Do you find any veterinary medicines regulations overbearingly bureaucratic?

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Beats — Sat, 27 Sep 2025 17:41:56 GMT

I skimmed that link, Rob, and didn't find it convincing re any substantial evidence to back up the author's first line assertion that paracetamol was "one of the most underused drugs in veterinary medicine... for dogs in the acute setting".

On the other hand, I think there is reason to dispute some assertions in that article which appear (unless I have misunderstood) to misquote the few articles that are available on the topic, such as paracetamol is not anti-inflammatory:

"Original work examining the anti-inflammatory effect of paracetamol showed that at approx. 25 mg/kg TID per os paracetamol was analgesic in dogs, but lacked significant anti-inflammatory effect."

https://pubmed.ncbi.nlm.nih.gov/3184254/

"On the third post-operative day the reductions in swelling compared with placebo averaged 33% with 1.5 g paracetamol (P = 0.02)"

I'm certainly not suggesting that anyone attempts to repeat this study however to see if the findings are consistent!

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Rob Loxley — Sat, 27 Sep 2025 12:29:28 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247745#247745"]

There's a discussion, I think on here but could have been VV, regarding this and the BSAVA formulary. The actual editor chipped in and, IIRC, the 10mg/kg was based on 1 or 2 papers with very small numbers of animals. Versus millions of Pardale V sold, hopefully with adequate pharmacovigelence.

The dose is 33mg/kg, not 10mg/kg. They really should change that.

[/quote]

It's updated in the latest edition.
Matt Gurney has a few articles about paracetamol dose and longterm use eg https://www.zeropainphilosophy.com/post/paracetamol-it-s-all-about-the-dose

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Evelyn Barbour-Hill — Sat, 27 Sep 2025 00:28:19 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247779#247779"]and in the back of my mind always think could I explain and defend this decision if I had too.[/quote]

Certainly. And I could. It doesn't mean that every academic "expert' in the world has to agree.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Fri, 26 Sep 2025 05:37:15 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247760#247760"]Why would you ever be asked to defend or explain it anyway?[/quote]

I hope none of us ever are, and as far as I am aware none of us have been so far.

But, the cascade rules are there and we are obliged to adhere to them wherher we like it or not (I don't)

I follow the cascade, and in the back of my mind always think could I explain and defend this decision if I had too. Maybe I overthink it, as I know others who seem to disregard it entirely.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Fri, 26 Sep 2025 05:31:12 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247777#247777"]In humans you can get 30/500 and 8/500 co-codamol. The Pardale V has 9/400. If I have a really bad head I find the 8/500 (2X) noticeably better than just the same dose of paracetamol. [/quote]

I used to take the 30/500 (1 or 2 as needed) fairly regularly for back pain 3-4 years ago, it was very effective. A couple of times I ran out and bought the 8/500 (x2) over the counter instead, but it barely worked at all for me.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Michael Woodhouse — Thu, 25 Sep 2025 22:42:44 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247753#247753"]In my view the amount of codeine in Pardale-V is homeopathically low anyway, so I would question how much difference it would make?[/quote]

When Pardale V was unavailable a few years ago we used just paracetamol. I personally know of half a dozen dogs that did less well on just paracetamol compared to Pardale. In humans you can get 30/500 and 8/500 co-codamol. The Pardale V has 9/400. If I have a really bad head I find the 8/500 (2X) noticeably better than just the same dose of paracetamol.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Evelyn Barbour-Hill — Thu, 25 Sep 2025 15:06:14 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247753#247753"]If asked to defend or explain it, I think just stating "I don't want to give codeine" could get you on to very thin ice, but as far as I know it has not been put to the test yet.[/quote]

Well, VMD have not objected to what i do.

Why would you ever be asked to defend or explain it anyway?

And if it did come to that, I have quite genuine reasons and could soon dream up a couple more.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Thu, 25 Sep 2025 07:38:07 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247741#247741"]

Clive Ansell said:
, for prescribing generic paracetamol over and above the licensed pardale-V?

