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Pentosan questions from a vet

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  • Original Poster

    #21
    On my previous horse I had a different vet who was suggested to me as having a lot of experience with lameness out for an extensive lameness exam and they ended up doing the injections. Regular vet is about 2 miles away and is a reliable go to for pregnancies, emergencies, coggins, and shots.

    I don't event at a high level (AT ALL) but I'm interested in making my horse the best she can be, I don't want to waste my money with unproven supplements, and I don't want to mask any signs of pain with NSAIDS.

    How big of a deal is the risk of bleeding?
    http://weanieeventer.blogspot.com/

    Comment


    • #22
      Another option would be for you to try Adequan and see if it helps your horse. You don't have to figure out where to get it and your vet is familiar with it. You would probably want to do the loading dose and then see if she is going better. My older horse is on Adequan (and has been for years). If Adequan helps her, then you might want to do more looking into the Pentosan.

      I did ask my vet about Pentosan and she did research on it. She mentioned that it did have anticoagulant properties for approximately 24 hours after administering it. So the risk of bleeding is not for a long window of time.

      Comment

      • Original Poster

        #23
        I sent the additional information to my vet, she will not use any compounded product without FDA approval. She says the side effect of bleeding is a concern especially with a compounded product. She said there is no guarantee with compounded products that you are getting what drug you expect in the concentration on the label and that compounded products are not generic products. She would prefer that I use a feed through supplement (which have no guarantee of content but she says less risk of harm) and then try approved products.
        http://weanieeventer.blogspot.com/

        Comment


        • #24
          I truly mean no disrespect to you or your vet, but let me see if I have this right.

          You have an older horse with probably some age related little lameness/soreness. Nothing horrible, but you want to try and help the horse as much as possible.

          Your vet, who doesn't specialize in lameness, doesn't know anything about Pentosan, but is willing to read about it if you do the research, yet in the same breath says compounded products are dangerous because she read about a case in the newspaper and the risk of bleeding is too high.

          Isn't that kind of an uninformed sweeping generalization based on... not much?

          Pentosan has very mild heparin like qualities - the only caution is that a JOINT injection not be administered within 24 hours of Pentosan administration. I assume an animal with some sort of bleeding disorder or headed for surgery might not get it either. But that's not to say the horse is going to keel over looking like it just died of Ebola.

          People are cautioned not to take certain medications before surgery, too. It does not make their medications dangerous or unsafe to take.

          Drug manufacturers constantly get dinged on things. So do food manufacturers. To me it means the inspections are working. If companies kept getting clean bills of health I'd be suspicious. No system is without fault.

          Is it an option for you to seek the opinion of a vet who specializes in lameness evaluation? Not because of the Pentosan, but because another set of eyes and a different exam may yield better information.

          And perhaps that vet is more educated on the various treatment options if OA or another problem is revealed during a exam. Because it doesn't sound like your vet is really up to speed. None of the feed through products are proven to work; with the arguable exception of products containing ASU. And those products are extremely expensive.

          Let's say the problem ends up being some sort of soft tissue issue, and not OA. None of the OA drugs will work on that, even the feed through, so you'll save some money.

          There is research out there comparing the efficacy of Adequan, Legend, Pentosan, ASU, and glucosamine. At this time, Pentosan appears to win by a mile - though later research may end up showing a completely different drug is even better. OA can be helped by different shoeing, as well. So working with a good vet and farrier, as a team, is invaluable.

          Anyway -try looking for that research and see what you think. Good luck!
          Brothers and sisters, I bid you beware
          Of giving your heart to a dog to tear.
          -Rudyard Kipling

          Comment


          • #25
            Originally posted by enjoytheride View Post
            I sent the additional information to my vet, she will not use any compounded product without FDA approval. She says the side effect of bleeding is a concern especially with a compounded product. She said there is no guarantee with compounded products that you are getting what drug you expect in the concentration on the label and that compounded products are not generic products. She would prefer that I use a feed through supplement (which have no guarantee of content but she says less risk of harm) and then try approved products.
            In a way you can't blame her after reading the report on Wedgewood. I mean really, using drugs that are expired by 3-4 years to make compounded drugs and then sell? (or something like that, there was some pretty bad violations in that report) Remember if something happens to a horse because of a compounded drug, the vet is the one that will get the blame.

            Comment

            • Original Poster

              #26
              She never said she read a report on Wedgewood specifically. I sent her the information on Wedgewood based on the experiences of the people on COTH and UDBB and due to their prices. She referenced the story of contaminated back injections as a reason she does not like compounded medications.

