Recuvyra

Re: Recuvyra

Birte Toft — Thu, 13 Feb 2014 22:12:29 GMT

Recuvyra is just becoming available to us now, and I expect a rep will descend on us shortly.

Those of you who have been using it for a while, what are your experiences? It sounds like a lot of hassle, but I suppose most things do when you actually bother to read the instructions.

Re: Recuvyra

Yantha Smyth — Sat, 25 May 2013 10:01:21 GMT

[quote user="Michael Woodhouse"]Well, I am now Recuvyra trained. It didn't cover how to say the word.......[/quote]

i was at a pain management lecture at bsava, and the speaker pronounced it as 'recoverer'....

Re: Recuvyra

Michael Woodhouse — Sat, 25 May 2013 00:44:16 GMT

Well, I am now Recuvyra trained. It didn't cover how to say the word.......

It sounds a pain in the backside, expensive, wasteful and inconvenient. Still I am now on a list and can order it if I want to.

To my delight the back ordered Comfortan turned up

Be interested if anyone has a go with the product. Also interested in people's thoughts on this versus fentanyl patches - I can still see an argument using them under the cascade.......

Re: Recuvyra

John Flynn — Thu, 23 May 2013 17:02:43 GMT

I tend to use paracetamol at the *high* 30mg/kg q8hrs dose Michael talks about, but not usually for more than 5 days and then drop down to the 10mg/kg q12hrs dose - interesting to hear, Michael, that you have kept dogs on this long-term and not noted a problem. When I used Pardale-V in the past, I assumed that the analgesic effect noted was from the paracetamol rather than the codeine (which I thought had no analgesic effect in the dog, but that's jsut an assumption I made).

Anecdotally, I prefer NSAID and paracetamol to NSAID and tramadol, but then I'm not the biggest tramadol fan - I tried it out when fashionable 5-10yrs ago, but rarely use it now - when I do, I go for 5mg/kg q4-6hrs.

Haven't seen any (or looked!) PK/PD data on paracetamol in the dog, but the limited data on tramadol seemed to back up that it was crap in the dog and any analgesic effects were probably limited to the parent-molecule rather than the M1 metabolite (which is 200 times more potent than the parent molecule in humans but not formed in detectable levels in the dog); I do wonder about a 'placebo'-effect as lots of owners have had tramadol themselves and therefore assume that it will make their dog feel as amazing as they did and sometimes you see what you expect...?

Re: Recuvyra

bob lehner — Thu, 23 May 2013 14:20:57 GMT

[quote user="Mark Holmes"] So is recommending something prescribing it?[/quote]

From VMD Guidance Note on retailing:

Prescriptions
57. A prescription may be oral or in writing. Prescribing is considered to be the action of deciding, instructing and recording which treatment should be administered to an animal. It can be carried out by a veterinary surgeon, or a pharmacist or an SQP, according to the distribution category of the VMP concerned.

Re: Recuvyra

Bob Russell — Thu, 23 May 2013 10:13:13 GMT

Never heard of a Chemist charging £7 to anyone other than for NHS prescriptions. Perhaps use another Chemist!

It is appropriate for them to refuse to sell products knowingly to be used for animals. Most of my clients are savvy enough not to let slip that the product is for their pet but mainly so they can avoid (sensibly) my prescription charge.

Re: Recuvyra

Thomas Johnson — Thu, 23 May 2013 08:28:21 GMT

[quote user="mariette asselbergs"]

The main reason being that if you write a prescription, or anything on a piece of paper, then the chemist charges £7 extra for providing drugs on prescription. I always warn the owners not to show anything I have written down for them when I send them to get codein cough syrup.

[/quote]

I'm not sure that's right. The NHS prescription charge is £7.65, so any drug prescribed for you on the NHS, whether it costs £0.50 or £500, costs you £7.65, the difference either way is then sorted between the pharmacist and the NHS.

Anything you buy over the counter or on a private precription is charged at cost plus whatever mark-up the pharmacist puts on it, in the same way we would charge for drugs. But pharmacists cannot sell over the counter drugs for a use they are not licensed for, such as using human medications in animals.

