Can veterinarians and pet owners trust compounding pharmacies?

With all the bad press veterinary compounding pharmacies got in the last couple of years, you'd think they'd want to be very careful to preserve the trust of veterinarians and pet owners. But a recent experience with what I thought was a trustworthy company has made me wonder if they're going to be able to survive pending regulatory crackdowns.



My Borzoi, Kyrie, has a slight problem with urinary incontinence. A couple of times a week I give her the medication phenylpropanolamine (PPA), a decongestant that was removed from the human over-the-counter market because of a possible association with an increased risk of stroke. It is also a drug that can be used in the manufacture of methamphetamine.



She's allergic to the flavoring in the chewable form of the drug, so my veterinarian prescribed an unflavored compounded version. The pharmacy she recommended is one I'd used for another medication for another dog, and it was one that had come highly recommended by a number of veterinarians I knew and trusted.



That mattered to me because there are some pet pharmacies that don't deserve that trust, that apply pressure to veterinarians to approve refills and prescriptions when the pet hasn't been seen recently -- or even skipping that pesky "prescription" step entirely. I didn't want to trust Kyrie's health to a company like that.



It turns out, though, that I did. Last week, I called in a refill for Kyrie's PPA. She rarely needs it, so the refill had expired last December -- nearly 9 months earlier. I left the refill request on their automated system, and said that I wasn't sure if they needed me to call my vet to have the refill authorized, or if they would call her, but I left my number in case there was a problem.



Two days later, I have Kyrie's meds. It just so happened I saw my vet the next day, when Rawley needed a cut pad looked at. I thanked her for authorizing the refill so quickly, and she gave me a strange look. "I didn't hear anything from the pharmacy," she said.



She went digging, and not only had no one at the practice authorized it, no one was asked to authorize it. In conversations she had with the pharmacy, it turns out that their representative had authorized the refill him or herself, and tacked on two more refills just for the heck of it.



Kyrie is 11 and a half years old, and while she's pretty healthy, she's had some issues. That nameless, faceless voice on the phone has never laid eyes on her, let alone examined her, nor, presumably, is qualified to prescribe medication in any case.



I assumed, trusted, that my dog was being given this refill because my veterinarian, who had recently seen and examined her, had authorized it. I don't want "no questions asked" refills of potentially harmful drugs. I don't want to give my money to a pharmacy that does business that way.



The person my veterinarian spoke to at the pharmacy insisted they didn't do business that way normally. They're well-thought-of in the veterinary world. They value their reputation. It was, she assured my vet, a fluke.



But my veterinarian's trust is shattered, and so is mine. Not only in this one company, but in all veterinary compounding pharmacies. Did someone there think it was okay because it was "just a dog"? Is business suffering, so there's been a slackening of the rules in the service of the bottom line? Did they simply fail to train their employees in how to comply with the law?



I don't know. I do know that the next time I need a compounded medication, I'm not going to know where to turn. And that's going to hurt not just this one company, but the entire industry.



Compounding pharmacies need to clean up their act or the FDA won't just clean it up for them, it will do what many people believe it wants to do anyway and shut them down. And that's going to hurt dogs like Kyrie who need a medication in a form not otherwise available.



Photo: Kyrie gets comfy.

Comments

[David S. Greene]

That is very worrisome, Christie. If they're not calling for authorization, what other shortcuts are being taken that you/we don't know about?

[Deb]

This is of great concern as I depend on a compounding pharmacy for my dog's potassium bromide to control his ideopathic epilepsy. They're an in state company, and because of that I have naively thought of them as being aboveboard, reputable and honest. Sigh.

[Phyllis DeGioia]

Oh boy, Christie, this scares me to death. Two of my pets are taking compounded meds. Both have been doing so for less than a year, and one has been refilled only once, and the other has yet to be refilled (hopefully it won't need to be).



Good and bad apples in every barrel. It's up to us to select the places we do business with...

[Kim]

Christie, there's a product by Homeopet that is called "Leaks No More".