Pasrdale-V contains codeine. In your judgment your patient should not have codeine. That's the end of the matter. You don't have to make a detailed case for not giving the codeine.

[/quote]

I'm not disagreeing, but that's the cascade folks.

If prescribing for, say osteoarthritis, why would you not want to give codeine as it may give analgesia superior to paracetamol alone? (In my view the amount of codeine in Pardale-V is homeopathically low anyway, so I would question how much difference it would make?)

If asked to defend or explain it, I think just stating "I don't want to give codeine" could get you on to very thin ice, but as far as I know it has not been put to the test yet.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Thu, 25 Sep 2025 07:30:37 GMT

[quote userid="25265" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247744#247744"]

What I’m advocating for looks more like this:

“I usually prescribe around a half tablet for every Y kilograms, Mrs X, but paracetamol is a prescription-only medicine in dogs. If you ever want to use it, give me a call, we’ll double-check it’s sensible, and I can pop a prescription up so you can buy it cheaply from a chemist.”

[/quote]

But one would also have to explain that paracetamol is not licenced for animal use, so before I can consider prescribing it I am legally obliged to prescribe licenced medications first, unless there is a good clinical reason not too, which I have to enter into the clinical notes, and would have to be able to explain and defend to a court or an RCVS enquiry, if it were ever necessary.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Thu, 25 Sep 2025 07:23:09 GMT

[quote userid="8958" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247743#247743"]So Mrs X comes in and says ' Everyone else gives paracetamol to their dog, as a professional what's the dose' So I reply 'well I can't tell you'. I feel a little embarassed and frankly a bit daft.[/quote]

In that situation I would give the dosage. I feel it is better that they know and give the correct dose, rather than getting it wrong and possibly causing harm. Others may not agree.

I would also point out that I cannot advise, recommend or prescribe it first line, because it is not licenced for animal use.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Thu, 25 Sep 2025 07:16:54 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247748#247748"]You could add: "However it might cause autism, [/quote]

Yep, I think we should all be seeking advice from Mr Trump before prescribing any medications.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Noweia — Wed, 24 Sep 2025 21:42:09 GMT

It's all well and saying, we should only give the dose in a written prescription. But that is also a consult fee. I'd like at least basic meds like a painkiller or lubricant eye drop to be available without prescription. Imagine having to pay £75 for a painkiller every time you get a headache?

Yes animals can't advocate for themselves but neither can kids and there are meds on the shelf for those.

Also yes people will give the wrong doses but they do that anyway even with prescribed meds

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Beats — Wed, 24 Sep 2025 20:38:18 GMT

[quote userid="25265" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247744#247744"]“I usually prescribe around a half tablet for every Y kilograms, Mrs X, but paracetamol is a prescription-only medicine in dogs. If you ever want to use it, give me a call, we’ll double-check it’s sensible, and I can pop a prescription up so you can buy it cheaply from a chemist.”[/quote]

You could add: "However it might cause autism, so I have a disclaimer for you to sign also, and owing to its effects in causing superbugs, I will be wanting to review Z every 5 days to ensure that I am not over-prescribing it and exercising appropriate animicrobial stewardship."

https://www.foxnews.com/health/common-painkillers-may-fuel-deadly-superbugs-resist-antibiotics-study-warns?msockid=3cceb2b9bed56c791b2ea396bf2e6d48

Seriously though, I am not a pardale-V fan at all:

chalky white tablets that seem to taste bad.

a controlled drug necessitating all sorts of extra rules around prescribing etc.

does the amount of codeine in that do anything helpful beyond the paracetamol?

but most crucially, having a drug called pardale that kills cats and one called peridale that treated constipation in cats and then allowing some marketing genius to make all your pots of tablets look identical has got to be one of the worst re-brands I have ever seen by a drug company (I think the atipamezole and medetomidine got the same treatment at the time also IIRC). There is prednidale also in a similar vein - madness!

