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  1. #41
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    Quote Originally Posted by DoubleTwistedWire View Post
    Thanks for that. Whe I get home tonight I will look it up. There have been several articles in vet mags that say it's illegal and even vets that have been in trouble for adding flavor to bute. I am very interested to compare the notes. In fact, asking a vet about this right now as I type this he reminded me of a letter that was sent out to most vets that you can not compound bute. I'm confused, so is the vet I'm with!



  2. #42
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    Perhaps VETS are not allowed to compound drugs, but legal, licensed compounding pharmacies are?
    Click here before you buy.


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  3. #43
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    Quote Originally Posted by davistina67 View Post
    Thanks for that. Whe I get home tonight I will look it up. There have been several articles in vet mags that say it's illegal and even vets that have been in trouble for adding flavor to bute. I am very interested to compare the notes. In fact, asking a vet about this right now as I type this he reminded me of a letter that was sent out to most vets that you can not compound bute. I'm confused, so is the vet I'm with!
    davistina, that first link is to the October 2009 letter from the FDA to veterinarians. The specific paragraph regarding compounding:

    The numerous FDA-approved phenylbutazone products for horses, available in multiple dosage forms and two flavors, greatly reduce the need for compounding. In very limited cases when you have specific patients that require phenylbutazone in a strength or dosage form that is not available among the approved products, phenylbutazone can only be legally compounded by using an FDA-approved phenylbutazone product as the starting material. Phenylbutazone should not be compounded from bulk. An animal drug that is compounded from bulk drug ingredients is not FDA-approved, and therefore, the safety and effectiveness of the compounded drug, as well as the adequacy of the manufacturing process, have not been evaluated.
    LookinSouth, while I haven't used Pentaussie, I have happily used Pentosan, at a significantly lower cost than than per dose. However, I'm not familiar with the cost of the additional glucosamine injections, so you may want to price glucosamine + Pentosan versus doing the two combined.



  4. #44
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    Quote Originally Posted by LookinSouth View Post
    Gah!! Just heard from my vet and they are charging 310.00 for FOUR doses of Pentaussie! Usually they are very reasonable about not marking up RX but that works out to 77.50 per dose

    I would love to hear from others what they are paying for Pentaussie so I have a leg to stand on when I ask why the price is so high...sigh.
    http://www.heartlandvetsupply.com/sh...taussie-equine

    Is there any reason you specifically want the Pentaussie over the Pentosan? I get a 50ml vial of Pentosan from Wedgewood for $119 (which includes the shipping costs). That's 10 5 ml doses...

    Veterinary compounding brochure from AVMA...
    http://www.avma.org/issues/drugs/com...g_brochure.asp
    Only two emotions belong in the saddle: One is a sense of humor. The other is patience.



  5. #45
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    [quote]
    Quote Originally Posted by bugsynskeeter View Post
    Thank you! I am wondering if the dosage for Pentaussie is 12ml per dose? Or 6ml like Pentosan? If it is 12 ml per dose that would explain the price.

    Is there any reason you specifically want the Pentaussie over the Pentosan? I get a 50ml vial of Pentosan from Wedgewood for $119 (which includes the shipping costs). That's 10 5 ml doses...
    Yes unfortunately my vet will not write a script for Pentosan. Otherwise I would be jumping all over that like a fly on poop.



  6. #46
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    LookinSouth, did your vet say why they would not write the script? Just curious?

    As far as compounding bute, I asked a couple vets today. They all said no way. It seems from that letter the FDA sent out in 2009 that they left the door open slightly on the matter, but I certainly can't think of a reason why you would need to compound bute. In a quick search I did find a couple things stating you couldn't. In fact, on is a letter to a compounding pharm stating that they must stop compounding bute. Seems a bit confusing!

    Also something interesting is that if a vet sells someone a compounded drug, which they must not have as a bulk compound product, that it must be sold to the client at cost. Basically, a vet can not mark up compounded drugs. I know some vets do and if your vet is doing that to you, mention it to them and I'm sure they will sell it to you at cost as it is a very widely known law they are breaking.

    http://www.superiorbute.com/FDA%20Warning%20Letter.pdf

    http://www.bendequine.com/documents/...ylbutazone.pdf



  7. #47
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    [quote]
    Quote Originally Posted by davistina67 View Post
    LookinSouth, did your vet say why they would not write the script? Just curious?
    We just briefly chatted through email so her response wasn't overly specific but they said they don't prescribe Pentosan because it is not researched, proven, nor is it FDA approved to administer. They also said there is no real evidence it actually works and it is not legal to prescribe.

