khuly