I do keep some in stock, but personally prefer normal paracetamol tablets or oral suspension (and no I don't tell them to go to Asda, I give them the tablets / bottle myself, with a label in capitals stating that PARACETAMOL KILLS CATS tattooed on it).

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Michael Woodhouse — Wed, 24 Sep 2025 08:20:29 GMT

[quote userid="8958" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247742#247742"]How are you so sure it's 33mg/kg, sounds like you've taken the pardale dose and divided it [/quote]

Erm, yea. Pardale V licensed vet paracetamol, 400mg, 1 per 12kg so 33.333333333333333333 and so on, forever.

The dose is 33mg/kg, not 10mg/kg. They really should change that. They should probably also show their references on non licensed meds too......

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Ben Walker — Wed, 24 Sep 2025 02:42:36 GMT

[quote userid="8958" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247743#247743"]

Kinda illustrates my point.

So Mrs X comes in and says ' Everyone else gives paracetamol to their dog, as a professional what's the dose' So I reply 'well I can't tell you'. I feel a little embarassed and frankly a bit daft.

[/quote]

What I’m advocating for looks more like this:

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Neil Wheadon — Tue, 23 Sep 2025 23:44:44 GMT

[quote userid="25265" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247735#247735"]

Sorry for the second post but the potential errors are also serious. Paracetamol dosing in human adults is one-size-fits-all. A client who is told a dose for their Labrador in a consult might not realise (or might forget) that it isn't appropriate for their Chihuahua. Or might realise it is weight-dependent but not that it doesn't apply to their arthritic cat.

We shouldn't want our clients to view paracetamol as a GSL medication for their pets just because it is cheaper. Much better to reinforce that the meds are used with qualified advice.

[/quote]

Kinda illustrates my point.

So Mrs X comes in and says ' Everyone else gives paracetamol to their dog, as a professional what's the dose' So I reply 'well I can't tell you'. I feel a little embarassed and frankly a bit daft.

One of the first questions I ask these days in a consult is 'Have you given fluffy anything?' I think that maybe in 1 in 5 cases they've had a dose of meloxicam from the neighbour, chloramphenicol from the chemist, surolan that's been in the cupboard for a year (2 days ago that one) etc etc. Ask but don't judge.

It's nothing to do with the cascade really, it's trying to educate people on the correct dose, because you'll never stop people sourcing treatments from friends.

Neil

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Neil Wheadon — Tue, 23 Sep 2025 23:37:47 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247733#247733"]*cough* it's not, though.[/quote]

'choke' A British vet Univesity trialled it at 90mg/kg, to no adverse effect apparantly

How are you so sure it's 33mg/kg, sounds like you've taken the pardale dose and divided it

Neil

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Evelyn Barbour-Hill — Tue, 23 Sep 2025 16:05:29 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247738#247738"], for prescribing generic paracetamol over and above the licensed pardale-V? [/quote]

Pasrdale-V contains codeine. In your judgment your patient should not have codeine. That's the end of the matter. You don't have to make a detailed case for not giving the codeine.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Ben Walker — Mon, 22 Sep 2025 23:11:35 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247738#247738"]what clinical arguments could we put forward, for prescribing generic paracetamol over and above the licensed pardale-V[/quote]

Well, as you point out, we’re off label after five days, so the hoop to jump through is whether there is no UK veterinary product that is suitable. Main things that jump to mind for Pardale-V vs alternative paracetamol formulations:

Is the codeine appropriate? The dog would have to either be on tramadol or have a reason not to be. Seems like we could put that forward.

Might tablets be unpalatable? Capsules or suspensions could avoid that pesky problem.

If tablets or caplets are well tolerated then the number of tablets needed per dose might prove a challenge to some owners. Being able to dose the patient in 250mg split line increments instead of 200mg could mean fewer tablets per dose in bigger dogs.