    I am not sure what is different about Pentaussie that makes it a more viable choice in their opinion since I thought it wasn't FDA approved in the US either? But I haven't had a chance to ask about that yet...



  8. #48
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    [QUOTE=LookinSouth;6077882]


    We just briefly chatted through email so her response wasn't overly specific but they said they don't prescribe Pentosan because it is not researched, proven, nor is it FDA approved to administer. They also said there is no real evidence it actually works and it is not legal to prescribe.

    I am not sure what is different about Pentaussie that makes it a more viable choice in their opinion since I thought it wasn't FDA approved in the US either? But I haven't had a chance to ask about that yet...
    Interesting, guessing she is in the camp that with it being compounded that it puts her lively hood at risk if she prescribes it.



  9. #49
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    I just started using pentosan with glucos.

    It's thrilling. The horse was on previcox and legend and now I just give the pent/gluc.

    I'm on the 3rd month.

    My friend who works in a clinic said she can get the 12ml (1 dose) vials for 50 bucks.

    I get them from my vet for $65. But I'm also a really good customer and we do our vet well. So I think I talked him down a bit on the price. ; )
    http://kaboomeventing.com/
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    Horses are amazing athletes and make no mistake -- they are the stars of the show!



  10. #50
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    Quote Originally Posted by LookinSouth View Post
    Is the loading dose the same as Pentosan? 4, 6ml doses every 5-7 days? If so, then a course of Pentaussie would still be much more cost effective than Adequan or Legend at 160.00 for a full course which is awesome.
    I have given 4 doses of PentAussie so far, my vet said to do 4 doses, of 6 mL, a week apart. I paid $195 for 3 vials so $65 per vial, $32.50 a dose. I think it's doing the trick, ever since the 3rd dose my trainer hasn't said my horse looks sore.

    About whether PentAussie is FDA approved--since it has a US patent and is made in the USA, I assume it is FDA approved as a surgical lavage, but not for the "maintenance" that we are using it for.

    I am a pharmacist, so let's see if I can clear anything up. First off, phenylephrine injection is commercially available and FDA approved, at least for humans--so put down the Preparation H! Second, compounding does have different degrees. It is legal to take a drug (say Bute) and manipulate it into a different dosage form. It is illegal to buy a bulk bottle of phenylbutazone and make tablets from it--tablets of Bute are commercially available. It is illegal to take a bulk bottle of omeprazole powder and make capsules from it--commercially available again. It is legal to take omeprazole powder and compound it into an apple-flavored liquid suspension--not commercially available (as far as I know.)
    There were/are laws against compounding unless it was for a specific patient. HOWEVER, there is some case law for veterinarians to be able to have a supply of meds to provide to their clients-- I know my dog's vet kept compounded Trilostane capsules on hand to dispense before Vetoryl was available. I believe that the compounding laws are federal laws as davistina said, though my last law class was over 10 years ago. Of course, some states could have stricter laws than the federal laws.



  11. #51
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    Quote Originally Posted by OTTBs View Post
    I have given 4 doses of PentAussie so far, my vet said to do 4 doses, of 6 mL, a week apart. I paid $195 for 3 vials so $65 per vial, $32.50 a dose. I think it's doing the trick, ever since the 3rd dose my trainer hasn't said my horse looks sore.

    About whether PentAussie is FDA approved--since it has a US patent and is made in the USA, I assume it is FDA approved as a surgical lavage, but not for the "maintenance" that we are using it for.

    I am a pharmacist, so let's see if I can clear anything up. First off, phenylephrine injection is commercially available and FDA approved, at least for humans--so put down the Preparation H! Second, compounding does have different degrees. It is legal to take a drug (say Bute) and manipulate it into a different dosage form. It is illegal to buy a bulk bottle of phenylbutazone and make tablets from it--tablets of Bute are commercially available. It is illegal to take a bulk bottle of omeprazole powder and make capsules from it--commercially available again. It is legal to take omeprazole powder and compound it into an apple-flavored liquid suspension--not commercially available (as far as I know.)
    There were/are laws against compounding unless it was for a specific patient. HOWEVER, there is some case law for veterinarians to be able to have a supply of meds to provide to their clients-- I know my dog's vet kept compounded Trilostane capsules on hand to dispense before Vetoryl was available. I believe that the compounding laws are federal laws as davistina said, though my last law class was over 10 years ago. Of course, some states could have stricter laws than the federal laws.
    Thanks, interesting to get everyone's take on it since some vets do stuff like that, and most don't. Just curious!



