Apometic and Emedog, is this an abuse of the cascade?

RE: Apometic and Emedog, is this an abuse of the cascade?

Lucy Fleming — Mon, 08 Jan 2018 09:12:48 GMT

[quote user="Kate Richardson"]not necessarily, if you are a small practice/branch and end up discarding a proportion of the bottle after 28 days[/quote]

True, we tend to use it a lot, and would almost always use up a bottle within 28 days

RE: Apometic and Emedog, is this an abuse of the cascade?

Michael Woodhouse — Sun, 07 Jan 2018 00:13:31 GMT

[quote user="Edward Jones"]It costs £10 more a bottle.[/quote]

List price. Dechra much more generous than Zoetis on discounts with generics. I'd be amazed if we paid more per dose for it.

RE: Apometic and Emedog, is this an abuse of the cascade?

Kate Richardson — Sat, 06 Jan 2018 08:57:06 GMT

[quote user="Lucy Fleming"]

[quote user="Edward Jones"]It costs £10 more a bottle[/quote]

That's a bit disappointing. I wonder if it works out to less per dose?

[/quote]

not necessarily, if you are a small practice/branch and end up discarding a proportion of the bottle after 28 days

RE: Apometic and Emedog, is this an abuse of the cascade?

Lucy Fleming — Fri, 05 Jan 2018 08:40:02 GMT

[quote user="Edward Jones"]I find the pain reaction with cerenia a significant issue in a few dogs and can affect ease of examination in the future.[/quote]

We've started keeping ours in the fridge, and it does seem to be less painful. I always put a fresh needle on as well (I do notice a pain response if I don't, I presume as minute quantities of the drug go through the dermal layers?), and inject slowly (slowing down if getting a pain response is the thing I find tricky, as I am notorious for my general lack of patience)

[quote user="Edward Jones"]It costs £10 more a bottle[/quote]

That's a bit disappointing. I wonder if it works out to less per dose?

RE: Apometic and Emedog, is this an abuse of the cascade?

Edward Jones — Fri, 05 Jan 2018 08:32:35 GMT

[quote user="Mark Hedberg"]

[quote user="Bob Russell"]

Notification that Dechra are releasing a maropitant product. It has a 56 day broaching date so at least some of the companies are listening!

Smaller bottles and/or longer lifespan to reduce waste actually matters especially for smaller practices!

[/quote]

Quite interested - allegedly may sting less?

[/quote]

It costs £10 more a bottle. I might try a bottle to see if it stings less, however. I find the pain reaction with cerenia a significant issue in a few dogs and can affect ease of examination in the future.

RE: Apometic and Emedog, is this an abuse of the cascade?

Mark Hedberg — Thu, 04 Jan 2018 19:33:20 GMT

[quote user="Bob Russell"]

Notification that Dechra are releasing a maropitant product. It has a 56 day broaching date so at least some of the companies are listening!

Smaller bottles and/or longer lifespan to reduce waste actually matters especially for smaller practices!

[/quote]

Quite interested - allegedly may sting less?

RE: Apometic and Emedog, is this an abuse of the cascade?

Neil Wheadon — Thu, 04 Jan 2018 19:24:58 GMT

Will they do an apomorphine?

Neil

RE: Apometic and Emedog, is this an abuse of the cascade?

Bob Russell — Thu, 04 Jan 2018 10:57:59 GMT

Notification that Dechra are releasing a maropitant product. It has a 56 day broaching date so at least some of the companies are listening!

Smaller bottles and/or longer lifespan to reduce waste actually matters especially for smaller practices!

RE: Apometic and Emedog, is this an abuse of the cascade?

Dave Leicester — Wed, 27 Dec 2017 13:53:10 GMT

[quote user="Emily Rainbow"]

[quote user="Michael Woodhouse"]

Careful. Some animals given apomorphine may still have ingested a toxic dose of whatever before emesis induced.

[/quote]

That’s a given and other factors need to be considered. The case that springs to mind was a chocolate tox that was made to ‘vomit’ within 45mins using crystals. I used apomorphine and still got more chocolate up 90mins later.

Never had a chocolate case return with clinical signs following initial apomorphine use (within a sufficient time period).

[/quote]

No method of emesis induction will completely empty the stomach. Studies have shown between 60-80% of the stomach contents to be recovered, with various confounding factors involved.

Induction of emesis with soda crystals may well have worked a 2nd time, and recovered more chocolate, in the case you mentioned too.

RE: Apometic and Emedog, is this an abuse of the cascade?

Dave Leicester — Wed, 27 Dec 2017 13:49:07 GMT

[quote user="bob lehner"]

[quote user="vetbl.locum"]

[quote user="Dave Leicester"]I don't believe there is any issue with using soda crystals,[/quote]

I vaguely remember a problem reported by VDS a while ago , cannot recall details but I started using Apometic after that report.

[/quote]

There have been problems recorded where people (inc. vets and nurses) have been confused between Washing Soda crystals (sodium carbonate) and Caustic Soda crystals (sodium hydroxide) - both colloquially called 'soda crystals' and found under the domestic kitchen sink for cleaning purposes.

