What do you think about Bravecto Injectable (and this film)?

RE: What do you think about Bravecto Injectable (and this film)?

Sarah Keir — Mon, 14 Oct 2024 20:24:11 GMT

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245542#245542"]

My understanding is that there may be less of a risk of resistance because the active is delivered reliably, and not subject to owner compliance.

My understanding is that the environmental impact should be less than with a spot on because a) the product does not wash off in the rain, and b) the active is insoluble and binds to soil, so will be unlikely to spread.

[/quote]

Bullshit. I think you need to educate yourself on the effect antiparasecticides are having on the environment and what we are storing up for the future with these 'forever chemicals'. You are old enough to have read 'Silent Spring'. Please talk to Andrea Tarr

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Mon, 30 Sep 2024 11:32:57 GMT

[quote userid="5012" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245563#245563"]It would not be an unreasonable argument that this could have some effect on the environment. It could kill or harm insect and other invertebrate life, as well as wash off in to water courses.[/quote]

Clive Ansell MSD says this about it: “Fluralaner is a modern systemic isoxazoline parasiticide and is excreted overwhelmingly in faeces, with very little being passed out in urine. As with all medicines and parasiticides, excretion into the environment will occur but consideration of the possible environmental impact forms part of the robust regulatory assessments our products undergo. Where the faeces are disposed of via designated dog waste bins or in household waste this will limit environmental exposure, but in the event spot faecal contamination occurs, the active binds to soil and is highly insoluble, which limits the likely spread via water.”

RE: What do you think about Bravecto Injectable (and this film)?

Evelyn Barbour-Hill — Fri, 27 Sep 2024 11:18:49 GMT

[quote userid="5012" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245563#245563"]should we not be promoting responsible use and prescribing based on need, and not dishing it out willy nilly as a revenue generating tool or part of some tinpot health club scheme. [/quote]

Yes

RE: What do you think about Bravecto Injectable (and this film)?

Clive Ansell — Fri, 27 Sep 2024 07:28:22 GMT

[quote userid="4181" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245543#245543"]

Arlo Guthrie said:
Someone has raised the issue of people being given this on a health plan, and then the owner cancelling immediately and running off into the night

It's certainly a consideration. A lot of bad debt comes from these situations, where chasing them for often <£100 soon becomes economically unviable. We would usually only dispense 3 months supply of flea/wormer at a time for this reason.

[/quote]

Maybe the solution here would be a one off in advance annual payment where an expensive product that lasts a year is being given. This could be incentivised by making an annual payment cheaper overall than 12 monthly ones.

Some of the practices I work in have reported a rise in the number of clients setting up health club schemes, bagging a vaccination, microchip and 3 months worth of flea and worm control, then cancelling the direct debit. A lot of staff time and effort is then need to pursue debts, many of which they are unlikely to get back.

RE: What do you think about Bravecto Injectable (and this film)?

Clive Ansell — Fri, 27 Sep 2024 07:20:34 GMT

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245542#245542"]My understanding is that the environmental impact should be less than with a spot on because a) the product does not wash off in the rain, and b) the active is insoluble and binds to soil, so will be unlikely to spread.[/quote]

Fluralaner, the active drug in Bravecto, is mainly (90%) excreted unchanged in faeces. It would not be an unreasonable argument that this could have some effect on the environment. It could kill or harm insect and other invertebrate life, as well as wash off in to water courses.

It still begs the question; should we not be promoting responsible use and prescribing based on need, and not dishing it out willy nilly as a revenue generating tool or part of some tinpot health club scheme.

That said, I think it is a very good and effective product, and I use it first line now in almost all skin cases I see.

RE: What do you think about Bravecto Injectable (and this film)?

Michael Woodhouse — Tue, 24 Sep 2024 21:27:18 GMT

[quote userid="5012" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245541#245541"]

Do you mean not much difference compared to one tablet, or for 4 that would last the year?

If the latter, I could see folk being put off by a c£200 injection - just a thought?

[/quote]

I assume it's fairly standard with Bravecto to pay for 3 and get 1 free. If I compare cost price (to me, Vetcel buying group) of 3 paid for by owner tablets to the injection then cheaper for dogs less than 25kg, and more expensive over that. The list price is £29/ml before any discounts. 1ml/10kg. 3 month broach

My gut feeling is to price the same as 3 Bravecto tablets and charge out as bands - 10-20kg 20-40kg. Do a bit better on smaller dogs and worse on bigger dogs but ok overall.