  12. #52
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    Great response OTTBs. This is such a grey area. Correct me if I'm wrong, but the following is my understanding. We, as vets, are not allowed to have bute powder compounded if the FDA approved bute powder (which is readily availabl and not superiorbute) suits the purpose.....which it surely does for the huge majority of horses. If it is compounded (say for 0.25 mg per scoop, for a mini), it must be made from FDA approved product and be t made for that particular patient.
    In the case of compounded pentosan, I believe we should actually be importing it from countries where it is approved, with FDA approval and a bunch of paperwork. If we put that idea aside, if it is compounded It needs to be prescribed on a case-by-case basis (we should not be ordering bottles to have on hand at all times). And keep in mind that the oversight of compounding pharmacies is nothing like the FDA....i'm remembering those polo ponies that died following treatment with a misformulated,, compounded injection. And the recent discussion about Prascend vs compounded pergolide. I wonder if there's a study comparing dosing/concentration errors in FDA approved versus compounded batches of medications.....
    Remember that a vets liability insurance will NOT protect them if they are sued, and it was found that they did not follow compounding laws. Given that these laws are not always clear, it's a scary proposition to prescribe a compounded medication when there is an FDA approved alternative out there! Same is true for using medical devices like polyglycan....totally not legal because the FDA doesn't even consider it a drug (thus off-label use laws do not apply).
    I find these discussions very interesting...perspectives sure can be different depending on where a person is at in the chain of events.



  13. #53
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    Sorry guys, new to the board....didn't format that response properly. :-)



  14. #54
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    Quote Originally Posted by davistina67 View Post
    Hard telling what the vets particular reason is but the reason most won't write a script for Pentosan is that it is very illegal for a vet to write that script.
    You keep using that term. I don't think it means what you think it means.

    It is only wrong to:

    1)refuse to write a prescription instead of dispensing a med when there is a legitimate need for the medication

    2) use a compounded medication when there is an approved veterinary form of the drug in that strength and form. For instance, I have a hyperthyroid cat. She is impossible to pill and is not a candidate for I131. I use transdermal methimazole gel in her ear. That is not illegal.

    3) use/write for a medication that is expressly forbidden (there are some meds that have been taken out of use in vet med because there is no slaughter withdrawal time and/or the danger to humans is too great, these are 'banned' substances)

    Quote Originally Posted by davistina67 View Post
    Oh my. It is not FDA approved for horses. Since that is what we are talking about I didn't think I would need to spell it out. The thing that is extremely alarming about your vet is that he carries it on his truck. That is an absolute no-no. A vet can not stock a compounded drug to be sold from stock. If there is a suitable need for a compounded drug, it must be on a case by case basis. You can't just keep a supply of compounded drugs and sell them. But to each their own!
    Just because something is stocked on one's vet truck doesn't mean they are selling it. They could be, oh, I don't know, using it ON THEIR PATIENTS.

    Quote Originally Posted by davistina67 View Post
    Thanks for that. Whe I get home tonight I will look it up. There have been several articles in vet mags that say it's illegal and even vets that have been in trouble for adding flavor to bute. I am very interested to compare the notes. In fact, asking a vet about this right now as I type this he reminded me of a letter that was sent out to most vets that you can not compound bute. I'm confused, so is the vet I'm with!
    If you had read the actual articles you might have noticed that the people who got their hands slapped were compounding to an already available approved form (ie. apple or citrus flavored powder, an apple flavored paste, etc)

    I suppose all of us clinics (large and small) with FlavoRx systems are breaking the law?

    You know, I have to say, if I ever found out that my assistant or technician posted some of the extremely misinformed things so called 'veterinary technicians' had posted in this thread and in others I would think long and hard about firing them. They are the first line of client education and if they can't be bothered to educate themselves then I don't want them spouting off the misinformed and misleading things that some of them seem to do here on a regular basis.
    Last edited by Grataan; Jan. 17, 2012 at 04:45 AM.
    Michael: Seems the people who burned me want me for a job.
    Sam: A job? Does it pay?
    Michael: Nah, it's more of a "we'll kill you if you don't do it" type of thing.
    Sam: Oh. I've never liked those.



  15. #55
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    Quote Originally Posted by Grataan View Post
    You keep using that term. I don't think it means what you think it means.

