Cascade question/discussion

RE: Cascade question/discussion

Thomas Johnson — Fri, 31 Aug 2018 08:49:15 GMT

[quote user="Edward Jones"]Was it 10 years or so ago when Libromide was brought out, forcing us to use it over the cheap as chips generic? How was that anything other than a cynical misuse of the cascade by the licensee?[/quote]

The situation before Libromide came out was a bit odd though. We had Epilease produced by VetPlus, but it was classed as a neutraceatical or food supplement. I think when Libromide came out there was a realisation somewhere that it was inappropriate for KBr not to be a POM-V, which is why Epilease disappeared, though it is now back as a POM-V.

RE: Cascade question/discussion

Martin Atkinson — Thu, 30 Aug 2018 10:49:43 GMT

Well, I was all set to order some Metrobactin from NVS and low and behold it was not on their system so back to the generics (for now)!

RE: Cascade question/discussion

Edward Jones — Thu, 30 Aug 2018 09:16:24 GMT

Was it 10 years or so ago when Libromide was brought out, forcing us to use it over the cheap as chips generic? How was that anything other than a cynical misuse of the cascade by the licensee?

Palatable tablets are a pain for the significant minority of patients who won't take them. Then the client is left with an enormous and strong tasting tablet to give, plus the increased risk of the dog eating the whole lot at once if they accidentally get to the blister pack. A traditional small tablet can be squashed into a treat of the patient's/client's choice, or is much easier to administer directly.

RE: Cascade question/discussion

Gillian Mostyn — Wed, 29 Aug 2018 22:27:39 GMT

[quote user="Anthony Todd"]Still waiting for one example where POM-V has helped any animal get better where the same human generic has failed or caused problems.[/quote]

But you are completely missing the point.

The legislation aims to ensure vets are using tried and tested meds that are proven to be useful in THAT species for THAT problem. There is no argument that a handful of drugs (and it really isn't many) were left unchanged, but then cost more as a veterinary formulation. However, that is a small price to pay for a system that now encourages R&D, the reformulation of drugs to improve compliance, and the correct use of the drugs we have available to us. Paying a few pence more for vomend really isn't a biggie.

I don't know about what others think...but I think we've had more new really good drugs become available to us in the last few years than I ever remember before. And most of our drugs are now palatable, appropriately sized or able to be split. Life is so much easier! (Anybody else remember the massive pills that were kaobiotic? WTH was I doing getting people to get those down dogs necks??? )

The only problem is that the drug shelf needs to be bigger....far more choice!

RE: Cascade question/discussion

Liz Barton — Wed, 29 Aug 2018 21:41:01 GMT

A Veterinary Times investigation has found evidence of widespread violations of the cascade

In a statement, the VMD said: “The VMD is seeing an increase in the number of reports of potential cascade misuse and questions around the use of the cascade. This has caused us to review our guidance and advice in this area – we will be writing an article to remind vets of their responsibilities under the cascade.”

https://www.vettimes.co.uk/news/vmd-to-review-guidance-over-misuse-of-cascade/?utm_source=Vet+Times+Newsletters&utm_campaign=cb88f5fc60-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_fe3d844056-cb88f5fc60-82892441

I'll look forward to receiving my written reminder then...

RE: Cascade question/discussion

Rob Loxley — Tue, 28 Aug 2018 18:53:51 GMT

[quote user="Robin Grimmer"]Why is the Metrobactin data sheet dose so much higher than the formulary dose for metronidazole?[/quote]

Depends which edition of the BSAVA formulary you read! Metrobactin was licensed for infections including giardia and this does need the high end of the dose range IME (though panacur would be my 1st line just for giardia)

RE: Cascade question/discussion

Anthony Todd — Tue, 28 Aug 2018 18:46:47 GMT

[quote user="Charlotte Marshall"]The one new drug from dechra is zycortal injection.[/quote]

Looks like they got it from Novartis and all the original development [the hard and expensive bit] was done in the US. Other manufacturers too.

Please correct me I've got it wrong.

RE: Cascade question/discussion

Robin Grimmer — Tue, 28 Aug 2018 17:54:05 GMT

Why is the Metrobactin data sheet dose so much higher than the formulary dose for metronidazole?

RE: Cascade question/discussion

Clive Ansell — Tue, 28 Aug 2018 17:42:22 GMT

[quote user="Sarah Keir"]I think Metrobactin has been out for a couple of years now - ongoing discussion on the dosing though as the licensed dose if very close to the toxic dose so I actually use the licensed product off license. [/quote]

I've used a lot over the last 3 months or so, seem to have had a long run of haemorragic diarrhoea cases, some pyrexic, some not. A handful have tested positive for giardia too.

I have been prescribing Metrobactin at data sheet doses of 25mg/kg/bid, and not seen any problems with side effects at all. That said I do tend to slightly underdose rather than the other way round according to bodyweight.