              However, the lameness vet I used gave me compounded Acytl D Glucosamine to use on my last horse so it must vary from vet to vet.
              http://weanieeventer.blogspot.com/

              Comment


              • #27
                Oy Vey !

                Comment


                • #28
                  Originally posted by BansheeBreeze View Post
                  Stifles was my first thought too, as my horse has a similar issue. Feels like they forgot to pick the foot up or it got stuck in a hole for a step. Random steps, generally when the horse is tired. My vet said the stifle was catching, not quite locking up but similar, just snagging. It had gotten pretty bad but when I moved barns he was out in a large field 24/7 and the issue has gone away, just by him being able to move around a lot freely. Would definitely get a second opinion from a vet who has more experiences with lameness.
                  My mare takes the same wonky steps, and we've found it's her back and not her stifles. Specifically the tuber sacrales, lumbo-sacral and sacro iliac ligaments (please excuse spelling mistakes, I'm trying to read the vets writing).

                  I've got a gelding that's been on Pentosan for 4 months now, and it's completely changed his life. No more stiffness from the time you get on until you get off. Can buck and play in turn out, and we NEVER saw that before.

                  Comment


                  • #29
                    Originally posted by enjoytheride View Post
                    She never said she read a report on Wedgewood specifically. I sent her the information on Wedgewood based on the experiences of the people on COTH and UDBB and due to their prices. She referenced the story of contaminated back injections as a reason she does not like compounded medications.

                    However, the lameness vet I used gave me compounded Acytl D Glucosamine to use on my last horse so it must vary from vet to vet.
                    It's fine to have an opinion, and to share it--that's what health professionals DO. But it is also in the job description to DISCUSS the risks and benefits of a proposed therapy with the patient/client and ask them to participate in MUTUAL decision-making. If her stance is "I think that's too dangerous" but she is basing this on a gut feeling or personal opinion and in doing so is going way outside the normal range of practice, it's worth perhaps considering a second opinion.

                    This is a difficult and sticky area to negotiate. She's not refusing to consider a gold-standard, approved therapy with piles of proven benefits. But Pentosan is not exactly pumping them full of kerosene, either. It is within a reasonable standard of care among many vets. So therefore (IMO) the appropriate response is to DISCUSS WITH THE CLIENT her reservations, the perceived risks and benefits, and to allow the client to decide. If she feels she must decline a prescription based on her personal beliefs, it would be appropriate (but not mandatory, of course) for her to recommend a second opinion.
                    Click here before you buy.

                    Comment


                    • #30
                      Originally posted by davistina67 View Post
                      In a way you can't blame her after reading the report on Wedgewood. I mean really, using drugs that are expired by 3-4 years to make compounded drugs and then sell? (or something like that, there was some pretty bad violations in that report) Remember if something happens to a horse because of a compounded drug, the vet is the one that will get the blame.
                      Wedgewood is not the only compounding pharmacy to make pentosan, nor is pentosan the only product coming out of Wedgewood. They also compound and sell drugs for human use. Many hospitals use compounding pharmacies for lots of their meds. I'm not sure where the "OMG it's coming out of a compounding pharmacy it must be crap" idea is coming from.
                      "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                      Comment


                      • #31
                        Originally posted by enjoytheride View Post
                        ... She said there is no guarantee with compounded products that you are getting what drug you expect in the concentration on the label and that compounded products are not generic products. She would prefer that I use a feed through supplement (which have no guarantee of content but she says less risk of harm) and then try approved products.
                        What am I missing here? She prefers a feed-through supplement, which in general have no research to support them, but some anecdotal evidence that they may help. But won't support Pentosan, even though there is strong anecdotal evidence that it helps some horses dramatically. She wants you to supply the evidence to support your desire to try it.

                        Seems close-minded and somewhat backward to me.

                        Comment


                        • #32
                          But Pentosan is not exactly pumping them full of kerosene, either. It is within a reasonable standard of care among many vets. So therefore (IMO) the appropriate response is to DISCUSS WITH THE CLIENT her reservations, the perceived risks and benefits, and to allow the client to decide.
                          My horse vet is feels this way: Pentosan is quite a bit more effective than Adequan, in his experience. And it costs less. So NOT talking to his clients about it, should they ask about joint therapy, feed-through supplements or Adequan, would be irresponsible on his part. He'd much rather try Pentosan than start right on a joint injection.

