Veterinary Compounding Updates - Market Pharmacy Compounding Specialists

Permanent surgical sterilization in dogs and cats is not always possible or desired. Animals adopted at an older age that were never neutered or spayed may have developed health problems that now prevent them from undergoing surgery. Other animals may be intended for periodic breeding but must be kept non-pregnant for periods of time. For these animals, non-permanent contraceptive methods are required. For female animals, no new products for estrus (“heat”) prevention or suppression have been introduced in the last decade, and in fact, contraceptive options in female dogs have even declined due to the recent withdrawal of mibolerone (Cheque^® Drops) which was used successfully as a contraceptive agent in many dogs prior to its discontinuation.

The most widely used agents for cycle prevention in dogs are the progestins and include medroxyprogesterone acetate (MPA), megestrol acetate (MA), proligestone (PR), chlormadinone acetate (CMA), delmadinone acetate (DMA), norethisterone acetate (NTA) and melengesterol acetate (MGA). There is no universally safe and effective dose of any of the progestins in dogs or cats. Megestrol acetate is the only drug approved for contraception in dogs in the United States and is associated with serious adverse effects in dogs and cats at recommended doses, including mammary enlargement or tumors; milk production; listlessness; increased appetite, thirst, and urination; bone marrow suppression; temperament changes; or uterine changes including pyometra (infection) and infertility. Cats may develop Addison's disease, diabetes, or liver damage. Veterinarians are very reluctant to use megestrol acetate in patients for contraception, and are seeking safer alternatives. Long-acting depot injections of progestins pose an even greater risk of adverse effects, as the treatment cannot be quickly discontinued in the event of an adverse effect.

Androgens are another class of drugs used for contraception in dogs, but with the loss of Cheque^® Drops from the U.S. market, there are no commercially available forms of mibolerone. In males, androgens inhibit sperm production, but can also result in increased libido, priaprism, and growth of prostatic tumors. In females, androgens cause a negative feedback inhibition of GnRH secretion thereby suppressing ovarian activity. Ovaries of treated females contain primary and secondary follicles, but few that mature to size required for ovulation. Adverse effects in females include mammary gland atrophy, clitoral hypertrophy (15-20% of dogs treated), cessation of lactation, vaginal discharge, vaginitis, increased mounting and aggressive behavior, anal gland inspissations, musky body odor, obesity and tearing. The manufacturer (when the drug was available) recommended against use in breeding animals and recommended using no longer than 24 months in any animal. They also caution against use of the drug in animals with known liver or kidney disease, and specifically advise against use in Bedlington terriers.

Compounding pharmacies are able to supply mibolerone pursuant to an individual prescription for an individual animal. Please contact our compounding pharmacy for more information.

Concannon PW, Meyers-Wallen VN. Current and proposed methods for contraception and termination of pregnancy in dogs and cats. J Amer Vet Med Assoc 1991;198:1214-1225.

Wildt DE, Kinney GM, Seager SWJ. Reproduction control in the dog and cat: An examination and evaluation of current and proposed methods. J Amer Anim Hosp Assoc 1977;13:223-23

Do you have problems getting your pet to take a needed medication? Working together with veterinarians and pet owners, we compound customized medications in the best size, shape, consistency, and flavor for each animal. Our specialized equipment allows us to prepare concentrated oral solutions; flavored medicated treats; pastes; dusting powders; nail, hoof and beak preparations; ear drops, and much more - just let us know what you need. For example, we flavor medicine in tutti fruitti for birds, banana for exotics, beef or liver for dogs, and tuna or fish for cats.

As an alternative to oral administration, medications can be compounded into a transdermal cream or gel which can be applied to the inner surface of the ear or a hairless area such as the inside of the leg or abdomen. The drug can then be absorbed through the skin, avoiding the need to administer oral medication.

Giving ear drops to an animal can be very challenging. We can prepare an adherent ear gel, or a drop without alcohol that may be much more pleasant for your pet.

Problems with licking? We can compound a bitter-tasting solution which can be sprayed onto a wound or over stitches to discourage an animal from licking the area.

Copyright 2004, Storey Marketing - Veterinary Website Updates. Reproduction prohibited without subscription from Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Market Compounding Pharmacy.