RE: Cascade question/discussion

Clive Ansell — Tue, 28 Aug 2018 17:37:16 GMT

[quote user="Thomas Johnson"]Do you think it is wrong for pharmaceutical companies to ask us to pay a bit more when they have developed veterinary licensed versions of human drugs that have been re-formulated to make them easier for us to use, either through less frequent dosing, more appropriate tablet sizes or more making them more palatable?[/quote]

I don't think it is wrong as such, but my fundamental objection is being compelled to prescribe it via the cascade legislation. I feel a clinician in discussion with their client should be able to make an informed choice weighing up the pros and cons, including cost, of a specifically licenced product vs a generic, without it being criminalised. Whatever happened to the concept of the so called free market? the words scam, cartel and racketeering spring to mind.

RE: Cascade question/discussion

Charlotte Marshall — Tue, 28 Aug 2018 17:17:55 GMT

The one new drug from dechra is zycortal injection.

RE: Cascade question/discussion

Anthony Todd — Mon, 27 Aug 2018 20:42:29 GMT

[quote user="robloxley"]But again you miss that veterinary 5mg preds are less than pennies to buy (in fact we pay less than the NHS going on the BNF price for 5mg generics)! [/quote]

I promise you that human generics are cheaper, in bulk, than copy-cat V-POMs and exactly the same.

NOT reformulated flavoured generics of course, which I have no objection to at all.

RE: Cascade question/discussion

Rob Loxley — Mon, 27 Aug 2018 17:47:31 GMT

[quote user="Anthony Todd"]What is illogical duplicitous and a rort is to relabel generic 5mg prednisolone as "Vetpred 5mg", or whatever, and sell it at an inflated price when it is exactly the same drug, probably even made in the same factory, as the human generic[/quote]

But again you miss that veterinary 5mg preds are less than pennies to buy (in fact we pay less than the NHS going on the BNF price for 5mg generics)!

RE: Cascade question/discussion

Anthony Todd — Mon, 27 Aug 2018 17:34:58 GMT

[quote user="robloxley"]You asked for a specific! [/quote]

Yes I did, and the contra-arguer cited a specific changed formulation of a generic drug, to increase convenience or palatability, of which I have no objection.

What is illogical duplicitous and a rort is to relabel generic 5mg prednisolone as "Vetpred 5mg", or whatever, and sell it at an inflated price when it is exactly the same drug, probably even made in the same factory, as the human generic.

RE: Cascade question/discussion

Rob Loxley — Mon, 27 Aug 2018 16:58:42 GMT

[quote user="Anthony Todd"]It is amazing how intelligent highly trained scientists argue the general with a specific.[/quote]

You asked for a specific!

[quote user="Anthony Todd"]Still waiting for one example where POM-V has helped any animal get better where the same human generic has failed or caused problems[/quote]

RE: Cascade question/discussion

Anthony Todd — Mon, 27 Aug 2018 15:38:14 GMT

[quote user="Sarah Keir"]

If you write a written prescription for phenobarbitone that is what is will be supplied. If you write 'Epiphen' or 'Epityl' then that is what will be supplied.

[/quote]

And what are the chances that a chemist will have either of those in stock, and why would he, as he will realise, and hopefully most people, that they act the same, even if some are flavoured?

I wager the basic research into a new drug [not an ancient drug like phenobarbitone!!] is the major expense in developing said new drug and not the flavouring or modification of the basic active chemical.

Can't really criticise a manufacturer who adds a twist to the pharmacology [flavour, scoring tablet size etc] but that is much cheaper to achieve than starting from scratch.

Still waiting for a new drug from Dechra aren't I??

I have no argument at all with generics "improved" in presentation for use in animals.

If the generics are so bad and the POM-V are so good why is Dechra doing so well??

RE: Cascade question/discussion

bob lehner — Mon, 27 Aug 2018 15:35:16 GMT

Yes - and if there is a suitable licensed product available that is what you should be prescribing.

The pharmacist has no authority to change the product you have prescribed without asking you.

RE: Cascade question/discussion

Sarah Keir — Mon, 27 Aug 2018 12:56:34 GMT

If you write a written prescription for phenobarbitone that is what is will be supplied. If you write 'Epiphen' or 'Epityl' then that is what will be supplied.

RE: Cascade question/discussion

Anthony Todd — Sun, 26 Aug 2018 12:03:10 GMT

Of course not!

It is amazing how intelligent highly trained scientists argue the general with a specific.

To be clear, I am talking about generics, widely used, and for years, in human medicine and vetmed before any restrictive laws.

Take prednisolone, phenobarbitone and ampicillin as good examples.

I am just stating that this law is pointless and, if you like, an ass.

