epiphen to phenoleptil conversion

Re: epiphen to phenoleptil conversion

Martin Jones — Sat, 14 May 2011 11:52:24 GMT

[quote user="Michael Woodhouse"]

We have made a concerted effort to move everything over to the Phenoleptil. We get as close as we can to the existing dose, so the dog that was on 60mg bid would get 62.5mg from me [closer than 50mg!].

[/quote]

In which case, if costs are an issue then it's probably worth doing, but if not it's likely to be seen as a faff, with potential to have problems with incorrect dosing.

I suppose the sensible way would be to offer the new drug, with the proviso that changing meds can be a new problem, use a combo of 50mg/12.5mg to get as close to the original dose as possible and then wean down over several months so that a single-strength tablet is used.

Or just put new cases onto phenoleptil, which would allow a non-scientific, anecdotal (i.e. top flight, gold standard) clinical 'audit' as to whether it works as well as epiphen.

Re: epiphen to phenoleptil conversion

Michael Woodhouse — Fri, 13 May 2011 21:14:43 GMT

[quote user="Martin Jones"]What are people generally doing re doses? If a dog is on, say, a 60mg epiphen twice daily, do you just put them onto a 50mg phenoleptil twice daily? Or do you give a 50mg + 12.5mg?[/quote]

It can get silly ending up with 5 versions of the same drug on the shelf. We have made a concerted effort to move everything over to the Phenoleptil. We get as close as we can to the existing dose, so the dog that was on 60mg bid would get 62.5mg from me [closer than 50mg!]. If the latest bloods were top end of dose range then may reconsider.

[quote user="Martin Jones"]Anybody had any problems with this?[/quote]

No. Found it quite straightforward. Heartening to see a vet licensed drug cheaper than the generic! to Animalcare if they are on here?

Re: epiphen to phenoleptil conversion

Clive Ansell — Fri, 13 May 2011 17:04:21 GMT

I'm very much of the "if it ain't broke, don't fix it" brigade. If a patient is stable on Epiphen why not keep it on the current regime, changing the brand and the dose is asking for trouble. As well as dosage change, the bioavailability may be different?

Imagine the scenario: a dog that is stable and had no seizures for a while is on 60mg bid Epiphen, then is changed to 50mg bid Phenoleptil. 5 days later it goes into status epilepticus (which may or may not be related to the medication change) and spends the weekend in an OOH clinic with a £2000 bill - who is going to take the rap??

I suppose if one has to change, then base it on the last blood results and clinical picture as to whether rounding up or down. If the practice no longer stocks Epiphen there is always the option of writing a prescription.

Another option may be say to the client "we now have an alternative drug which is cheaper for you, however there is always a risk if changing meds" that way they make the choice and take responsibility.

I had a client in last night with a huge 60Kg epileptic GSD that has always been difficult to manage and went into status epilepticus and spent the new year at a branch of a well known national OOH clinic. And the bill was £2000. This dog has been stable on 240mg Epiphen and 650mg Libromide bid since January, but I wouldn't change its meds at all at the moment.