Treatment of Nausea, Vomiting, and Retching in Patients with Cancer

Nausea, vomiting, and retching (NVR) are a problem for 50-60% of patients with advanced cancer. These problems are more common in patients under 65 years old, in women, and in those with cancer of the stomach or breast. Nausea is the queasiness or feeling of “stomach upset” which may lead to the urge to vomit. Vomiting, or emesis, is the actual act of "throwing up." Patients rate nausea as a more unpleasant symptom than vomiting alone and consider it to be as distressing as pain. Retching, also called "dry heaves" may resemble an attempt to vomit that does not remove anything from the stomach. Although most people think that nausea or vomiting is secondary to chemotherapy or radiation, in most cases the cause of nausea, vomiting, or retching (NVR) is multifactorial, and when planning treatment, all contributing factors should be considered. Other common causes of vomiting in patients with advanced cancer include side effects of medications, especially chemotherapy and opioids (during initial period of opioid treatment), radiation to pelvic or abdominal areas, gastritis or ulceration, constipation, renal failure, hypercalcemia, raised intracranial pressure, vestibular (balance) disturbance, anxiety, and cough.

Effective management of individual symptoms during initial and continued therapy profoundly influences symptom response throughout the course of cancer therapy. Unless the symptoms of NVR have been effectively prevented or managed during the first cycle of the first course of chemotherapy or radiation, the actual or perceived threat of the disease, its treatment, and discomforts relating to therapy, can arouse a variety of emotional and physiological responses.

Neurotransmitters are chemicals in the body that transmit nervous impulses, such as dopamine, acetylcholine, histamine, and serotonin (5-HT). Antiemetic drugs are predominately neurotransmitter blocking agents which are effective at different receptor sites and therefore treat different causes of vomiting. For example, 5HT3 antagonists (e.g. ondansetron, tropisetron, granisetron, dolasetron) are effective for chemotherapy/radiation induced nausea and vomiting, but are not the first line of therapy for nausea and vomiting due to other causes, and their benefit is often reduced in the course of multiple cycles of chemotherapy. However, although the benzodiazepines (e.g., lorazepam and alprazolam) are only minimally effective as antiemetics, they can be particularly useful when anxiety is associated with nausea and vomiting. As there are often numerous causes of NVR in patients in the palliative care setting, 30% of patients require two or more antiemetics combined with other medications that help to eliminate nausea and spasms of the gastrointestinal tract. NVR can be treated with oral drugs, but alternative preparations such as transdermal or topical creams, oral lozenges, or suppositories may be preferable, especially for patients with severe vomiting.

Ask our pharmacist about the benefits of customized medications to meet specific patient needs. For example, we can compound combinations of compatible medications into a single dosage form to simplify dosing regimens. When patients are unable to swallow, we can prepare medications as topical or transdermal dosage forms such as creams, gels, or lozenges, thereby avoiding the need for injections. Oral medications can be flavored to please each patient, from choices such as coffee, root beer, watermelon, and many more.

What Flavors Do Horses Prefer?

Equine medications are frequently flavored with molasses or apple, but apparently, these are not the top two flavors most pleasing to the equine palate! Horses prefer fenugreek, banana and cherry to all other flavors, according to one of the most detailed studies to date on horse flavor preferences.

According to a study which was published in the Journal of Applied Animal Behavior Science in December 2005, horses ranked flavors as follows: fenugreek, banana, cherry, rosemary, cumin, carrot, peppermint and oregano. Three of the most popular flavors added to commercial horse feed - molasses, garlic and mint - did not fare nearly as well. In fact, most horses in the study rejected garlic-flavored food, unless it was their only choice.

Dr. Debra Goodwin and her colleagues at the University of Southampton in the UK began by offering 15 flavors that currently or historically have been included in equine diets to six mares and two geldings of varying ages. The researchers added these flavors to standard cereal by-product meals. The horses mostly rejected echinacea, coriander and nutmeg-flavored meals. Previous studies indicated that horses love the smell of coriander, but they apparently do not like the taste of this spice (just as many humans love the smell of coffee but hate the taste). In a second test, the researchers offered the remaining 12 flavors in pairs and calculated how quickly and how much the horses ate, and the results were ranked as above.

Horse owners should be encouraged to see which flavors their horse prefers. When veterinarians can prescribe a medication to be compounded with the patient’s favorite flavor, compliance increases resulting in improved outcomes, which is satisfying to both owners and veterinarians.

Approximately 20% of the population may experience recurrent aphthous ulcers. Also known as "canker sores," these mouth ulcers are found on the inner cheeks, lips, or gums; typically may appear white, yellow, or red in color; and may occur in clusters. Mouth ulcers can be very painful, causing the patient discomfort when eating, speaking, or swallowing.

Customized medications can be particularly helpful for the treatment of aphthous ulcers. Our compounding pharmacy can prepare medications in special bases that adhere to the oral mucosa. Unique dosage forms which meet the needs of each patient can overcome the challenge of treating pain inside the mouth. Examples of customized therapies include:

When exotic animals need to be medicated, it often presents a significant challenge to the veterinarian and owner or zoo staff. If the animal is wild or potentially dangerous, it may need to be sedated (perhaps by using a tranquilizer dart) to receive each dose of medication. This is a laborious and costly project. Also, due to the variance in size and eating habits of exotics, rarely are medications commercially available in the best dose and dosage form to treat a particular animal. Therefore, zookeepers and owners of exotics appreciate the creativity and expertise of compounding pharmacists in providing customized medications and unique solutions to countless medication challenges.

