Pharmacy

Have you ever had one of your pet’s prescriptions filled at your friendly neighborhood pharmacy?

Whether it’s a small place or one of those big box retailers, most pharmacies outside your vet’s office will be staffed with pharmacists … human pharmacists. Which means your pets meds are being prepared by highly skilled human beings who may be more than qualified to medicate you safely, but by and large possess scarce knowledge of the kinds of animal drugs your veterinarian is wont to prescribe. 

The result of this perfectly legal — and I hasten to add, typically safe — arrangement is that errors in prescription drug details (such as dosages and individual species’ sensitivities) occur far more commonly than happen in the preparation of medications for human consumption.

Here’s a recent article detailing the emerging dangers in this department.

In case you’re wondering, this is nothing new. Pharmacists have always made more errors in the veterinary department. It makes sense. After all, these well-trained professionals have never been specifically schooled in the art and science of multispecies drug actions and interactions. 

These limitations comprise the primary reason why most veterinarians have long sought exclusive control over animal drugs by maintaining their own in-house pharmacies. Indeed, virtually all hospitals offer well-stocked pharmacies for their clients’ convenience and their patients’ safety alike.

The reality of modern veterinary practice, however, is that we veterinarians are no longer masters of our own pharmacies. This is the result of several changes in the world of animal health:

1. Animal-only drugs started to become big business a couple of decades ago. This meant that pharmacies — starting with the behemoth, Internet-based boys — began to compete mightily for the larger margin drugs and products newly devoted to pets and heavily marketed to their owners. Consequently, veterinarians could no longer compete with such cut-rate price points. 

2. Challenged by the steep prices of these newfangled drugs and products, pet owners developed a taste for shopping around for the best-priced items.

3. As veterinary medicine became more sophisticated, a whole new host of human products began making inroads into the expanding veterinary formulary. Everything from esoteric insulins, astronomically priced antifungals, and human drugs as novel as Prozac and Viagra meant the market for animals drugs had evolved from a nice-enough niche market topping to a serious bottom-line booster.

4. Veterinarians, responding to the high prices for so many of these drugs, have elected to outsource some of them. No longer are most of us willing to keep the arcane or esoteric on our shelves — not when their prices are so steep and the risk of a total loss through expiration is so high.

5. Pharmacists big and small read the writing on the wall and hustled in to gain a slice. Even every mom-and-pop pharmacist felt compelled to offer their services to veterinarians too.

Problem is, the vast majority of those legally allowed to fill prescriptions for your pets may not be well-qualified to do so. After all, just as cats cannot be treated as small dogs when it comes to drugs, pets in general cannot be treated as smaller versions of humans.

Not only can animal dosages differ dramatically depending on the pet’s weight, the metabolic mysteries of dogs and cats mean vastly different doses on drugs relative to those for their human counterparts.

Add that to the significant issue of idiosyncratic drugs reactions — many of them potentially fatal! — and the role of the human pharmacist as stand-in for the veterinary variety starts to look somewhat suspect — especially since human pharmacists are neither schooled in nor required to know the slightest bit about animal medicine.

Even more confusing, consider the question of discrepancies in prescriber conventions between physicians and veterinarians: Interestingly, most veterinarians and physicians differ in how they abbreviate the dosages and frequencies of medications. 

For example, a human doc might write “2 Q 12 hrs,” which translates to two [units of medication] every 12 hours. Veterinarians, meanwhile, have largely learned to use a “BID” abbreviation for this same prescription, one that’s based in a Latin root that denotes “twice a day.” 

In addition to the vagaries and variations in animal drug dosages and reactions — combined with such seemingly arbitrary variations in convention — are why pharmacists, trained in animal drugs or not, might reasonably be expected to make more mistakes when dispensing animal drugs, increasingly so now that so many more of them are being asked to take on animal-dispensing detail.

So what’s a legitimately concerned pet owner to do? Here are my eight steps for smart pet owners faced with drug decisions on behalf of their pets:

1. Know what you’re up against.

For starters, knowing there’s an issue afoot — as I’ve explained above — is half the battle. 

2. Buy in-house.

Knowing the pros and pitfalls, you can choose to buy in-house at your veterinarian’s office … or go elsewhere knowing well what challenges you may face.

3. Consider purchasing from a veterinary-only and/or veterinary-certified pharmacy.

Not all pharmacies are human-only. Some places — especially many online outlets — offer VIPPS certification, indicating they’re certified by the National Board of Pharmacies to — theoretically, anyway — know what they’re doing veterinary-wise. 

4. Ask for descriptions and pay attention.

Ask your veterinarian to describe the prescription in words and units (milligrams, etc.) — not abbreviations — and pay attention! Make sure that what you’re supposed to be getting is what you’re actually getting.

5. Develop relationships.

Use the same pharmacy (and preferably the same pharmacist) every time. This way you can develop trust with someone who understands the peculiarities of your pet and actually pays extra attention to your prescription.

6. Generic choices can have toxic additives.

If you’re getting a generic from a human pharmacy, check to see whether the preparation you’re receiving is pet-safe. Some liquids, for example, contain xylitol, an extremely toxic sweetener sometimes contained in generics — especially for Neurontin (Pfizer’s trade name for gabapentin). To be 100 percent safe, run the medication’s list of inactive ingredients past your veterinarian or one of the pet poison control hotlines.

7. Be especially careful with insulin.

For some reason, I’ve heard more horror stories about insulin overdoses than about other pharmacy concerns. Make sure you’re getting what the doctor prescribed (U-40  or U-100 insulin) and that the syringes (U-40 or U-100) match the units on the bottle. (I know these numbers sound confusing, but if you’ve got a diabetic patient at home, you really need to know what this means. Ask your vet if you don’t.)

8. Call if you’re unsure.

If there’s any question as to the right drug, dosage or preparation — as in the case of a last-minute substitute — have the pharmacist call your veterinarian!