    It is only wrong to:

    1)refuse to write a prescription instead of dispensing a med when there is a legitimate need for the medication

    2) use a compounded medication when there is an approved veterinary form of the drug in that strength and form. For instance, I have a hyperthyroid cat. She is impossible to pill and is not a candidate for I131. I use transdermal methimazole gel in her ear. That is not illegal.

    3) use/write for a medication that is expressly forbidden (there are some meds that have been taken out of use in vet med because there is no slaughter withdrawal time and/or the danger to humans is too great, these are 'banned' substances)



    Just because something is stocked on one's vet truck doesn't mean they are selling it. They could be, oh, I don't know, using it ON THEIR PATIENTS.



    If you had read the actual articles you might have noticed that the people who got their hands slapped were compounding to an already available approved form (ie. apple or citrus flavored powder, an apple flavored paste, etc)

    I suppose all of us clinics (large and small) with FlavoRx systems are breaking the law?

    You know, I have to say, if I ever found out that my assistant or technician posted some of the extremely misinformed things so called 'veterinary technicians' had posted in this thread and in others I would think long and hard about firing them. They are the first line of client education and if they can't be bothered to educate themselves then I don't want them spouting off the misinformed and misleading things that some of them seem to do here on a regular basis.
    I will ignore your ignorant comment at the end. Thanks!

    If you had followed along, you would have seen that at the time I posted the one comment I didn't have time to read the info or look it up. So please enlighten all of us oh knowledgeable one. Why will most vets not write a script for Pentosan? Oh yes, and I'm sure a lot of vets stock stuff on their truck to just drive around with! LOL You missed the point.

    And please tell me, where do you find a requirement to get bute compounded?



  16. #56
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    I have it compounded all the time. I have several patients that are impossible for the owners to pill or give paste to orally, and absolutely hate the citrus and apple flavors. For those I prescribe an alfalfa molasses flavored compounded powder or a black cherry powder.

    I have no problem writing a prescription for Pentosan SHOCKER I KNOW. I prefer a different product.

    I don't think you know as many vets as you think you do. Certainly not enough to say "most vets won't" I go to AAEP every year and I would never say "most vets won't write for X off label product." There are three reasons some people don't write for things 1) they misunderstand compounding law. 2) they are unfamiliar with the product or 3) they prefer a different medication.

    I hope to God you don't talk to your boss' clients the way you speak on this BB because if you do you are a)misinforming clients and b) losing him business. It is quite clear to me that you have almost no knowledge of the inner workings of an ambulatory veterinary truck. You think the only reason we stock things on our trucks is to dispense them to clients? BS. 99% of the stuff on my truck is on my truck for ME TO USE. Like the giant bottle of Flunixin. Or the giant bottle of Butorphenol. They are multi dose vials I draw individual doses out of and give when I am on calls.
    Michael: Seems the people who burned me want me for a job.
    Sam: A job? Does it pay?
    Michael: Nah, it's more of a "we'll kill you if you don't do it" type of thing.
    Sam: Oh. I've never liked those.



  17. #57
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    It is clear the reason you are on this board is that you have tIme to because you are not very busy. Yes, I to go to The conferences. You must run with a very different crowd! This is clear since you write compound scripts since your clients are unable to paste a horse. I'm sure there are a few I'm the world but have yet to meet any. Good luck and I hope things pick up for you!



  18. #58
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    I really doubt you attend a lot of vet conferences. Unless it's to serve coffee.

    For the OP - if you'd like to read up on Pentosan and the research behind it - check out the research done at Colorado State. Here's a link to get you started - http://www.equineortho.colostate.edu...olysulfate.pdf

    Here's the site: http://www.equineortho.colostate.edu/current.htm

    It's shown to be superior to Adequan. But there was also research done on ASU, IRAP, stem cells, and other treatments for osteoarthritis in the horse.

    Your vet may prefer not to prescribe it for you - but there IS research out there showing its efficacy. And there is a lot of really interesting information out there on things like IRAP, stem cells, PRP, etc. Hope you find the links useful.

    ETA - you asked about experiences with PentAussie. Sorry - I cannot tell you anything about that particular product. But I have given Pentsoan and recently switched to Pentosan Gold (Pentosan, Glucosamine, and HA).

    The results were dramatic. My older field hunter has a new lease on life and is working happily. A little too happily.
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  19. #59
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    Seriously, davistina, I love my vet dearly but if someone who worked for him came across like you do I would find a different vet and I would tell him why so he had the opportunity to fire you first.
    Click here before you buy.


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  20. #60
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    I see ignorance is shining brightly today by those that think they know something but have little field experience!



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