Occasionally, a study in the veterinary literature will support the use of novel dosage forms in a particular species. For example, at the College of Veterinary Medicine, Kansas State University, researchers tested the possibility of using a transmucosal form of fentanyl (an anesthetic and pain reliever) for a sedative in great apes. The animals were trained to accept and suck slowly on a piece of placebo candy, given as a treat, after an overnight fast. On the day of the study, the animals were given the lollipop formulation of fentanyl. The resulting plasma concentrations of fentanyl supported transmucosal absorption, similar to that reported in humans. However, although transmucosal fentanyl was shown to be a useful adjunct for sedating orangutans and gorillas, its acceptance by chimpanzees was suboptimal and unpredictable.

Compounding pharmacists can provide additional therapeutic options by preparing unique dosage forms containing a needed medication in a preparation that is the optimal size, shape, flavor, color, scent, concentration, and consistency for a particular species. Here are some examples of various medication problems that were solved with customized therapies:

A gorilla with an eye infection needed an eye drop that had to be administered four times each day. However, sedating this animal four times daily was impractical, so the compounding pharmacist was able to prepare the antibiotic in a solution that was administered by spraying the gorilla’s eyes several times daily using a “super soaker” squirt gun. The gorilla appeared to enjoy the refreshing wash!

For penguins and snakes, medication can be compounded into an appropriate dosage form that can then be inserted into the animal’s food (such as a mouse or fish).

Monkeys can receive “birth control pills” as flavored medicated “treats”, with placebos for the males so they get a treat, too!

When an elephant needs a suppository, that is no small job! However, a snow cone cup (paper cone) can serve as a super-sized mold.

Our pharmacists are often asked by pet owners if it is safe to give animals medications that were originally intended to treat humans. Many common prescription and over-the-counter human medications are used for animals; however, the response, side effects, and dosages may differ greatly from those of humans. For example, dogs may require up to twenty times the typical human dose of a particular thyroid medication, but only a fraction of the aspirin dose. Animals, including cats and dogs, often lack the required enzymes for metabolizing (breaking down) a drug and therefore are unable to eliminate the drug from the body, or break it down much slower than humans do. Therefore, certain medications may need to be avoided or given in significantly reduced doses. For example, aspirin is safe for use in several species of animals, including dogs, if given in appropriate doses. However, aspirin is usually not recommended in cats, except in much lower dosages under strict veterinary supervision - and even small doss of acetaminophen (e.g. Tylenol®) can be poisonous to a cat. Human drugs are often used very differently in pets. Various medications that are used to treat anxiety or depression in humans are used for other purposes in animals, such as calming aggression, stopping urine spraying, improving appetite, and reducing territoriality or obsessive licking.

Our professional staff works together with pet owners and veterinarians to provide customized solutions to medication problems and meet each animal’s specific needs.

Compounding broadens veterinarians’ prescribing options, allowing them to offer customized dosage forms to meet each animal’s specific needs and solve medication problems. The goal of compounding for pets, exotics, and zoo animals is to enhance the veterinarian’s ability to treat patients in a more effective and efficient manner.

Compounding makes it easier to medicate animals, who readily accept the customized dosage forms. Owners no longer have to risk contracting disease or infection from scratches or bites inflicted by an aggressive animal who is resisting medication, because options now include medicated “treats” and transdermal dosage forms. Transdermal delivery is particularly useful in animals who should not be stressed due to cardiovascular or hypertensive problems. Medicated creams or gels can be applied to the inside of an animal’s ear or another closely clipped or hairless area. This dosage form has been successfully used to administer antiemetics (especially handy for animals who are nauseated by car rides), cardiac or hypertensive drugs, or behavioral therapy. The amount of medication incorporated into the medicated chews or “treats”, capsules, topical, transdermal, or liquid preparations can be formulated to the specific request of the veterinarian, thereby eliminating the need for the animal’s owner to cut tablets or divide the contents of commercially prepared capsules.

We DO NOT practice veterinary medicine. We DO help veterinarians and other animal care specialists to solve medication problems by providing specially compounded medications which meet the unique needs of each animal.

* This is the title of a peer-reviewed article which appeared in the October 2000 issue of Veterinary Forum.