Great compliance, can't have a prescription. Equally with the PHP lots of people don't claim their full allocation that they have paid for and there is no clawing back a 12 month injection.......

I suspect discounts will increase as they don't sell a huge amount and then it will get a bit more affordable and grow.

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Tue, 24 Sep 2024 12:38:46 GMT

[quote userid="8991" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245548#245548"]Thought it was good, lighthearted, and gave a decent overview of the product.[/quote]

Thanks David Mills - much appreciated.

Interestingly, it seems to have generated a lot of discussion elsewhere on other social media, like linkedin, facebook, instagram etc, so I think the main purpose is reaching out to those who don't usually read news, where it can be helpful for them to see a really short summary pop up on their newsfeed

So I'm going to start doing daily short news reports in addition to product brief films.

Here's the first

https://www.instagram.com/reel/DATK0R0NUiJ/

RE: What do you think about Bravecto Injectable (and this film)?

David Mills — Tue, 24 Sep 2024 10:23:43 GMT

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film"]So, first question ... what do you think of the film?[/quote]

Thought it was good, lighthearted, and gave a decent overview of the product.

I wouldn't expect all the ins and outs of the products, and I'm sure you wouldn't be comfortable / should be going into all the technical details anyway - that will be the jobs of reps. Drugs that come out with a genuine new application or USP like this one are interesting to hear about especially in a quick 60 minute run through.

I suppose the profession is always healthily sceptical about new products or new products in different forms, but that is just the way it is.

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Tue, 24 Sep 2024 08:49:20 GMT

[quote userid="8991" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245545#245545"]Pricing wise I can't see it being significantly more expensive than bravecto tablets 4x a year. [/quote]

I'm told it's not, but the difference is having to pay up front.

RE: What do you think about Bravecto Injectable (and this film)?

David Mills — Tue, 24 Sep 2024 07:57:47 GMT

[quote userid="4181" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245543#245543"]What's the tick risk in Chelsea?![/quote]

Slightly tangential fun fact - currently working in somewhere relatively prosperous which shouldn't have a high lungworm burden - yet seen 3 lungworm cases in the last 3 months which had all gone to their second homes in the SW a few weeks previously.

It will work for some people and areas, not others.

A slight drawback is lack of lungworm cover. But then that would mean keeping regular contact with owners for that cover so maybe a positive.

Pricing wise I can't see it being significantly more expensive than bravecto tablets 4x a year.

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Tue, 24 Sep 2024 07:41:00 GMT

[quote userid="4181" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245543#245543"]

Arlo Guthrie said:
Less of a problem in Chelsea.

What's the tick risk in Chelsea?!

[/quote]

Yeah, but when they head off to their estates in the highlands ...

(actually, that's a bit of a dated stereotype these days)

RE: What do you think about Bravecto Injectable (and this film)?

Rob Loxley — Tue, 24 Sep 2024 07:27:59 GMT

A lot of clients pay their flea/worm as part of a health plan subscription, so they might directly not see the one-off cost.

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245542#245542"]Someone has raised the issue of people being given this on a health plan, and then the owner cancelling immediately and running off into the night[/quote]

There's also the factor of wastage, as while there's a 3 month in use life, it's expensive at £500+ per bottle to be throwing away if not used (or someone drops the bottle or leaves out the fridge)

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245542#245542"]Less of a problem in Chelsea.[/quote]

What's the tick risk in Chelsea?!

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Tue, 24 Sep 2024 07:22:18 GMT

[quote userid="5464" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245528#245528"]There are plenty of products with similar names that we use in cats.[/quote]

Chris Geddes Hi, I meant because in this case, the product is called Bravecto Injectable for Dogs!

Clive Ansell Although not a vet I will jump in here because I did work in this area for many many years!

My understanding is that there may be less of a risk of resistance because the active is delivered reliably, and not subject to owner compliance.

Someone has raised the issue of people being given this on a health plan, and then the owner cancelling immediately and running off into the night. Not sure whether that is a significant risk and means it cant be offered on a health plan or not - guess it depends on geography. Less of a problem in Chelsea.

RE: What do you think about Bravecto Injectable (and this film)?

Clive Ansell — Tue, 24 Sep 2024 06:07:41 GMT

[quote userid="3169" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245540#245540"]Not a vast difference in cost by size of tablet. Cheaper for small dogs, more than double for a 60kg newfie[/quote]

Do you mean not much difference compared to one tablet, or for 4 that would last the year?