Re: Recuvyra

mariette asselbergs — Wed, 22 May 2013 18:38:44 GMT

"the chemist promptly took the bottle back and said they would need a prescription if it was for animal use." (Michael)

Mariette

Re: Recuvyra

tess — Tue, 21 May 2013 14:41:09 GMT

GUVS were recommending paracetemol at 10mg/kg bid. Given that Pardale is the only licensed product I would use that at a scaled down dose.

Human surgeons have been using Paracetemol and NSAID for years- I was prescribed that combo after a major op about 8 years ago. Paracetemol and ibruprofen are recommended to be used together in children who are unwell with a high temp.

Re: Recuvyra

Evelyn Barbour-Hill — Tue, 21 May 2013 12:51:30 GMT

[quote user="Mark Holmes"]So is recommending something prescribing it?[/quote]

Yes.

Re: Recuvyra

patrick murphy — Tue, 21 May 2013 12:42:59 GMT

Ive seen them use paracetamol iv intra operatively in people surgery

Re: Recuvyra

Michael Woodhouse — Tue, 21 May 2013 10:16:25 GMT

All medicines are categorised based on their indications on the label. If you are using the drug outside the label requirements then it requires prescription.

An example would be wormers for farm animals. You can buy Dectomax over the counter from a SQP, but if you want to give it to a horse you are breaking the law by doing so. By going away from its licensed indications requires veterinary prescription.

An old boss of mine used to send dog owners to the chemist to buy Benalyn for kennel cough. One went into the local chemist and asked for some. They then casually asked how much to give a Labrador - the chemist promptly took the bottle back and said they would need a prescription if it was for animal use.

In one of the VMD guidance notes it mentions the use of 'human' paracetamol as a stop gap if owners ring at night. If you suggest they buy Tesco paracetamol and there was a problem you are the prescribing veterinarian. I suspect this is one reason Pardale didn't go for the human standard of 500mg paracetamol.

Re: Recuvyra

Mark Holmes — Tue, 21 May 2013 09:59:54 GMT

[quote user="bob lehner"]

Yes - I guess if they go off and buy Tesco Paracetomol and give it to their dog (or cat!!) that's nothing to do with the Cascade if you are not prescribing it.

[/quote] So is recommending something prescribing it?

Re: Recuvyra

bob lehner — Tue, 21 May 2013 09:33:14 GMT

Yes - I guess if they go off and buy Tesco Paracetomol and give it to their dog (or cat!!) that's nothing to do with the Cascade if you are not prescribing it.

Re: Recuvyra

Mark Holmes — Tue, 21 May 2013 08:29:24 GMT

[quote user="bob lehner"]

[quote user="Mark Holmes"]Does cascade apply when paracetamol isn't POM?[/quote]

From VMD:

'The cascade allows veterinary surgeons to legally prescribe medicines that are not authorised for the relevant clinical case or for the relevant species under treatment when there is no authorised veterinary medicinal product (VMP)

available.'

i.e. Not just POMs.

[/quote] Sorry I read this as legally prescribe - does this not relate to POM? If owners just use Tesco own brand they don't need a prescription.

Re: Recuvyra

bob lehner — Tue, 21 May 2013 08:21:17 GMT

[quote user="Mark Holmes"]Does cascade apply when paracetamol isn't POM?[/quote]

From VMD:

available.'

i.e. Not just POMs.

Re: Recuvyra

Mark Holmes — Tue, 21 May 2013 05:51:49 GMT

[quote user="Michael Woodhouse"]

[quote user="David Mills"]Never used pardale-V. It could well be an effect of the codeine, though - have you tried just pure paracetamol? That's what I'm really interested in (although didn't make it clear). [/quote]

Not sure I could come up with a decent justification not to use the licensed product.

[/quote] I find paracetamol working great in my own dog. Actually better than all the NSAIDS and tramadol. The wife has even started complaining about her again. Does cascade apply when paracetamol isn't POM?