There is a separate issue here, which is that the cascade requires us to prescribe (for example) tramadol for osteoarthritis before we can consider paracetamol (or gabapentin, etc). Not ideal.

But I don’t think the solution is to encourage us to give informal, possibly undocumented, dosing guidance to clients. And in the specific example of paracetamol I think we have enough leeway to serve our patients.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Michael Woodhouse — Mon, 22 Sep 2025 21:32:37 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247738#247738"]Don't forget, Pardale-V at that, or infact any, dose is only licensed for "a maximum of 5 days" beyond that it is off label. [/quote]

Only because long term studies are expensive. I spoke to them as a new grad, and that was the answer they gave me back then.

It's very recently that the data sheet was updated to remove the contraindication with other NSAIDs and reclassify to POM-V from POM-VPS. I do feel if there were 'overdose' issues or regular toxicity reports, that it would be fed back to the profession in a more effective way, than if people were just buying people pills from Tesco.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Clive Ansell — Mon, 22 Sep 2025 19:52:21 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247733#247733"]

*cough* it's not, though. It's 33mg/kg or possibly even higher (the data sheet says for animals up to 6kg, 1/2 tablet every 8 hours - and gives no lower size limit).

I've had 100's dogs on the full Pardale dose for many years with no issues. It's clinically much less effective at 10mg/kg.

[/quote]

Don't forget, Pardale-V at that, or infact any, dose is only licensed for "a maximum of 5 days" beyond that it is off label.

[quote userid="25265" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247734#247734"]

Neil Wheadon said:
Not being allowed to tell a client the dose of paracetamol is 10mg/kg. It's practically (or maybe it is) a criminal offence !!

Ditto Michael Woodhouse, but again, you are allowed to do this!

Follow the cascade. Put the prescription in writing. You are (very reasonably) recommending people use a medication for a purpose it isn't authorised for. Write it down so there's less risk of error. The regs are not the issue here.

[/quote]

Are you sure?

Under what circumstances could we justify, and what clinical arguments could we put forward, for prescribing generic paracetamol over and above the licensed pardale-V?

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Ben Walker — Mon, 22 Sep 2025 17:44:01 GMT

[quote userid="14693" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247736#247736"]The overlords expect you to charge. We dont all have the luxury of waiving it[/quote]

I know. And I understand. You want to give your clients access to a cheaper option and your hands are tied. What I haven’t heard is an explanation for why the regs should be changed in response to that.

I don’t imagine the overlords would appreciate you giving free dosing recommendations either, so wouldn’t you end up feeling pressure to not even document the discussion?

I’ve explained why I think it is a good idea to actively prescribe these drugs rather than go on a nudge and a wink. We should be upset at the employers who remove our discretion rather than the regs in this instance.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Lesley Strong — Mon, 22 Sep 2025 15:08:38 GMT

Re Prescription given for GSL and for the owner to just buys it at Tesco

The overlords expect you to charge. We dont all have the luxury of waiving it

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Ben Walker — Mon, 22 Sep 2025 09:58:10 GMT

We shouldn't want our clients to view paracetamol as a GSL medication for their pets just because it is cheaper. Much better to reinforce that the meds are used with qualified advice.

RE: Do you find any veterinary medicines regulations overbearingly bureaucratic?

Ben Walker — Mon, 22 Sep 2025 09:49:11 GMT

[quote userid="8958" url="~/f/non-clinical-questions/31237/do-you-find-any-veterinary-medicines-regulations-overbearingly-bureaucratic/247732#247732"]Not being allowed to tell a client the dose of paracetamol is 10mg/kg. It's practically (or maybe it is) a criminal offence !![/quote]

Ditto Michael Woodhouse, but again, you are allowed to do this!

Why demand change to the regulations rather than simply waiving the prescription charge in these cases? It sounds like you aren't looking to earn anything from the prescription anyway.