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Pentosan, Legend or Adequan ???

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  • #61
    My vet and I have briefly talked about pentosan. It wasn't an in-depth chat, more of a I've read about pentosan, what's your take kind of chat, he said he liked it, it's been around for a long time, and thinks it would be a good option for my semi retired event horse.

    I'm making the assumption (would talk with my vet first) that if I switched to IM pentosan I could stop his joint supplement? He was on adequan and legend for a couple years, and during that time we didn't do any oral supplements.

    He's on Recovery EQ, and I'm spending about $90 every 40 days on that! But I think by my math pentosan would be more cost effective for me, that the Recovery EQ is about $72 a month, where pentosan cheaper (especially from horseprerace.com).

    I think I'm thinking out loud.....

    Comment


    • #62
      Originally posted by deltawave View Post
      Umm, I kind of practice medicine for a living. And have malpractice insurance.

      A medical practitioner is responsible for following the standard of care, for diagnosing and treating appropriately, for addressing with patient/client the relevant risks and benefits when remedies or procedures are recommended, for doing procedures safely and correctly and for prescribing treatments correctly. This certainly can and does include the use of off-label or compounded drugs.

      A horse that has an allergic reaction to (for instance) penicillin and dies does NOT represent a case of malpractice, provided the penicillin was prescribed for an appropriate reason and dosed correctly in an animal not known to be allergic.
      If a vet was on the scene and failed to attempt to treat the anaphylaxis that would be a different story, but if the treatment was attempted but the horse still died, or if the owner was giving the injection--no malpractice.

      Yes, vets are accountable for all treatments recommended, including compounded drugs. But if a client gives consent for the use of the compounded drug after an appropriate discussion of the risk, benefit, alternatives, then (provided this is documented somewhere) there is no malpractice, even if something adverse happens.

      This wouldn't prevent an angry or litigious owner from threatening a vet, but cases like this never make it past the first phone call to an attorney. Bad outcome =/= malpractice.
      So you are a vet? Then you should know the answer to that.

      When something goes wrong with compounded drugs the vet may be held responsible for it. From the AVMA:

      Q: What's my liability if there's a problem with a compounded medication?
      A: If you have a potential claim situation, you should always contact your liability carrier.

      Insurance carriers are unable to provide an unequivocal statement on the potential liability and related insurance coverage associated with compounding because the subject is a complex mix of state and federal regulations; with many situational variables, and a history of varying and unpredictable degrees of enforcement.

      Comment


      • #63
        Originally posted by deltawave View Post
        Umm, I kind of practice medicine for a living. And have malpractice insurance.

        A medical practitioner is responsible for following the standard of care, for diagnosing and treating appropriately, for addressing with patient/client the relevant risks and benefits when remedies or procedures are recommended, for doing procedures safely and correctly and for prescribing treatments correctly. This certainly can and does include the use of off-label or compounded drugs.

        A horse that has an allergic reaction to (for instance) penicillin and dies does NOT represent a case of malpractice, provided the penicillin was prescribed for an appropriate reason and dosed correctly in an animal not known to be allergic.
        If a vet was on the scene and failed to attempt to treat the anaphylaxis that would be a different story, but if the treatment was attempted but the horse still died, or if the owner was giving the injection--no malpractice.

        Yes, vets are accountable for all treatments recommended, including compounded drugs. But if a client gives consent for the use of the compounded drug after an appropriate discussion of the risk, benefit, alternatives, then (provided this is documented somewhere) there is no malpractice, even if something adverse happens.

        This wouldn't prevent an angry or litigious owner from threatening a vet, but cases like this never make it past the first phone call to an attorney. Bad outcome =/= malpractice.
        Also from the AAEP:

        It goes without saying, the prescribing veterinarian assumes responsibility/liability when using compounded preparations. Other considerations with regard to liability; the veterinary is responsible for “due diligence” on the compounding pharmacy (as noted above, be sure you are utilizing a reputable pharmacy). Be sure the proper medical and dispensing records are kept and the preparation is properly labeled. From an ethical perspective, it would be prudent for the practitioner to inform the client a compounded preparation is being used to treat his or her animal. The practitioner should also make clients aware of the potential risks associated with using these preparations (this should be done with any product, whether using FDA-approved products or compounded preparations).


