More than one-third of Oregon veterinarians surveyed reported cases in which retail or online pharmacists changed the prescribed dose of a medication for an animal patient or substituted a different product without the doctor’s authorization, according to the Oregon Veterinary Medical Association.
While the altered medications tended not to harm a patient, some veterinarians described cases in which an animal died or was euthanized.
About 115 Oregon veterinarians responded to the online survey, which the OVMA ordered in reaction to the now-stalled national Fairness to Pet Owners Act, which would require veterinarians to issue prescriptions to clients.
“It really goes back to February, when one of our members contacted our office because she had concerns about the House resolution,” Glenn Kolb, executive director of the OVMA, said today. “We started hearing some stories [about prescription errors].”
The good news, Kolb said, is that more than half of the survey respondents had been contacted by a pharmacist to answer questions about an order.
“Together they work hand in hand to meet the needs of the client and the best interests of the patient,” the survey noted.
The bad news, Kolb added, is that “When a pharmacy steps out of its scope of practice by making determinations and adjustments, the health of that pet can be jeopardized.”
The survey documented instances in which pharmacists did not follow the doctor’s orders, including changing a prescribed insulin product to a less expensive insulin, substituting a drug with one not indicated for the species, and filling a prescription at 10 times the prescribed dose or at subtherapeutic levels.
• “A veterinarian diagnosed an older dog with epilepsy and prescribed 15 mg of phenobarbital twice daily. When the client arrived at the pharmacy to pick up the prescription, the pharmacist told her that the dosage was too high and that she should reduce it in half. With the subtherapeutic treatment, the dog continued to suffer from seizures, until several weeks later when the veterinarian discovered the problem upon a recheck. The dog was euthanized.”
• "A veterinarian prescribed itraconazole (Sporanox) to treat ringworm in a cat. However, the retail pharmacy did not carry Sporanox but dispensed a compounded product that is unreliable and poorly absorbed in cats. The client elected to continue using the compounded product but experienced a treatment failure.”
• "A dog with an autoimmune disease was to be treated with the chemotherapy drug azathioprene. Instead, the retail pharmacist dispensed the antibiotic azithromycin. The patient relapsed and had to be euthanized.”
• A pharmacist suggested that a client purchase Rogaine to treat her dog’s alopecia. Minoxidil is the active ingredient in Rogaine and can cause cardiomyopathy in dogs, something the pharmacist did not know.
• "A veterinarian diagnosed atypical mycobacterium in a cat and prescribed a liquid antibiotic for the client to have filled at a nearby pharmacy. The dilution instructions by the retail pharmacist were significantly incorrect. As a result, the patient relapsed and was euthanized.”
The survey documented cases in which retail pharmacists changed medications even when the prescription stated “No Substitution.”
“It also is fairly common for both online outlets and brick-and-mortar pharmacies to switch a prescribed product for another product because they happen to be out of the prescribed product,” the survey reported.
A pharmacist should change a prescription only after a discussion with the veterinarian and after obtaining authorization, the survey concluded, adding, “It is important that retail pharmacists understand that cats and dogs are not little people.”
The OVMA has been in contact with the Oregon Board of Pharmacy and submitted an article for the board to share with its members, Kolb said. The organization also will contact the Oregon State Pharmacy Association.