Compounding benefits through medication form options

If a patient is difficult to pill, prescribing a liquid or transdermal form factor can increase client compliance thanks to reduced stress for both person and pet. Photo: BigStock/huettenhoelscher Veterinarians know the challenges of prescribing and dispensing prescription medications. Medications can sometimes be difficult to administer, causing additional stress on the pet and pet owner, and ultimately resulting in an uncooperative animal. The consequences can be significant, such as discontinuation or interruption of treatment or negatively impacting the bond of trust between pet parents and pets, and overall creating physical and emotional stresses that can negatively impact the pet’s long-term health. The pet owner could also look for other solutions, whether that be on the internet or through another veterinarian, which could lead them to take their business elsewhere. In these situations, compounded prescriptions may be a viable alternative for both the pet and the veterinarian. u According to the U.S. Food and Drug Administration (USDA), drug compounding is often regarded as the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual pet patient. Compounding can also include the combining of two or more drugs. Compounding pharmacists partner with veterinarians to tailor a prescription to meet a pet’s needs by modifying flavor, dose, or route of administrations (or all three) to make dispensing to one’s pet more seamless (and less stressful!) for all involved. ) Compounding can also provide options for easier administration—for example, via a transdermal pen, dissolvable tablet, or a peanut butter-flavored chew—to make the taste and texture more palatable for pets that may have problems taking large volume liquid products or tablets. Who benefits from compounding? Not only do the pet and owner benefit from the use of a compounding pharmacy, but the veterinary practice can, as well. When appropriate, compounding provides veterinarians and their teams with an opportunity to offer a solution for the pet owner to enhance the human-animal bond versus causing stress and anxiety for the pet and the owner. Compounding can also provide veterinary practices with innovative ways to provide additional services and increase customer loyalty. Having a customized approach by adapting a medication specifically for the special needs of their pets has especially proven to resonate with younger pet owners, helping deepen the veterinarian and pet owner bond and strengthen client satisfaction. “Compounded medications can be a win-win for the pet, their parent, and veterinary practice in that the precise dose of medication can be administered more easily with the pet actually looking forward to their medication or at least not resisting,” says Link Welborn, DVM, DABVP, chief veterinary officer of Covetrus North America. For instance, Ruby was rescued in 2009 by her owner Aubrie, where she was found with her mouth duct-taped shut and her ears cut off. After battling multiple health conditions over the past 14 years, Ruby has been prescribed many medications and started hating pills and medication time, making administering her medications a challenge. After Aubrie spoke with her veterinarian, they decided to try compounded options, which have made medication time significantly less stressful, ensuring Ruby gets the treatment she needs. For pets that suffered extreme trauma, compounded medications can help to reduce their fear of taking medicine. According to a blog by Marty Becker, DVM, who founded Fear Free* [and columnist for sister publication Veterinary Practice News], forcing medication can cause pets to fear pet parents and diminish their bond, while also creating safety concerns. Dr. Becker recommends veterinarians offer options for pet owners to accommodate these challenges, such as tapping into compounded medication options, bringing their pet into the clinic for medication time, or scheduling a house call veterinarian who can administer the medication. As an added benefit, dosage and flavoring help improve medicine administration at home. Veterinarians can have medication compounded to the exact dosing necessary or opt for flexible dosing if there are variances in what the pet may need. Flexibility and palatability options significantly reduce the stress of medicating pets at home instead of having to go to the clinic. This could include flavoring options that may be unconventional to most humans but are delicious treats to pets such as vanilla butternut squash, which can help mask the bitterness of a medication. When would a veterinarian use a compounded version of a medication? While most pet owners will find what they need from commercially available medications, compounding should be considered in the following scenarios: A pet exhibits stress, discomfort, or behavioral issues when given medication. Remove an allergen that may cause an allergic reaction. When a dosage level for the pets’ weight is not commercially available. If a pet doesn’t like the taste or texture of a medication. When there are too many pills for the pet to easily take, you can combine them into one easy-to-give option. Using a transdermal gel versus a syringe/capsule form, making prescription pet medication easier for the pet to take and the owner to administer. When there is not an FDA-approved veterinary product to treat the ailment. In urgent cases, to provide medication more quickly than waiting for a commercially available version to be shipped to the client’s home. When a commercially manufactured product has been discontinued or is on a manufacturer backorder. What are the different forms of compounded medications? Sometimes, the toughest pets to medicate are the ones who need medication the most. Fortunately, there are several forms of pet-friendly compounded medication available. These unique dose forms allow the veterinarian to customize the medication into a product that is easier to give for the pet owner and less stressful to receive for even the trickiest patients. Flexible tablets: This dose form offers flexibility and ease of administration. With flexible tablets, the pet’s owner can simply snap the scored tablet in half, or thirds to meet the pet's dosing needs. Liquids and suspensions: These are dose forms that can be compounded into a variety of different flavors and dosing levels enabling veterinarians to have the right amount for even the tiniest patients. Highly enticing flavors