Urine spraying is a cat's way of marking territory, and is unrelated to normal urination. Most common in non-neutered males and multi-cat households, the spraying of urine on vertical surfaces like drapes and furniture is his way of identifying "his" property or covering the scent of other cats. Prior to treatment, a veterinarian will typically perform an exam to rule out any physical cause.

Administration of fluoxetine hydrochloride (the active ingredient in Prozac®) for treatment of urine spraying in cats can be expected to considerably reduce the rate of urine marking. Researchers recommend that most cats should be treated more than eight weeks before treatment is withdrawn. A randomized, placebo-controlled, double-blind clinical trial studied 17 neutered cats more than 1 year old with objectionable urine spraying behavior. The medication dosage for each cat was individualized and fish-flavored by a compounding pharmacy. The average number of spraying episodes per week in treated cats was 8.6 at the start of the study and decreased significantly to an average of less than one episode per week after 8 weeks of fluoxetine therapy. The mean weekly spraying rate of cats receiving placebo did not decline. The main adverse reaction to the drug was a reduction in food intake.

Treatment errors, over and under treatment, or inappropriate use of antimicrobial medications can result in chronically diseased ears. Commercial drying agents should be avoided in inflamed, chronically diseased ears because most contain isopropyl alcohol and varying concentrations of benzoic, acetic, salicylic, or boric acid. Each of these products individually can be extremely irritating to already infected ears.

The key to successful management of chronic canine otitis is early intervention, identifying the cause of the condition so that it can be treated specifically and appropriately. Treatment should continue until the infection is resolved (often a minimum of 4 weeks). It is not uncommon for treatment of canine otitis media (middle ear infection) to continue uninterrupted for 8 to 12 weeks.

Otitis externa (infection of the outer ear) is a common disease in dogs. Systemic antibiotic therapy is not always required. By administering the appropriate antibiotic or antifungal medication as an otic (ear) preparation, therapy may be complete in as little as 14 days. Direct application of medication to the ear canal will result in a higher concentration in the ear than can usually be obtained when medication is given orally.

There is no single topical otic preparation that will satisfactorily treat all conditions. Once your veterinarian has identified the problem, if the needed antibiotic is not commercially available as an otic formulation, we can compound a preparation to meet each animal’s specific needs.

Copyright 2004, Storey Marketing - Veterinary Website Updates. Reproduction prohibited without subscription from Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Market Compounding Pharmacy.

Trouble with “Pilling the Cat”? Check out the studies of Transdermal Drug Delivery!

This method of drug delivery involves incorporating the active drug into an appropriate base that can be applied to the skin and allow the drug to be absorbed transdermally (“across the skin”), instead of via the gastrointestinal system.

The Clinical Pharmacology Laboratory of Texas A&M University College of Veterinary Medicine has recently started studies with the use of transdermal drug delivery, using gel technology. These studies, funded by a grant from the Morris Animal Foundation, will take place over the next 2 years (2002-2003) and are targeted to identify drugs that can be used in a transdermal formulation in dogs and cats. The drugs currently being considered for the studies are:

For updates, check their website:
http://www.cvm.tamu.edu/vcpl/Research/Transdermal/transderm_main.htm

Copyright 2004, Storey Marketing - Veterinary Website Updates. Reproduction prohibited without subscription from Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Market Compounding Pharmacy.

When a bird, hamster, iguana, ferret, or other small or exotic pet is ill, treatment can be hampered if it is difficult for the owner to administer needed medications. Our compounding experts can help by formulating specialized dosage forms to meet the specific needs of each animal.

Birds: Often, medications are only commercially available as a tablet, capsule, or injection, or the liquid form may not be adequately concentrated or properly flavored for a bird. We can often compound the needed medication into a concentrated flavored liquid or medicated treat that a bird will readily consume. Each bird has personal preferences, and we offer a variety of bases and flavors to please.
Hamsters, gerbils, etc.: We have found that it is often easy to give medications to these animals when they are formulated as a flavored oral paste. Hamsters usually love medicated raspberry puree!
Exotics may be attracted to bright colors, or may be more likely to consume medicated dosage forms that are consistent in color with their usual diet. We have found that emus like yellow and ostriches prefer green. Favorite coordinating flavors are hay and celery!
Need to mask a bitter flavor or the taste of vitamins? We have special techniques which are very successful.

We welcome your questions. Bring us your medication problems!

Copyright 2004, Storey Marketing - Veterinary Website Updates. Reproduction prohibited without subscription from Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Market Compounding Pharmacy.

