medication for a tricky American patient...

Re: medication for a tricky American patient...

Kerry Peak — Mon, 15 Jun 2015 19:01:47 GMT

That's a good idea - thanks. The owner did mention something about a company called 'Lilly' so have emailed them to see what they say.

Re: medication for a tricky American patient...

Thomas Johnson — Mon, 15 Jun 2015 10:55:01 GMT

[quote user="Kerry Peak"]

Thanks everyone.

i think it must actually be 'Humulin' N, I will double check. The owners are adamant that they don't want to change her medication, despite me advising them that we aren't familiar with it. I will offer to import it for them if possible or they can make their own arrangements.

[/quote]

You could try phoning Eli Lilly to find out if 'Humulin N' (USA) and 'Humulin I" (UK) are the same product.

Re: medication for a tricky American patient...

Kerry Peak — Sun, 14 Jun 2015 15:05:36 GMT

Thanks everyone.

Re: medication for a tricky American patient...

KMurphy — Fri, 12 Jun 2015 17:49:57 GMT

I once treated a dog that spent 6 months here, 6 months in the USA. She was started on Humilin N by her US vet and we wrote a prescription for Humilin I, which we had decided at the time was equivalent (both medium duration isophane insulin), for the owner to collect at the local pharmacy.

I spoke to MSD at the time and they suggested if we wanted to transition her to Caninsulin to start as though she were a new case so maybe that would be a possibility for your dog. As this dog was constantly travelling back and forth we felt it best to keep things as consistent as possible.

Re: medication for a tricky American patient...

Michael Woodhouse — Fri, 12 Jun 2015 16:30:20 GMT

is there a legitimate way that the previous American vet can send the product direct, through the post?

I thought if already prescribed then we get by a lot of the paperwork issues.

Re: medication for a tricky American patient...

Andrew Kent — Fri, 12 Jun 2015 11:25:20 GMT

[quote user="Martin Atkinson"]In any case, I would question the efficacy of depot injections for the treatment of Addison's and I wouldn't make the assumption that it is as stable as the owner likes to think it is until I'd performed full bloods and a glucose curve?[/quote]

We don't really use it over here but actually the stabilisation rate is higher for DOCP than fludrocortisone so I wouldn't write it off as an option. It is often used in cases that don't stabilise well on fludrocortisone. This drug is very importable so if they want it and are willing to pay the additional cost why not? Contacts would either be to call Novartis (who make it) to see if they have a route to get it or to speak to somewhere like IDIS about importation.

[quote user="Kerry Peak"]sorry - it is indeed meant to be 'Hypurin N'. [/quote]

That makes a lot more sense - though I still struggle to find much more about it. The hypurin range of insulins are available in the UK but may have different names - I would worry that this is a neutral insulin with that name which may not be a particularly suitable thing to use for management. Do you know what doses/frequencies they are using?

Are you sure it isn't HUMILIN N?? That I can find much more about - its an NPH insulin - in which case Hypurin NPH would be the closest alternative over here and (I would think) should be fairly equivalent.

Andy

Re: medication for a tricky American patient...

Bob Russell — Fri, 12 Jun 2015 10:04:52 GMT

[quote user="Martin Atkinson"]

There was a very similar thread to this a while ago and I thought it was the same one that had been bumped until I saw the date of the OP.

Rather than busting a gut trying to obtain these products, I would be more concerned with treating the patient with products I was unfamiliar with and would therefore get it on to a protocol I was used to and would explain that this is more important to the owners.

In any case, I would question the efficacy of depot injections for the treatment of Addison's and I wouldn't make the assumption that it is as stable as the owner likes to think it is until I'd performed full bloods and a glucose curve?

[/quote]

I would prefer it to be on medication that I was familiar with but would also be a bit concerned that the change over might end up being a bumpy one!

Chatting to the owners should resolve the situation, one way or another!

Re: medication for a tricky American patient...

Martin Atkinson — Fri, 12 Jun 2015 09:32:01 GMT

There was a very similar thread to this a while ago and I thought it was the same one that had been bumped until I saw the date of the OP.

Re: medication for a tricky American patient...

Bob Russell — Fri, 12 Jun 2015 09:20:52 GMT

[quote user="Hannah Wynne Richards"]

Good luck with the bureaucracy.

Wynne

[/quote]

The VMD website makes importation very simple as far as the paperwork is concerned. It is perfectly acceptable to maintain a patient on the same medication rather than get caught up with cascade.

There are no licensed products for Addisons per se although preds are clearly a licensed product. Not ideal on its own for hypoadrenocorticalism.

Being able to afford the stuff is likely to be the biggest problem!

(I doubt the VMD have enough staff to even look at the Special Import Site!)

Re: medication for a tricky American patient...

Hannah Wynne Richards — Fri, 12 Jun 2015 08:05:14 GMT

Good luck with the bureaucracy.

Wynne

Re: medication for a tricky American patient...

Kerry Peak — Fri, 12 Jun 2015 05:50:05 GMT

sorry - it is indeed meant to be 'Hypurin N'.

luckily they have a good few months supply of each product so we have some time to try and decide what to do.

Re: medication for a tricky American patient...

Linda Filshie — Thu, 11 Jun 2015 23:36:01 GMT

I'm guessing your "heparin n" is probably hypurin n, which might help! Unless it was a typo/autocorrect in which case, as you were!

Re: medication for a tricky American patient...

Neil Wheadon — Thu, 11 Jun 2015 23:16:58 GMT

I'd turn this on it's head.

Ask the client if he can do the research for you.

I had an American last year do this and he felt very empowered by the whole process, taught me a thing or two and it was a huge success

Neil

Re: medication for a tricky American patient...

Andrew Kent — Thu, 11 Jun 2015 23:11:07 GMT

Hi Kerry,

You can import DOCP with a licence from the States but the cost will probably make the clients eyes water :-) The best way to do it is often to use an importing company.

I have no idea what Heparin-N is and nothing comes up on google as to what type of insulin it is - do you have any more info?

Andy