Re: Recuvyra

Michael Woodhouse — Mon, 20 May 2013 23:18:39 GMT

[quote user="David Mills"]There are plenty associated with the codeine component - sedation, vomiting, reps depression, constipation - which would be clinically acceptable to avoid.[/quote]

We sell thousands of Pardale V tablets every year and I have never seen any of the above at licensed dose rates.

Re: Recuvyra

David Mills — Mon, 20 May 2013 23:14:50 GMT

[quote user="Michael Woodhouse"]Not sure I could come up with a decent justification not to use the licensed product.[/quote]

There are plenty associated with the codeine component - sedation, vomiting, reps depression, constipation - which would be clinically acceptable to avoid.

Re: Recuvyra

Michael Woodhouse — Mon, 20 May 2013 23:10:01 GMT

Not sure I could come up with a decent justification not to use the licensed product.

Re: Recuvyra

David Mills — Mon, 20 May 2013 23:07:55 GMT

[quote user="Michael Woodhouse"]I have found tramadol very useful and get a benefit in almost every dog I use it in, whatever the experts say.[/quote]

Me too.

[quote user="Michael Woodhouse"]What dose rate are you using? The licensed dose rate is 33.3mg/kg paracetamol and 0.75mg/kg codeine. If you are only giving less than 1/3 that dose I wouldn't be surprised if you noticed little effect. [/quote]

Never used pardale-V. It could well be an effect of the codeine, though - have you tried just pure paracetamol? That's what I'm really interested in (although didn't make it clear).

Re: Recuvyra

Michael Woodhouse — Mon, 20 May 2013 22:48:50 GMT

[quote user="David Mills"]I don't think its a panacea, and haven't noticed any effect when I've used it in patients.[/quote]

I have a number of patients much improved on a conventional NSAID + paracetamol & codeine.

What dose rate are you using? The licensed dose rate is 33.3mg/kg paracetamol and 0.75mg/kg codeine. If you are only giving less than 1/3 that dose I wouldn't be surprised if you noticed little effect. If I had a splitting headache I wouldn't be surprised if it didn't go away with half a paracetamol.

Never had any adverse effects.Have had them on both NSAID and Pardale V long term.

Had occasional dogs on NSAID+Pardale+tramadol with appropriate warnings. A little bit of ketamine seems to helps some dogs a huge amount (got the idea from someone on here - Mark Holmes?).

I have found tramadol very useful and get a benefit in almost every dog I use it in, whatever the experts say.

Re: Recuvyra

David Mills — Mon, 20 May 2013 22:38:30 GMT

Just be aware that evidence (except anecdote) is limited to an experimental in vivo study. More, these referral centres are seeing an absolute miniscule number of OA patients compared to GP.

I don't think its a panacea, and haven't noticed any effect when I've used it in patients. I'd be interested to hear of other people's experience. I think there is a real danger of taking these opinions as gospel without examining what underlines them - which in the case of paracetamol is no published evidence that I'm aware of. What may be a big factor is that owners who attend referral centres tend to give more positive feedback on symptom improvement than those attending GP.

Re: Recuvyra

Claire Fisher — Mon, 20 May 2013 22:21:55 GMT

[quote user="KathW"]

[quote user="tess"]

IFor arthritis with an acute flare ups they are now recommending adding in paracetemol to NSAIDs for 3-4 days as required.

[/quote]

I've heard this from colleagues but everyone is very vague - who are "they" and what dose of paracetamol is recommended please?

[/quote]

I use 10mg/kg either bid or tid - recommended on CPD run by Liverpool vet school ortho dept. Can use the iv preparation for ops/hospitalised cases as well.

Re: Recuvyra

Michael Woodhouse — Mon, 20 May 2013 22:18:36 GMT

[quote user="KathW"]I've heard this from colleagues but everyone is very vague - who are "they" and what dose of paracetamol is recommended please?[/quote]

I use the Pardale V at licensed doses - they are higher than BSAVA doses.