Use of Caustic Soda as an emetic would be catastrophic and would certainly involve the VDS (and possibly Belgravia House).

[/quote]

That's certainly happened and is the reasons I was careful to qualify that statement with "in a controlled environment under veterinary supervision"

RE: Apometic and Emedog, is this an abuse of the cascade?

Dave Leicester — Wed, 27 Dec 2017 13:46:28 GMT

[quote user="Beats"]

Playing devil's advocate briefly though: while they are not presented by the manufacturer as "any substance... having properties for... preventing disease in animals", but surely when I use them I am presenting them in this manner.

Or to put it another way, if I was to market washing soda crystals for the purpose of inducing emesis after ingestion of a toxic substance, I would consider that a marketing authorisation was required? (based on interpretation of veterinary medicinal product from VMD: https://www.gov.uk/guidance/legal-controls-on-veterinary-medicines#definition-of-veterinary-medicinal-product-vmp)

If the simple fact that the soda crystals are making no claims for preventing disease in animals, and are manufactured for a different purpose, prevents them being a veterinary medicinal product when I use them, then would the same not apply also to "Apo-go" which certainly does not claim to be a "veterinary medicinal product" either? If there is a difference to how the definition of "veterinary medicinal product" is applied to "soda crystals" used to induce emesis and "Apo-go" used to induce emesis, what is the distinguishing feature that puts one outside the scope of the legislation while leaving the other within it?

[/quote]

The simple difference is that apomorphine is a POM (or a POM-V depending on brand) whilst washing soda crystals are not. Apomorphine exerts it's effects by pharmacological action, so whether it is presented as having an effect in animals or not is irrelevant as it qualifies as a 'veterinary medicinal product' under the 2nd definition.

RE: Apometic and Emedog, is this an abuse of the cascade?

Evelyn Barbour-Hill — Sun, 24 Dec 2017 19:06:04 GMT

[quote user="bob lehner"]

Use of Caustic Soda as an emetic would be catastrophic and would certainly involve the VDS (and possibly Belgravia House).

[/quote]

Even 40, 45 years ago, when people would ring up "Just after a bit of advice reely, my dog's just eaten some (whatever)" and I would tell them to make it sick immediately, and they would say "how do I do that, then" and I would tell them to give it a crystal of washing soda, like as not there would be a short silence followed by " woss that, then?"

RE: Apometic and Emedog, is this an abuse of the cascade?

Emily Rainbow — Sun, 24 Dec 2017 16:06:26 GMT

[quote user="Michael Woodhouse"]

Careful. Some animals given apomorphine may still have ingested a toxic dose of whatever before emesis induced.

[/quote]

Never had a chocolate case return with clinical signs following initial apomorphine use (within a sufficient time period).

RE: Apometic and Emedog, is this an abuse of the cascade?

Michael Woodhouse — Sun, 24 Dec 2017 12:58:52 GMT

[quote user="Emily Rainbow"]Have seen soda crystals used.... produced one or two vomits and dogs to represent later with clinical signs of toxicity. [/quote][quote user="Emily Rainbow"]Have seen soda crystals used.... produced one or two vomits and dogs to represent later with clinical signs of toxicity. [/quote]

Careful. Some animals given apomorphine may still have ingested a toxic dose of whatever before emesis induced.

RE: Apometic and Emedog, is this an abuse of the cascade?

bob lehner — Sun, 24 Dec 2017 11:51:12 GMT

[quote user="vetbl.locum"]

[quote user="Dave Leicester"]I don't believe there is any issue with using soda crystals,[/quote]

I vaguely remember a problem reported by VDS a while ago , cannot recall details but I started using Apometic after that report.

[/quote]

Use of Caustic Soda as an emetic would be catastrophic and would certainly involve the VDS (and possibly Belgravia House).

RE: Apometic and Emedog, is this an abuse of the cascade?

Emily Rainbow — Sun, 24 Dec 2017 10:33:29 GMT

I really have no problem with it lasting a while and leading to dry retching. It’s not going to kill the dog and I know that their stomachs are definitely empty!

Have seen soda crystals used.... produced one or two vomits and dogs to represent later with clinical signs of toxicity. The gastric decontamination using them in my eyes is not good enough.

RE: Apometic and Emedog, is this an abuse of the cascade?

vetbl.locum — Sun, 24 Dec 2017 09:10:15 GMT

[quote user="Dave Leicester"]I don't believe there is any issue with using soda crystals,[/quote]

I vaguely remember a problem reported by VDS a while ago , cannot recall details but I started using Apometic after that report.

Current situation is just Drug company exploiting the cascade for their gain.

I used dose rate in BSAVA guide which is about quarter of apometic dose on their data sheet. Worked very quickly and didn't last too long.

Rgds

RE: Apometic and Emedog, is this an abuse of the cascade?