        Now after reading that, do you really think that a client would not have a case against a vet especially given the poor FDA report at Wedgewood? The Vet may win, but it sure is going to take a lot of time and money and I can see why vets won't use a compounded drug like Pentosan.

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        • #64
          The above discussion jogged my memory....

          For what it's worth...My vet that would not prescribe Pentosan because it was compounded told me that her insurance would not cover her for problems with compounded medications.
          Kanoe Godby
          www.dyrkgodby.com
          See, I was raised by wolves and am really behind the 8-ball on diplomatic issue resolution.

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          • #65
            A practitioner assumes responsibility with ALL DRUGS, compounded or not, for proper prescription and (if relevant) dispensing and dosing.

            I can see why vets would be leery, yes. But it is also (IMO) their responsibility to have a FULL discussion with clients if the client expresses an interest as to why they would or would not choose a particular compounded drug. "I'm afraid of a lawsuit" is really not a good enough reason, IMO. Compounded drugs are not some sort of shady, black market operation. Yes, the pharmacies need to be held to standards. Even "FDA" pharmacies are cited for violations all the time. Legislation is on the fast-track to bring compounding pharmacies under stricter control, which I support 100%.

            As one can easily see from reading this thread, people are perfectly willing to just buy the stuff from HorsePreRace and use it on their own without a vet being on the case at all.

            Ethically this is not a black and white issue. For an owner with limited means, compounded drugs can be a godsend. A vet who just will not even consider or discuss the pros and cons with a client and allow the client to decide is doing their client a disservice, IMO.

            If there's a procedure that I think a patient needs and I know how but I'm afraid to do it because I might get sued, I need to find that patient a new doctor, and myself a new career.
            Click here before you buy.

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            • #66
              Originally posted by CDE Driver View Post
              The above discussion jogged my memory....

              For what it's worth...My vet that would not prescribe Pentosan because it was compounded told me that her insurance would not cover her for problems with compounded medications.
              That is interesting! And of course would be a very good reason to avoid it--one's hands are tied with malpractice insurance if that is what you meant by "insurance"--but I would still, as the vet, MENTION THIS to my clients if the topic came up. It would certainly help that client make up his/her mind.

              But the above-referenced (quoted below) AAEP statement makes me wonder if the vet was fudging a little bit.

              Insurance carriers are unable to provide an unequivocal statement on the potential liability and related insurance coverage associated with compounding because the subject is a complex mix of state and federal regulations; with many situational variables, and a history of varying and unpredictable degrees of enforcement.
              Click here before you buy.

              Comment


              • #67
                Maybe I'm overly suspicious, but has anyone else noticed that horsecatcher joined the forum the same day davistina67 was banned?

                Comment


                • #68
                  I asked my regular vet who had never heard of Pentosan and tends to be conservative and not only would she not perscribe it but she wouldn't perscribe ANY compounded medications.

                  I spoke to my lameness vet and not only had he heard of it but he wrote me a scrip and he also deals with many other compounded medications.
                  http://weanieeventer.blogspot.com/

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                  • #69
                    davistina got banned at last? Huh--she had the distinction of being the only person, ever, that I put on the "ignore" list.
                    Click here before you buy.

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                    • #70
                      Originally posted by enjoytheride View Post
                      I asked my regular vet who had never heard of Pentosan and tends to be conservative and not only would she not perscribe it but she wouldn't perscribe ANY compounded medications.

                      I spoke to my lameness vet and not only had he heard of it but he wrote me a scrip and he also deals with many other compounded medications.
                      We must have the same vets!

                      I'm fine with my regular vet's unwillingness to prescribe compounded meds. That is their prerogative. I will continue to use them for the things they are great at.
                      I will, however, use the other vet for these things.
                      Kanoe Godby
                      www.dyrkgodby.com
                      See, I was raised by wolves and am really behind the 8-ball on diplomatic issue resolution.

                      Comment


                      • #71
                        Originally posted by deltawave View Post
                        What reasons are the vets giving?

                        A rik vs. benefit calculation is the owner's to make, WITH the vet. Not BY the vet. (IMO)
                        I agree - and that is exactly how my (amazing) vet handled it. My mare is 16, the world's greatest trail horse and a very unhappy pasture ornament. My decision is that anything that keeps her feeling great now is worth the small possibility of any negative consequences. I'd much rather she be active, happy, and pain free than have decades of discomfort, and I am absolutely certain she agrees.