The active ingredient in chocolate, and the substance that is potentially harmful to dogs, is theobromine. The LD50 - dose at which one-half of the dogs exposed to a substance will die - is about 50 mg of theobromine per pound of the dog’s body weight. Yet even a lower dosage can cause vomiting, excitement, increased urination, muscle tremors, and rapid heart rate. The concentration of theobromine varies with the type of chocolate. Milk chocolate has 44 mg theobromine per ounce. Semi-sweet chocolate has 150 mg per ounce. Baking chocolate has 390 mg per ounce. Therefore, for a 10 pound dog, the toxic dose of baking chocolate would be only one ounce, but the dog would have to eat almost 3 ounces of semi-sweet or 10 ounces of milk chocolate to get the same dose of theobromine. The fat in chocolate can also be harmful, and dogs often get enteritis or pancreatitis following excessive ingestion of milk chocolate. Diarrhea may also occur, requiring rehydration. If accidental chocolate ingestion occurs, a veterinarian should be consulted. If your dog begs for chocolate, our compounding pharmacy has a special non-toxic chocolate flavoring that we can combine with needed medications, and it truly “can help the medicine go down”!

Allergy symptoms resulting in skin inflammation is known as atopy or atopic dermatitis. This problem typically appears between one and three years of age, and progressive worsening is typical. Dogs with atopic dermatitis often have concurrent allergies and are prone to relapsing skin and ear infections, which significantly contribute to their discomfort level. Absorption of allergens through the skin may be the most relevant route of exposure in dogs, and may be reduced with topical therapy. Antihistamines often work better as preventive measures than as treatment, but may be the only therapy needed for animals with seasonal or mild to moderate signs. Several preparations, including glucocorticoids and anesthetics, can be used to decrease itching and relieve pain. Much research has been done in recent years to identify effective and safe alternative treatments for atopic dermatitis. For animals with severe or year-round clinical signs, immunotherapy (modification of the immune response) may be the best long-term therapy. Immunotherapy is effective in 60% to 80% of cases and is especially indicated in young animals.

Our compounding specialists work together with veterinarians and patients to customize and flavor medications, and create “pet-friendly” dosage forms.

As your pets get older and have more frequent “accidents”, you can take comfort in knowing that there are medications that can help with urinary incontinence.

Diethylstilbestrol (DES) is often prescribed by veterinarians to treat incontinence resulting from the hormonal problems of elderly, spayed female dogs. If your dog is treated with DES, your veterinarian may want to check laboratory values periodically. Contact your veterinarian if signs or symptoms of lethargy, diarrhea, vomiting, abnormal discharge from vulva, excessive water consumption and urination, or abnormal bleeding occur.

Phenylpropanolamine (PPA) increases urethral sphincter tone and produces closure of the bladder neck. The drug is used to treat urethral sphincter hypotonus and resulting incontinence in dogs and cats. PPA may cause some animals to lose their appetite. An increased risk of hypertension exists if PPA is administered concomitantly with aspirin or non-steroidal anti-inflammatory drugs. Possible alternatives to PPA for use in treating urinary incontinence in cats include the medications ephedrine, propantheline, oxybutynin, bethanechol, dantrolene, and phenoxybenzamine.

From: Veterinary Drug Handbook, 2nd edition, Donald C. Plumb, Pharm.D., editor

DES and Phenylpropanolamine are available as a bulk chemicals for veterinary use; these medications are no longer used for humans. Upon your veterinarian’s prescription order, we can compound a preparation containing the proper strength of medication in the most appropriate dosage form for your pet.

Canine acral lick dermatitis involves excessive licking of the paws or flank, even to the point of self-mutilation, and can produce ulcerations and infections that require medical treatment. Based on patterns of behavior and response to medication, veterinary scientists propose that canine acral lick dermatitis, also known as canine compulsive disorder (CCD), is an animal model of human obsessive-compulsive disorder. A randomized, placebo-controlled, double-blind crossover clinical study evaluated the efficacy of the medication clomipramine for treatment of canine compulsive disorder. Fifty one dogs with CCD were given clomipramine (dose adjusted for body weight) orally every 12 hours for 4 weeks and then placebo for 4 weeks. At the end of each treatment, each owner rated the severity of their dog's behavior. Results suggest that clomipramine was effective in dogs with CCD and was not associated with serious adverse effects, although sedation and reduced appetite were reported more commonly when dogs were given clomipramine than when they were given placebo. However, treatment for 4 weeks was not curative. Each dog's behavior was reevaluated 1 to 2 years after completing the study. Forty-five dogs available for follow-up evaluation still had their behaviors. The implication is that while drug therapy can be helpful, therapy may need to include behavior modification to optimally manage CCD.