It's GREAT for spay incontinence - my last client had a six month old lab female who would lose full bladder every time she fell asleep.



Two months later, even high doses of veterinary medication had not helped. We tried 48 hours of Leaks No More, and her owner says two years later that there's the occasional drip or dribble, but its rare. The product is cheap too, about $12 a bottle.



I'm not 100% convinced that homeopathy is the answer to everything (or very much at all) but we do use a few specific treatments that we have proven to be effective, and this product is the one we got the BEST response from. 100% of the dogs we've tested have responded in some form, the vast majority of them have been cured completely as long as doses aren't missed.



I have no connection to this company - but the results I have seen from it have been nothing short of life saving (imagine looking at ten years with a dog who has no bladder control) and still seems relatively unknown, although the product is widely carried by specialty pet stores.

[Ingrid King]

This is extremely unsettling. Being able to compound medications for pets is such an important part of taking care of their health needs, and usually, the reason veterinarians use compounded medications is because the pet won't take the meds any other way, so to loose trust in these medications at a time when your pet needs them is absolutely awful.



I don't know whether maybe using a local pharmacy would be a little more reassuring? But I suppose short of looking over their shoulder as they compound, nothing really will.

[Dr Monte]

In many states pharmacists are allowed leeway in writing and filling prescriptions. Here in Colorado they even have the ability to start a prescription if they feel it is needed without knowing the patients full medical history.



I suspect this person on the other side of the phone thought hey were doing yo a favor. You needed the meds, you had been getting the meds, it is a fairly safe drug (although even I have trouble getting it now because of diversion to illicit uses). You had not refilled it too frequently. So they over stepped a bit and were trying to save you time and be nice to you. As the company stated it isn't company policy and wasn't indicative of how they do business. Compounding pharmacies work in an even tighter box than regular pharmacies and way tighter than the internet clowns who have no qualms diverting product or selling product that isn't...well the product. After "refusing" three faxed RX's from one of those companies (I won't say which one...but Betty White stumps for them)they filled it anyway for my client. Evidently in the state they operate in, they claim that they can do this for their client.



We put a lot of trust in our suppliers daily. This trust is tested frequently. Claiming veterinary only sales only to find the product placed BY the company in pet stores or big box stores is just one thing that happens. Usually because we don't have a choice we still do business with these guys albeit grudgingly because what can you do? In this case, you have two choices. Stick with them now that you have alerted them to a chink in the business plan (which I would because up to then they did a good job for you right?)or go out and find a new supplier...who may have the same business plan.

[Christie Keith]

Dr. Monte, I don't agree. By that logic, they'd have sent me the med right away without waiting for my vet's approval, but they'd have still at least tried to obtain it. And they wouldn't have tacked on two more unauthorized refills, made a false notation in the file that my vet had approved it, and then argued about it for a while before admitting they'd screwed up.

Also, you say the drug's not particularly dangerous, but isn't that my veterinarian's call, not theirs? They don't know Kyrie. They don't know what medical conditions she has nor what other drugs she's on.

[Janeen]

I'm a bit hypersensitive on issues like this because I worked in a series of traditionally men-only jobs in the late 70s and early 80s. Women were extremely rare in these kinds of jobs at that time and many times I was the first woman a company had hired in any position other than a clerical one.



I lived under a microscope. I knew that every triumph - and more importantly - every mistake I made would be carefully filed away in my boss's gray matter as what he (always he) could expect from all women he might hire in the future. It was a powerful motivator - but it wasn't fair to me or to the women who came after me.



One clinic made a mistake. Possibly just one person at one clinic made a mistake. It was a thoughtless mistake. It was a potentially very dangerous mistake. But it is not a valid reason to write off all compounding clinics.



It does, however, rather powerfully point out the need for better oversight on compounding clinics.

[Mel]

Thanks for posting this. I had no idea pharmacies could do this with pet meds. I find it not only disturbing, but unprofessional. So glad you made me and others aware of this little known practice.