Beats — Sun, 24 Dec 2017 07:46:54 GMT

[quote user="Dave Leicester"]

'The Cascade' covers the prescribing of 'veterinary medicinal products' and the Veterinary Medicine Regulations 2013 - the legislation from which The Cascade is derived - define a 'veterinary medicinal product' thus:

(a) any substance or combination of substances presented as having properties for treating or preventing disease in animals; or

(b) any substance or combination of substances that may be used in, or administered to, animals with a view either to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis.

Washing soda crystals are not 'presented' as having properties for treating or preventing disease (they are a detergent), nor are they exerting a 'pharmacological, immunological or metabolic' action as they are thought to cause emesis through contact irritation. As such, they do not fall within the definition of a 'veterinary medicinal product' and would not be governed by The Cascade.

[/quote]

Interesting. I hadn't thought like this.

RE: Apometic and Emedog, is this an abuse of the cascade?

Michael Woodhouse — Sun, 24 Dec 2017 00:17:29 GMT

I've always found washing soda easy and effective and the poor dogs that got apomorphine keep dry retching for ages and that looks horrible.

Not a medicine so not a cascade issue.

For a while was hard to get hold of, but they sell it in the local co-op as an eco washing powder.

RE: Apometic and Emedog, is this an abuse of the cascade?

Dave Leicester — Sat, 23 Dec 2017 15:06:20 GMT

Just with regards to soda crystals.

(a) any substance or combination of substances presented as having properties for treating or preventing disease in animals; or

So, there is no legal compunction for you not to use them.

Additionally, someone commented that the use of soda crystals could not be legally defended. I beg to differ. The following paper Comparison of the use of sodium carbonate (washing soda crystals) and apomorphine for inducing emesis in dogs. demonstrates an efficacy for soda crystals which is comparable (though slightly inferior) to that of apomorphine.

The study concludes:

Sodium carbonate and apomorphine are both used to induce emesis in dogs that require

emergency gastrointestinal decontamination. The occurrence of emesis with sodium

carbonate was high but inferior to apomorphine in this study. Despite this, the advantages of sodium carbonate being less expensive and more readily available than apomorphine are

relevant to the choice of emetic agent. Therefore, although sodium carbonate is less

consistent for inducing emesis, it still has a place as a viable and safe emetic agent when

administered under the guidance of a veterinary surgeon

I don't believe there is any issue with using soda crystals, in a controlled environment under veterinary supervision, to induce emesis. It's particularly useful for hardship cases.

RE: Apometic and Emedog, is this an abuse of the cascade?

Neil Wheadon — Sat, 23 Dec 2017 14:25:33 GMT

[quote user="robloxley"] just the manufacturer has increased the price of their veterinary licensed drug from about £1 per mg to over £12 per mg.[/quote]

This is the point I was making and written in a way that makes the change even more startling.

For the cascade to work there has to be competition or a degree of sensible pricing rather than blatent profiteering which I feel is happening in this case. If the company really wanted to reduce wastage (great piece of spin) then put the original product in small ampules or use some imagination, how about a couple of different strength vials?

I certainly appreciate the backup and support that we get from a licensed product, DECHRA are a fine example and we should expect to pay a 'mark up' for this. It's cases like this where I feel an office meeting, powerpoint presentation and a decision more for shareholders brings the system into disrepute.

Neil

RE: Apometic and Emedog, is this an abuse of the cascade?

Rob Loxley — Sat, 23 Dec 2017 12:33:49 GMT

[quote user="Edward Jones"]but I've had a few people say it takes longer to work[/quote]

Interestingly the licensed dose for emedog is half that of the licensed dose for apometic

RE: Apometic and Emedog, is this an abuse of the cascade?

Edward Jones — Sat, 23 Dec 2017 11:33:33 GMT

I only used a third to half the licensed dose of apometic to avoid the excessive sedative effects, with no apparent loss of efficacy.

I've not yet used emedog, but I've had a few people say it takes longer to work, and the dogs keep vomiting for longer too.

RE: Apometic and Emedog, is this an abuse of the cascade?

Rob Loxley — Fri, 22 Dec 2017 18:55:53 GMT

[quote user="Neil Wheadon"]So Emedog will replace Apometic[/quote]

Apometic was a veterinary licensed drug (it's a long while since we had Apo-Go, the human drug?); so this issue is not about going from a human to a veterinary licensed drug, just the manufacturer has increased the price of their veterinary licensed drug from about £1 per mg to over £12 per mg. I still contend that (unless freezing/storing leftovers) you had to pay £21 for the old vial and now £13 for the new vial, and if you use a lower dose (0.04mg/kg s/c or even 0.02mg/kg i/v) you can still get the dog to vomit.

RE: Apometic and Emedog, is this an abuse of the cascade?

Bob Russell — Fri, 22 Dec 2017 15:48:39 GMT

Perhaps the real question is how different is the testing process between the available human generic data and the licenced products?

The level of product testing prior to release to the market often appears to be very limited indeed. Trial numbers and sizes often lamentably small. Human studies pre-launch will involve thousands/tens of thousands or more patients. The early cases will often be as experimental drugs and years may pass before the product is widely available.

I am far from convinced that we should be assuming the licenced product is that much more tested than the human generic. I also suspect much of the information presented to the licencing authorities is based on the use of human generics.