If you have problems medicating your pet, and are tired of the squirming, scratching, and spitting, we can help you! We can compound medications into chewable pet treats and flavor them to entice even the most finicky pet. Since each “chewie” contains a specified dose of medication, there is a lower risk of a pet receiving an incorrect dose than when a portion of a tablet or a liquid is administered. Medicated treats can be flavored with liver or beef for your dog. Cats usually enjoy chicken or fish flavors. Raspberry may be preferred by rodents, and tutti fruitti is a favorite of exotic pets. If you have difficulty medicating your pet, please contact us. Our compounding professionals will work together with you and your veterinarian to solve your medication problems.

House soiling is the most common behavioral complaint owners have about their cats. Ten percent of all pet cats may have a urination problem at some time. Cats that urinate outside their box may be displaying one of two very different behaviors: spraying or inappropriate elimination. In multi-cat households the risk of spraying for any one cat increases with the number of cats. If your cat sprays a horizontal surface, it can be differentiated from urination in that it typically leaves a long, thin wet area, rather than a puddle. Cats look very different when they are urinating merely for elimination. They use a squatting posture, usually voiding large amounts onto horizontal surfaces. It is important to differentiate between the two, since they have different causes and treatments.

Urine spraying is a marking behavior that generally has a territorial or anxiety based origin. Either intact males or females or cats that have been neutered or spayed can show urine marking behavior. When a cat displays inappropriate elimination, which is different than spraying, it is essential to consider possible medical causes. A cat should have a thorough physical exam by a veterinarian. If the veterinarian determines that the cat is physically healthy, then the cause for the house soiling is most likely behavioral. Inappropriate elimination can result if a cat’s litter box is not cleaned appropriately, if there is not an adequate number of litter boxes in a multi-cat household, or from a medical condition such as interstitial cystitis.

In a multi-cat household, it is important to determine which cat is exhibiting the behavior so that the proper intervention can be made. Even if one cat is observed marking or urinating outside the box, it does not rule out the possibility that other cats are also behaving inappropriately. When it is necessary to identify which cat in a multi-cat household is spraying or inappropriately eliminating, there is a safe and inexpensive dye (fluorescein) that can be orally administered. Fluorescein can be fed to one cat in the household. That cat's urine will fluoresce under ultraviolet light for approximately 24 hours. To detect urine with fluorescein indicator, scan the household with a commercial black light or black light purchased from a novelty store. Although urine will commonly glow, fluorescein treated urine fluoresces a characteristic bright yellow. Scanning may also reveal previously undiscovered sites of elimination. By treating each cat at two day intervals, the culprit can be identified.

Please contact our compounding pharmacy for more information about prescription fluorescein for oral administration.

Copyright 2004, Storey Marketing - Veterinary Website Updates. Reproduction prohibited without subscription from Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Market Compounding Pharmacy.

While phenobarbital is often used in veterinary medicine to treat seizure disorders, there are several concerns with its use:

There are no commercially available veterinary approved products
Phenobarbital tablets for human use are small, hard, and unscored, making them difficult to divide for individualized dosing
Phenobarbital elixir has a high alcohol content, which is problematic for cats or any species when chronically administered
Phenobarbital induces CYP450 hepatic enzymes which can result in substantial drug interactions with oral anticoagulants, steroids, antibiotics, beta-blockers, theophylline, etc.
Phenobarbital is contraindicated in dogs with hepatic disease

Our compounding pharmacy can prepare an alcohol-free, appropriately flavored oral suspension, which is highly bio-available and very easy to use when administering a loading dose (initial higher dose to quickly achieve high drug levels in the animal) or when a flexible dose is needed. Once the maintenance dose is established, the dosage form can be switched to a capsule (with a lower risk of mis-dosing by the owner) or a flavored chewable medicated “treat”, with the added benefit of high patient acceptance.

Please contact our compounding pharmacy for more information about customized medications for pets and exotic animals. Future updates will discuss other treatments for seizures in animals.

Primary hypertension in cats may be more common than currently recognized. High blood pressure can be quite problematic in cats, because of the associated increased risk for ocular injury or neurologic complications induced by high blood pressure. Hypertension should be considered in older cats with acute onset of blindness; retinal edema, hemorrhage, or detachment; cardiac disease; or neurologic abnormalities. Cats with hypertension-induced ocular disease should be evaluated for renal failure, hyperthyroidism, diabetes mellitus, and cardiac abnormalities. Blood pressure measurements and funduscopic evaluations should be performed routinely in cats at risk for hypertension (preexisting renal disease, hyperthyroidism, and more than 10 years of age).

In a study at the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, amlodipine was shown to be a safe and effective once-daily antihypertensive agent when administered to cats with coexistent systemic hypertension and renal insufficiency, and may improve their prognosis. In a retrospective study, amlodipine decreased blood pressure in 31 of 32 cats and improved ocular signs in 18 of 26 cats.

Contact our compounding pharmacy for customized, easy-to-administer dosage forms for your pets.

