Diltiazem 60mg tablets

Re: Diltiazem 60mg tablets

Ian Mostyn — Thu, 31 Dec 2009 16:07:17 GMT

[quote user="Hannah Wynne Richards"]

Totally infuriating, but "our's not to reason why "etc

Wynne

[/quote]

Why shouldn't we query it? Clarification would actually be very nice from the VMD for situations like this. Can't say that we have to understand the answer but perhaps we should ask the question of the VMD?

Ian

EDIT

Found this under VMD guidance. It adds enough vagueness in to go either way

COMPANION ANIMALS – PARTICULAR POINTS

40. The following circumstances might arise in companion animal practice:

• Animal Owner Considerations - If a veterinary surgeon considers that, for

example, an elderly or disabled pet owner would have difficulty in crushing

and administering tablets which were the only form in which an authorised

product was available, it would be unlikely that action would be taken if he

or she concluded that medicine in tablet form were not appropriate in the

circumstances, and alternatives in line with the cascade were considered.

• Medicines Commonly Found Around the Home - Sometimes a

veterinarian may judge there is a need to alleviate a pet's discomfort until

a home visit can be made or the animal brought to the surgery. It would

be unlikely that action would be taken if in such circumstances a home

remedy, e.g. aspirin, were to be recommended.

effective treatment of a particular condition in a particular animal requires a

different dosage from one that appears on the label of a product. In such

circumstances recourse to the cascade may be appropriate and the next

option would be to consider the merits of using that product at an off-label

dosage (another condition in the same species) or a different authorised

veterinary medicine. If neither can safely be administered at the dosage

required, the veterinary surgeon should consider further options under the

cascade.

Re: Diltiazem 60mg tablets

Ian Mostyn — Thu, 31 Dec 2009 16:05:29 GMT

If it was a difficult dog that was hard to medicate with 3 tablets at a time, surely that would be justification for using an appropriate size human medication rather than a small cat size?? (Assuming one was available). If cost is not an issue, compliance of the dog surely is?? Does the VMD have any common sense - probably. Are they likely to prosecute - not initially, surely they would just tell you to use Hypercard? Just my rambling thoughts.

Ian

PS The small animal exemption scheme for things like xeno / lapizole etc is out of the cascade and any drugs licensed in this way do not have to be considered if you would prefer a generic.

Re: Diltiazem 60mg tablets

Rajat — Thu, 31 Dec 2009 13:42:08 GMT

It is a bit far fetched for the VMD to expect people to euthanase or rehome their pets just to follow the cascade system when costs preclude the use of generic medication. This sort of rule just fuels internet pharmacies which sell licensed medications without prescriptions, as of course it is illegal to prescribe said generics.

I would never counsel an owner to go down this route but I wouldn't be surprised if many owners don't already do this!!

I don't get how a possible adverse effect from a generic product is worse than euthanasing a pet...

Raj.

Re: Diltiazem 60mg tablets

Hannah Wynne Richards — Thu, 31 Dec 2009 10:57:56 GMT

Totally infuriating, but "our's not to reason why "etc

Wynne

Re: Diltiazem 60mg tablets

Laurence Webb — Thu, 31 Dec 2009 10:05:46 GMT

[quote user="Ian Mostyn"]

Surely the VMD aren't that picky????

[/quote]

Probably not, but you never know when a government agency gets involved. Strictly speaking it is breaking with the cascade unless you could demonstrate why diltiazem licenced for use in cat was unsuitable for use in a dog whilst generic diltiazam was suitable on clinical grounds.

The VMD have previously told me that cost issues alone are not enough to break with the cascade. I had an animal on a generic human medication before a drug company helpfully licenced an animal product at 5 or 10 times the generic cost. The owner, unsurprisingly, was upset at the sudden jump in treatment costs and said they would be unable to afford to treat the animal if they had to pay for the licensed product. When I asked the VMD if we could go back to the generic product I was told that it would be illegal for me to do so.

Their helpful advice was that if the owner would not pay for the new product then they could always rehome it or euthanase the animal.

PS I see Hannah's beaten me to it!

Re: Diltiazem 60mg tablets

Hannah Wynne Richards — Thu, 31 Dec 2009 09:55:13 GMT

Problem with "Surely VMD are'nt that picky " is that the only logical reason for not giving 3 tabs is expense-not like dividing large tablets where you can argue that it is impossible to do so accurately. Both VMD and RCVS have said that we are not allowed to take expense into consideration when going outside the cascade-not even when the client is threatening euthanasia!!!!!!!!!!!!!!!!!!

Wynne

Re: Diltiazem 60mg tablets

Kevin Castle — Thu, 31 Dec 2009 08:43:52 GMT

You're right about nothing licensed for dogs. No chemists in surrounding areas have it. Only seems to be a sustained release capsule avaiable which can't be divided. Looks like may have to consider giving 3 hypercard twice daily. This will make Dechra happy!

Re: Diltiazem 60mg tablets

Ian Mostyn — Wed, 30 Dec 2009 18:27:07 GMT

But there is nothing licensed for dogs and nothing licensed of the size needed. Surely the VMD aren't that picky????

Try the local chemist?

Ian

Re: Diltiazem 60mg tablets

Laurence Webb — Wed, 30 Dec 2009 18:01:12 GMT

I'm not sure how many people would want to admit to keeping in generic diltiazem when there's a licensed animal product for cats. You never know when the VMD may be watching you. Their spies may have already infiltrated the forum.