It has the irony that, if a vet writes a script for, say, phenobarbitone, almost certainly the chemist will provide a human generic, has this struck anyone else but me?

With no evidence of problems many human generics have been simply rebranded as POM-V at increased prices.

They are almost certainly exactly the same drug, and formulation, probably purchased from the generic human manufacturer, and just put in a differently labelled container yet it is now illegal to prescribe or sell the original human POM, safe for humans, tablet.

I expect the usual "disagreer" to do so without any qualification, which, actually, could be helpful, and increase his credibility.

Yes, I do realise "it's the law".

RE: Cascade question/discussion

Thomas Johnson — Sun, 26 Aug 2018 09:55:56 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"] Now we have Vidalta[/quote] et seq

You miss my point. They are different drugs I was talking about generics like, pred, pheno etc.

[/quote]

I think Rob's point was that the active ingredient in Neomercazole and Vidalta is the same, it's carbimazole. This is a good example of a human drug that has been used successfully in animals for several years, but when a veterinary licensed version is produced they didn't just re-label it and charge us more, they re-formulated it to make it slow-release so it only had to be given once a day rather than three times a day. Do you think it is wrong for pharmaceutical companies to ask us to pay a bit more when they have developed veterinary licensed versions of human drugs that have been re-formulated to make them easier for us to use, either through less frequent dosing, more appropriate tablet sizes or more making them more palatable?

RE: Cascade question/discussion

Bob Russell — Sat, 25 Aug 2018 10:06:14 GMT

A mini industry has grown up around cascade and the veterinary medicine regulations. Other than farm residues not sure it has done much except provide jobs for a few more lower level civil servants.

Next inspection I have a feeling i will come out 'all guns blazing'!

RE: Cascade question/discussion

rhmrcvs — Fri, 24 Aug 2018 22:35:31 GMT

[quote user="robloxley"]

[quote user="rhmrcvs"]I met a Danish vet and her boss on a course couple years ago. They use human generics without hesitation, no concern re cascade.[/quote]

Googling the Danish ministry of environment and food https://www.foedevarestyrelsen.dk/english/Animal/AnimalHealth/Veterinary_medicine/Pages/default.aspx says "Restrictions: Veterinarians must use registered veterinary medical products for animals. If a registered product does not exist for a condition, a veterinarian may exceptionally use, hand out or prescribe:

A veterinary product registered for another species or for another condition in the same species, or, if this does not exist,
A registered medical product authorised for use in human beings, or, if this does not exist,
A compound prepared extemporaneously at a pharmacy in accordance with the terms of a veterinary prescription.

In accordance with EU-regulations, only drugs, for which an MRL (Maximum Residue Level) has been established, may be used for food producing animals."
Is this not similar to what we have to follow??

[/quote][quote user="robloxley"]

[quote user="rhmrcvs"]I met a Danish vet and her boss on a course couple years ago. They use human generics without hesitation, no concern re cascade.[/quote]

A veterinary product registered for another species or for another condition in the same species, or, if this does not exist,
A registered medical product authorised for use in human beings, or, if this does not exist,
A compound prepared extemporaneously at a pharmacy in accordance with the terms of a veterinary prescription.

[/quote]yes , looks like the cascade , but they routinely ignore it.....

RE: Cascade question/discussion

Clive Ansell — Fri, 24 Aug 2018 09:30:15 GMT

[quote user="Sarah Keir"]I have asked the VMD for clarification but will take up to 15 working days so I'll update this before Xmas![/quote]

And there you have it, no more fit for purpose than a water soluble tea pot would be.

May be contact our professional body, the RCVS, for guidance. Could see which one replies first.

If you're expecting a concise and direct answer to a direct question, you could be in for a long wait!

RE: Cascade question/discussion

Martin Atkinson — Fri, 24 Aug 2018 08:48:56 GMT

[quote user="robloxley"]

"Restrictions: Veterinarians must use registered veterinary medical products for animals. If a registered product does not exist for a condition, a veterinarian may exceptionally use, hand out or prescribe:

A veterinary product registered for another species or for another condition in the same species, or, if this does not exist,
A registered medical product authorised for use in human beings, or, if this does not exist,
A compound prepared extemporaneously at a pharmacy in accordance with the terms of a veterinary prescription.

[/quote]'tis what I thought, that a major beef over the cascade is that it was enforced on us because of EU regulations not a unique British thing so Danish vets as in all EU countries need to abide by its rules. Maybe things will change here after Brexit, on the other had now its established as a golden egg for the pharma companies who is going to kill the goose that laid it?!

RE: Cascade question/discussion

Sarah Keir — Fri, 24 Aug 2018 07:47:36 GMT

I am just pondering what lengths are reasonable to go to obtain a licensed drug. The default at present is the one wholesaler is out of stock so order the generic. I have asked the VMD for clarification but will take up to 15 working days so I'll update this before Xmas!