                          He also makes sure that you understand that this isn't an FDA approved treatment, that it is compounded, etc., and approved in Australia through their system so not unfounded hocus-pocus.

                          For the record, I've tried it on a few horses. Some, it has helped a whole big bunch. Some, meh, maybe, and some, not at all. My OTTB wouldn't be up for the kind and amount of ranch work we do, without it.

                          But I think your vet is not quite being reasonable about this. Maybe there is something we don't know, that she's not telling you, that would affect her opinion, because the consensus from what we know doesn't really make much sense.

                          Comment


                          • #33
                            Originally posted by enjoytheride View Post
                            I sent the additional information to my vet, she will not use any compounded product without FDA approval. She says the side effect of bleeding is a concern especially with a compounded product. She said there is no guarantee with compounded products that you are getting what drug you expect in the concentration on the label and that compounded products are not generic products. She would prefer that I use a feed through supplement (which have no guarantee of content but she says less risk of harm) and then try approved products.
                            You're paying the vet you use. If you don't agree with the way he/she is treating your horse I'd say find a vet whose thinking is more in line with yours.

                            For the record, my vet is willing to discuss treatment options with me. I told him I wanted to use Pentosan on my horse and pointed him to some research I had found. He wrote me the prescription and kept I've kept in touch with him about it's efficacy. He recently told me about some new research coming out of U of Colorado about Pentosan which leads me to believe that he's listening to what I (and other clients) have to say and is continuing to do research.

                            It's your horse and your money. In my opinion you're not asking for anything that's outrageous. You might just want to hire a different vet.
                            "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                            Comment


                            • #34
                              It might be worth a follow up conversation to determine if the vet knows that it is an approved drug, just an off-label use. Because she is unfamiliar, she may think that pentosan is not legal.

                              Comment


                              • #35
                                Originally posted by enjoytheride View Post
                                I sent the additional information to my vet, she will not use any compounded product without FDA approval. She says the side effect of bleeding is a concern especially with a compounded product.
                                Pentosan is FDA approved...just for humans, not horses. As to the bleeding risk, there is some good information in this article.
                                http://veterinarynews.dvm360.com/dvm.../detail/775273
                                A slightly increased risk of bleeding for 24 hours after administration would certainly not be enough to stop me from using a very effective, inexpensive medication.

                                Comment


                                • #36
                                  Originally posted by mswillie View Post
                                  Wedgewood is not the only compounding pharmacy to make pentosan, nor is pentosan the only product coming out of Wedgewood. They also compound and sell drugs for human use. Many hospitals use compounding pharmacies for lots of their meds. I'm not sure where the "OMG it's coming out of a compounding pharmacy it must be crap" idea is coming from.
                                  I know all of the except, what other compounding pharmacy makes Pentosan? Did you read the report on Wedgewood?

                                  Comment


                                  • #37
                                    Originally posted by davistina67 View Post
                                    I know all of the except, what other compounding pharmacy makes Pentosan? Did you read the report on Wedgewood?
                                    http://www.stokespharmacy.com/defaul...Osteoarthritis

                                    http://boothwynpharmacy.com/forms/BP...esReferral.pdf

                                    http://epcveterinarian.com/index.php...201&Itemid=250

                                    Here are three. Most of the compounding pharmacies don't provide a list of meds, they want you to contact them.

                                    Yes I read the warning letter. There were a lot of findings but few that in my opinion would compromise the integrity of the formulations.
                                    "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                                    Comment


                                    • #38
                                      I wonder how many manufacturers of oral supplements have regular inspections of their manufacturing facilities (is this even required)?

                                      People think nothing of feeding their horses the latest nutraceutical with God-knows-what in it, no testing, no efficacy or safety data, and no quality control and still get squeamish at the thought of a compounded pharmaceutical, or one that comes from a country where different-colored people live. Weird.
                                      Click here before you buy.

                                      Comment


                                      • #39
                                        Feeding and injecting something are big difference for me!

                                        Comment


                                        • #40
                                          Originally posted by davistina67 View Post
                                          Feeding and injecting something are big difference for me!
                                          Why? A toxic substance can be deadly when ingested or injected. And major drug companies can screw up FDA approved drugs as well as compounding pharmacies can. http://www.time.com/time/magazine/ar...8870-1,00.html

                                          Though this mess was not Baxter's fault
                                          I wasn't always a Smurf
                                          Penmerryl's Sophie RIDSH
                                          "I ain't as good as I once was but I'm as good once as I ever was"
                                          The ignore list is my friend. It takes 2 to argue.

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