If the latter, I could see folk being put off by a c£200 injection - just a thought?

RE: What do you think about Bravecto Injectable (and this film)?

Michael Woodhouse — Mon, 23 Sep 2024 23:17:29 GMT

[quote userid="5012" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245539#245539"]Might be cost prohibitive?[/quote]

Just costing PHP. Not a vast difference in cost by size of tablet. Cheaper for small dogs, more than double for a 60kg newfie

RE: What do you think about Bravecto Injectable (and this film)?

Clive Ansell — Mon, 23 Sep 2024 21:33:50 GMT

Might be cost prohibitive?

I dispensed a Bravecto tablet for a £24 Kg dog today, £51. Pro rata that would make the injection c£200 - would folk really pay that much? (I've not used it so don't know what it actually costs)

In light of recent events where there is concern about overuse, parasiticide resistance, and possible environmental impact; should we be prescibing a product with a 12 month duration of action?

RE: What do you think about Bravecto Injectable (and this film)?

David Mills — Mon, 23 Sep 2024 14:15:23 GMT

Surely you'd just try a tablet first? If no issues then give the injection.

Can see the appeal. Give at same time as annual vaccs. Great if they develop one for cats too.

RE: What do you think about Bravecto Injectable (and this film)?

Chris Geddes — Mon, 23 Sep 2024 13:53:24 GMT

[quote userid="2100" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245510#245510"]f) The clue is in the name. [/quote]

There are plenty of products with similar names that we use in cats.

RE: What do you think about Bravecto Injectable (and this film)?

Clive Ansell — Sat, 21 Sep 2024 10:16:55 GMT

[quote userid="6386" url="~/f/clinical-questions/31034/what-do-you-think-about-bravecto-injectable-and-this-film/245511#245511"]Personally it's a no. Any issues, you can't take it out of the body. [/quote]

The same could be said for Bravecto tablets and spot on too, with their 3 month duration, and any other long acting antiparasitic preparation.

I'm uneasy with a product that lasts that long too, but could potentially be of benefit in cases of poor and non compliance. It would be good if there were a one year alternative for cats, given the number of boomerang cases that keep returning because of non compliance.

RE: What do you think about Bravecto Injectable (and this film)?

Kate Richardson — Sat, 21 Sep 2024 09:44:03 GMT

Personally it's a no. Any issues, you can't take it out of the body.

RE: What do you think about Bravecto Injectable (and this film)?

Arlo Guthrie — Sat, 21 Sep 2024 08:23:06 GMT

Michael Woodhouse Thank you, that's very helpful, and I will endeavour to address at least some of those questions in future films. For this one, my thinking was:

a) Is it effective? Well, it's been through licensing, and in my (not inconsiderable) experience, flea treatments always claim 99% efficacy in trials, marketing materials etc. I am in no position to test such claims, so I assumed claimed efficacy would be taken as a given, and real life efficacy (which would likely be the same) would be discovered in real life.

But sure, a link to a trial should have been there. Here's one: https://pubmed.ncbi.nlm.nih.gov/37872632/ I will add it.

b) How do we give it?
I did answer this one in the film. But yes, will include in future ones.

c) What does it cost?
Sticky one, that, innit. I did think/ask about that. Depends on so many factors. All I could (but probably should) have said is 'about the same as the pills'

d) Broach time. It's supplied as powder plus solvent, so there isnt a broach time as such. But reconstituted fluralaner must be used within three months. I didn't think to mention this because I didn't have any real product to show (it's POM, and I couldn't be given some just for filming). But that is something to remember for next time.

e) Contraindications. In this case, it is just: "Do not use in cases of hypersensitivity to the active substance or to any of the excipients." which I would imagine is probably common to a lot of medicines.

f) The clue is in the name.

Overall, I was trying to get the concept across quickly (I am limited to 60 seconds). Mainly the point that taking efficacy, safety etc as a bit of a given (trusted manufacturer, known active, licensed), then here's something that offers huge convenience benefits for the owner and which owners have said they would buy from you, over and above the crap in the supermarket.

RE: What do you think about Bravecto Injectable (and this film)?

Michael Woodhouse — Fri, 20 Sep 2024 22:40:23 GMT

No. Feels like marketing hype. Put the syringe down.

Most Bravecto sold by our practice is tablets (10:1).

What I want to know about a new product

Is it effective

How do we give it

What does it cost

What is the broach time

Any contraindications

Can I give it to a cat

You said it was effective but provided no data.