for palatability can be created such as chicken marshmallow or vanilla butternut, which also mask the sometimes-bitter flavors of mediations. Soft chewables: When taking this form of medication, the soft, chewy texture makes dogs and cats think they are enjoying a tasty treat rather than taking medicine. Breakable tablets: This tablet is easy-to-swallow and allows dosing flexibility to treat smaller animals. By simply applying pressure to the tablet, it splits evenly. Transdermal gel: When medicating a pet orally becomes stressful or impossible and prevents compliance, an easy, click-dose pen with transdermal gel in it can be dispensed on the pet’s ear or other hairless area where the medication will be absorbed from the skin capillaries into the bloodstream. Miniature-tablets: This form takes shape in a 7-mm tablet that allows for precise dosing for small animals and is easy to swallow. Dissolving tablets: This form is a small tablet, that easily dissolves in the presence of saliva. It allows you to calmly place the medication inside of the pet's lip, and the medication will slowly dissolve in their mouth. What should vet practices look for in a compounding partner? Veterinary practices and clinics have options to consider when choosing a pharmacy partner for compounded medications. For example, there are office-use compounding medications that allow practices to stock and dispense a limited number of compounding medications. This offers timeliness and convenience for pet parents and vet practices, while ensuring pets get their medication as quickly as possible. Practices will want to partner with a compounding pharmacy that is able to offer the convenience of having these medications in stock on site. Other key consideration, include: High-quality standards To help ensure potency, sterility, and stability, it is important 503A compounding partners are compliant with USP 795/797/800 guidance and 503B providers are compliant with cGMP standards, are accredited by the Pharmacy Compounding Accreditation Board (PCAB), and adhere to all applicable local, state, and national regulations. High-quality ingredients Compounding pharmacies should use only USP/NF Grade APIs (active pharmaceutical ingredients) and require all vendors to supply a Certificate of Analysis for every lot/batch. They should routinely test APIs to ensure quality. Precision equipment It is important for compounding partners to invest in state-of-the-art equipment to keep pace with standards and quality requirements and to ensure precision and safety every step of the compounding process. Multistep pharmacist verification At least two pharmacists check each prescription for accuracy before it leaves the compounding pharmacy. Mila’s story A small mixed breed named Mila was initially timid, but very friendly when she met her new family in the shelter about a year ago. Once home, Mila started showing signs of fear, anxiety, and stress–even becoming unpredictably aggressive with family members she otherwise enjoyed being around. Mila is on a daily dose of gabapentin that can be scaled up based on need. Photo courtesy of Covetrus Along with implementing behavioral therapy, Mila’s veterinarian prescribed a selective serotonin reuptake inhibitor (SSRI) and gabapentin flexible tablets. The veterinarian prescribed the flexible tablets because they are easy for Mila’s owner to break accurately, allowing Mila’s dose to be personalized according to her needs on any given day. Mila takes 50 mg of gabapentin twice a day under normal conditions, but the dose can be increased up to 150 mg as necessary based on stressful situations that arise. Flexible tablets simplify medication administration to accommodate pets with variable dosing needs. With this treatment plan, Mila is now able to enjoy life with her new family and Mila's family can easily manage her anxiety. What are the advantages of compounding? As previously stated, compliance benefits all parties involved. When the owners are compliant, they can administer the medication with no hassle, which results in a higher likelihood of the pet receiving the full course of treatment. When pets are compliant, they receive the medication on time, in its most effective form, and they anticipate the medicine like they would a treat. As an effective component of personalized medicine, compounding turns the often-unpleasurable experience of taking medication into a fun experience. If you can target conditions more effectively based on the pet’s needs, recovery time may be faster. Customizable options often exist for mixing and matching treatments–offering extended choices for managing unique cases and allowing adaptability in the practice when a medication is discontinued. Compounding also supports prescription agility. A medication becomes agile when it can remove a specific allergenic component such as lactose, gluten, flavorings, or dyes – therefore avoiding an adverse reaction in the pet. Advances in pharmaceutical compounding also allow one to give multiple medications in a single dose. For pet owners, this can reduce the error of forgetting to give a medication while reducing the stress of administering multiple drug regimens. The future of compounding Compounded medications are the key to unlocking the full potential of personalized medication, prescription agility, and medication compliance. When appropriate for the pet, compounding allows vets to break out from the limitations of traditional, commercially available medications by offering a custom solution when it is needed. Improving the medication experience can lead to healthier and happier pet clients that may otherwise been unable to receive treatment. Jennifer O’Grady, Pharm D, RPh. PRS, Dr. O’Grady has 25 years of pharmacy experience, with a dedication to the practice of veterinary pharmacy, compounding, quality assurance and regulatory compliance. She obtained her Doctor of Pharmacy degree from the University of Iowa, College of Pharmacy and is a licensed pharmacist in 27 states. Dr. O’Grady serves as preceptor and adjunct faculty at the University of New England, School of Pharmacy. She is also the Covetrus vice president of North America Center Led Quality Regulatory Affairs. * Covetrus is a corporate sponsor of Fear Free

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Compounding benefits through medication form options

A look at how veterinary pharmacy compounding can diversify pet health solutions

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