Am J Vet Res 2002 Jun;63(6):833-9
J Am Vet Med Assoc 2000 Sep 1;217(5):695-702
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J Am Anim Hosp Assoc 1997 May-Jun;33(3):226-34

Demodectic mange (also called red mange, follicular mange, and Demodex) is a common skin disease of dogs caused by a tiny mite that cannot be seen without the aid of a microscope. This mite is normally found in the hair follicles of all dogs. Mites are transmitted from nursing mothers to their puppies within the first few days of life. The reasons that dogs develop mange are not fully understood, but genetics and immune suppression both play a role. Signs of disease appear only when mites reproduce unchecked. In puppies, this may occur due to an immature immune system; and in older dogs, mange usually occurs secondary to drug therapy or a disease such as cancer or hypothyroidism that suppresses the immune response. In mild cases, signs of demodectic mange include itching and scratching, reddened or scaly skin, blackheads, and patchy hair loss. More severe cases are accompanied by widespread hair loss, pustules, a crusty appearance, and bacterial skin infections. The head and feet are most commonly involved.

Demodicosis can only be definitively diagnosed by a veterinarian with a skin scraping. Milbemycin, which is normally marketed as a monthly heartworm preventive, may be effective against generalized demodicosis when it is used on a daily basis; however, the downside to this oral treatment is expense, as the medication may have to be given daily for up to 3 months to achieve cure. Therefore, treatment of generalized mange frequently involves regular dipping using the parasiticide amitraz. Initially, the dog’s hair may be clipped so that the dip can better reach the skin, and the dog should be bathed with shampoo which helps to clear up skin infections and opens the hair follicles so the dip can penetrate to the mites. Many dogs will relapse if not treated every eight weeks or so, even after an apparent cure.

Amitraz dips should be used only under the supervision of a veterinarian, and with caution and dosage adjustment in very small dogs. Many animals treated with amitraz experience side effects, most notably sedation. Development of more severe side effects may require an antidote. Amitraz is a drug of the monoamine oxidase inhibitor class, and any pet or person who is taking antidepressants known as selected serotonin reuptake inhibitors (such as Prozac®) could have a bad reaction if exposed to amitraz. Amitraz can cause a significant rise in blood glucose levels, so the dip should be used with caution on diabetic dogs, and humans with diabetes should avoid exposure. It is very important to keep amitraz out of the reach of children and pets, as severe toxicity has been reported following oral ingestion. The solution is flammable until diluted. Federal law restricts amitraz to use by or on the order of a licensed veterinarian.

Amitraz has been commercially unavailable, but can be compounded upon a prescription order from a licensed veterinarian. Please contact our compounding pharmacy for more information.

Perianal fistulas are abnormal passages into the rectum near the anus. Bacteria, moisture, feces, and other secretions can accumulate in the sinus of a fistula. Most affected dogs, such as German shepherds, have a low tail carriage, broad tail, and long hair, which may mask the lesion. Owners may report the dog licks of the perianal area; may have bloody stools, diarrhea, constipation, or foul discharge; and may be lethargic, and have personality changes and loss of appetite, perhaps due to chronic pain.

There may be an immunologic basis for perianal fistulas, because dogs often respond to immunosuppressive drugs. Mathews et al evaluated treatment with oral cyclosporine vs. placebo for 16 weeks. All lesions increased in size and depth in the placebo group, while surface area and depth decreased by 78% and 62% in the cyclosporine-treated group. By 16 weeks, fistulas had healed completely in 85% of the dogs; however, fistulas recurred in almost half of the dogs when treatment was discontinued. Even in dogs in which fistulas were not completely healed, cyclosporine administration appeared to be beneficial, because the surgical procedures that were required were less extensive than those that would have been necessary if cyclosporine had not been given.

The current recommendation is to treat dogs for as long as there is progressive improvement, and for 4 additional weeks after all fistulas resolve. Cyclosporine blood levels should be monitored. Ketoconazole can be administered concurrently with cyclosporine to reduce the amount and cost of cyclosporine required in large animals.

Tacrolimus is 10-100 times more potent than cyclosporine, is reported to have fewer side effects, is effective topically, and is less expensive than cyclosporine. Misseghers et al evaluated ten dogs with perianal fistulas who were treated with topical tacrolimus 0.1% ointment once to twice daily for 16 weeks. Full healing of the fistulas occurred in 50% and was noticeably improved in 90% of dogs.