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                        • Original Poster

                          #72
                          First ride yesterday after first injection (Thursday). Horse definitely happier to stretch from right into left bend and right lead is a lot simpler. I am surprised to see quick results. Observation will continue.

                          So far I like it
                          See those flying monkeys? They work for me.

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                          • #73
                            My horse got his first injection on Thursday (IM, neck) and I showed him today. He was not at all fussy when asked to change leads (he's been a bit grumpy about that lately), jumped around beautifully and seemed quite happy! So far, so good...
                            Proud member of the "Don't rush to kill wildlife" clique!

                            Comment


                            • #74
                              Originally posted by Discobold View Post
                              Maybe I'm overly suspicious, but has anyone else noticed that horsecatcher joined the forum the same day davistina67 was banned?
                              And, I was just thinking to myself...
                              Disclaimer: Just a beginner who knows nothing about nothing

                              Comment


                              • #75
                                My vet hadn't prescribed Pentosan before, but he was willing to do so and eager to to see how mare does on it. He was also familiar with Dr. McIlwraith. He ordered from Wedgewood, came out and gave the first injection - just in case. Though he did not ask me to, I would have been glad to sign a waiver indicating that I understood the risks, etc. My vet uses Wedgewood, and I have read the FDA report as well as discussion here. I would not have any problem signing a waiver / release from liability for using Wedgewood either.

                                I just feel that, given the research, it is wrong for vets to push Adequan and especially supplements (those options are not risk free) without also presenting Pentosan as a treatment option -- and if the vet isn't comfortable prescribing it; then offer a referral to a vet that is comfortable prescribing it.

                                Ordering Pentosan from company willing to ship it out without a prescription, however, is not something I would personally be comfortable with.
                                Disclaimer: Just a beginner who knows nothing about nothing

                                Comment


                                • #76
                                  100% agree with every word above.
                                  Click here before you buy.

                                  Comment


                                  • #77
                                    Originally posted by slp2 View Post
                                    Recently, a fellow boarder found out about a study that Atlanta Equine Center is doing on Pentosan. They were looking for horses that have been on Adequan in the past to try Pentosan. They send you the pentosan to administer and you are required to provide information on your horses performance as compared to Adequan. My older horse has been on Adequan for years. She was accepted into the study and we have just started on the Pentosan loading dose (1 injection per week for 4 weeks, then every 2 weeks).

                                    My vet had to approve the prescription (which she did after reviewing the study). I am very interested to see how my mare does on Pentosan vs. Adequan. I will post here to update as we go. She is 19 and is still happy to do her job. But she raced and then evented--so she has had plenty of mileage on her legs. Any support I can provide to make her a little less creaky is well worth it!
                                    Please keep us updated.

                                    Sophie was head bobbing lame within 2 months of her IA injection to her fetlock. It took the full 4 week loading dose protocol for her to go sound on Pentosan but the results were AMAZING. She needs a dose every 3-4 weeks. If I let it slip she lets me know but within a day or 2 she's back to normal.
                                    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.

                                    Comment


                                    • #78
                                      Originally posted by carolprudm View Post
                                      Please keep us updated.

                                      Sophie was head bobbing lame within 2 months of her IA injection to her fetlock. It took the full 4 week loading dose protocol for her to go sound on Pentosan but the results were AMAZING. She needs a dose every 3-4 weeks. If I let it slip she lets me know but within a day or 2 she's back to normal.
                                      Same here - Jet was not truly sound until after the loading dose, but she is doing great now. I had very nearly given up on being able to really ride her again, so I am a true believer now.

                                      Comment


                                      • #79
                                        The clinic I am using apparently does not compound Pentosan. Their onsite pharmacy is an accredited compounding pharmacy so I am a little baffled at this. She would prescribe PentAussie. I did not get into a discussion with her as to why, because I was just texting her. I ended up getting Pentosan from Horse Prerace, which honestly I am not entirely comfortable with. But I am not sure what my other options are at the moment; PentAussie is a lot more expensive and as I understand a weaker dose.

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                                        • Original Poster

                                          #80
                                          As I undertand it there is really only one source for pentosan polysulfate sodium - a German pharmaceutical company. It was first made in 1947, so it is no longer under patent but the process for extracting/synthesizing it is complex. Compounding pharmacies probably have differing purchasing relationships by which they can offer pentosan, PentAussie or something else.
                                          See those flying monkeys? They work for me.

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