Oklahoma State Univ College of Veterinary Medicine newsletter, Vol. 10, No. 1, 2003
Can Vet J. 2000 Aug;41(8):623-7
J Am Vet Med Assoc. 1997 Nov 15;211(10):1249-53
J Am Vet Med Assoc. 2002 Apr 1;220(7):1009-16 - Aust Vet J. 2002 Apr;80(4):207-11

Frostbite is tissue injury that occurs when an animal is exposed to freezing temperatures, especially when accompanied by high winds. The areas that are mainly affected include the feet, tail, tips of the ears, and other exposed extremities. To prevent frostbite, keep your pet protected from prolonged exposure to freezing temperatures by limiting the amount of time your pet is outdoors.

The body responds to exposure to cold temperatures by reducing blood flow to outer parts of the body and preserving blood flow to the vital internal organs. Without proper blood flow, the ears, tail and toes are lacking in oxygen and warmth. Ice crystals can form in these body tissues, resulting in tissue death.

Unfortunately, frostbite injury is not immediately apparent. When frozen or near-frozen, the skin appears very pale. As the skin warms, it becomes somewhat reddened and the area becomes painful. The preliminary signs of frostbite in dogs are easily missed because the areas that are affected are usually covered with hair. It may take several days before you notice the signs of frostbite injury. Watch for skin discoloration on the ears, tail and toes, pain and swelling, blisters, sloughing of skin, and skin ulcers.

If you suspect that frostbite has occurred, remove your pet from the freezing environment and begin to slowly re-warm the affected tissues by using warm water or applying warm moist towels that are changed frequently. Do not place the animal in hot water. Do not rub or massage the affected areas, as this can cause significant damage to the frostbitten tissues. Call your veterinarian immediately for appropriate treatment to prevent infection and relieve pain. Pentoxifylline, a drug used to treat peripheral vascular disease, may be prescribed to prevent further tissue damage. Wounds may need to be cleaned. In severe cases, amputation of the affected area may be required to prevent further infection and the development of gangrene.

Frostbite is also a common problem in birds in colder climates and may be seen with cold weather in southern climates. Risk factors in birds include unseasonable weather, use of anesthetics, wire caging, metal leg bands, and missed migrations. It is important that frostbite treatment be initiated as soon as possible. Blister formation, seen in mammals, is not typically evident in bird legs, but swelling caused by fluid accumulation may be seen.

Fungal infections are often found in reptiles that are kept under suboptimal environmental conditions such as too high or too low temperature and humidity, lack of hygiene, and exposure to chronic stressors such as overcrowding and improper cage design. In many cases, mixed bacterial and fungal infections are present, requiring both antimicrobial and antifungal therapies. In snakes and lizards, the most common site of fungal infection is the integumentary system (“skin”). Systemic mycoses in reptiles most commonly affect the respiratory tract and the gastrointestinal system.

Therapy of fungal infection in reptiles should last for a minimum of 2 to 4 weeks and be accompanied by supportive care such as fluids and nutritional support. The prognosis for recovery is moderate. Topical antifungals are used to treat local, superficial fungal lesions; however, treatment of systemic fungal infections requires systemic therapy. Azoles (including itraconazole and ketoconazole), amphotericin B, and nystatin are most commonly used. Due to nystatin’s distinct taste, successful administration may depend upon choice of an appropriate flavor and dosage form. Since extreme variations exist among the numerous species of lizards, snakes, and crocodilians, it is understandable why substantial variations in drug efficacy and toxicities exist when an attempt is made to extrapolate doses from one species to another.

Cardiovascular disease is a major cause of feline mortality. Cardiomyopathy is the most common type of heart disease, which is related to structural and functional impairment of the heart muscle. Sadly, most affected cats have no symptoms until they present with congestive heart failure or thromboembolic disease (blockage caused by a clot). Asymptomatic cats suffering from cardiomyopathies may be diagnosed following routine physical exam that reveals irregular heart rhythms or murmurs.

The average age of onset is 6-9 years, with a wide range of 6 months to 13 years. Cats with restrictive cardiomyopathy tend to be older with an average age at diagnosis of approximately 9-12 years. Nonspecific signs of disease include depression, reluctance to move, anorexia, relentless crying (secondary to pain from embolism), dyspnea or tachypnea. Cough is unusual in cats with cardiomyopathy. Some cats exhibit vomiting. More advanced cases will have thromboemboli that induce paralysis (usually to the rear limbs).

While there are no studies showing that treatment of asymptomatic cats prolongs survival, many veterinary clinicians feel it is beneficial to begin treatment as soon as a diagnosis of cardiomyopathy has been made. There is currently no data to indicate the most effective therapies, whether combined therapy is more advantageous than using a single medication, or whether therapy is significantly better than no therapy. Regardless of the drugs utilized, the goals of chronic therapy are to eliminate congestion; prevent arterial thromboembolism; halt, slow, or reverse myocardial dysfunction; promote enhanced quality of life; and prolong survival.

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