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While we’re here at Equimed, let’s talk equine meds: medications, pharmaceuticals – drugs, baby! 

I think that pharmaceutical therapies are one of the greatest areas of misunderstanding between medical practitioners and patients/clients.  Practitioners (physicians and veterinarians alike), dispense and prescribe (I’ll get into the difference between those verbs in a moment) drugs for our patients so frequently that we tend to forget that terms like “Ceftiofur sodium” are not part of the everyday societal lexicon.  Non-medical personnel in turn often hold a variety of misconceptions, myths, and fears around medication.  Some of these include:

1. If my horse is sick, he needs antibiotics
2. Natural remedies are “safer” than chemical pharmaceuticals
3. I can stop the medication as soon as he is feeling better
4. Medications work the same in all animals (and people)
5. Since medications make you better, they must be safe
6. If two animals have similar symptoms, they need the same medication.
7. If some is good, more is better.
8. Every disease or condition requires medication to “get better”
9. Pharmaceutical companies charge so much because they’re just out to screw us over
10. Veterinarians make most of their money by selling drugs
11. There is no difference between getting medication from my veterinarian, a licensed pharmacy, a reputable pet pharmacy, any website on the internet, and my sister-in-law’s tack trunk.

(In case you’re wondering, the answers to the above statements are:

1.  Maybe
2. Not necessarily  -- many of the most dangerous poisons are “natural”
3. Please check with your veterinarian before stopping or changing any dosing
4. Really, no.  Do you have hooves?  Or fur?
5. Use under the direction of a licensed professional; do not try this at home
6. Perhaps, but often not
7. Not necessarily, and see #5
8. There may be an app for everything, but there isn’t necessarily a shot or a pill for everything
9. Well, they aren’t in it for the charity, but development of new drugs is an expensive and highly regulated business
10. Nope
11. Do you really need me to answer this one?  Wasn’t the sister-in-law’s tack trunk a give away?)

Let’s take a quick look at that whole “prescription” thing.  Prescribing is tricky territory for veterinarians.  Most people think of the term as a synonym for recommending.  After all, back before physicians typed a few keystrokes into the computer and our names magically popped up on the light board in the clinic pharmacy, we used to take a piece of paper to the drug store to get our medications.  This precious square of recycled plant fibers was covered in mysterious symbols that only the pharmacist could interpret, but from that prescription slip, the pharmacist somehow knew to give us both the cough syrup from Aisle 3 and a bottle of antibiotics.  I think this led a lot of people to assume that the process and legalities are the same for recommending an over-the-counter medication as they are for writing a prescription for a legend drug.

No, a legend drug isn’t a medication that wields a magical sword, nor is it one that has been inducted into the Pill Hall of Fame.  As much as I hate to cite Wikipedia, the entry for Prescription Medication has some clear and accurate wording on the subject.

“In the United States, the term "prescription drug" is most commonly used, but they are also called Rx-only drugs or legend drugs, after the Federal and State laws which mandate that all such drugs bear a "legend" prohibiting sale without a prescription…”

On veterinary prescription medications, the legend reads: "Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian."  The key words in that sentence are “federal law” and “licensed veterinarian.”  The Veterinary Practice Acts of most states require a valid Veterinary Client Patient Relationship (VCPR) before a legend drug can be prescribed for an animal.

I’m getting to a point here; trust me, I don’t enjoy legal gobbledegook any more than you do.

According to the American Veterinary Medical Association (AVMA), a valid VCPR exists where all three of the following conditions exist:

1. “The veterinarian has assumed responsibility for making clinical judgments regarding the health of the animal(s) and the need for medical treatment, and the client has agreed to follow the veterinarian’s instructions.
2. The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of an examination of the animal(s), or by medically appropriate and timely visits to the premises where the animal(s) are kept.
3. The veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or the failure of the treatment regimen.”

Ok, back to our regularly scheduled programming.  The preceding snooze-fest was necessary because it illustrates a critical point in understanding medications (and the decisions of your veterinarian) – the difference between prescription and over-the-counter (OTC) medication.  Returning to our Wikipedia page (It must be true; I read it on the internet!) we find that OTC drugs  are those “used to treat conditions not necessarily requiring care from a health care professional and have been proven to meet higher safety standards for self-medication by patients. Often a lower strength of a drug will be approved for OTC use, while higher strengths require a prescription to be obtained…”  An example of different labeling for different strengths of the same drug in equine medicine is the Gastrogard/Ulcergard situation.

Both medications contain the anti-ulcer medication omeprazole, but the label dose per day of Gastrogard is 4 times higher than the daily dose for Ulcergard.  The labeling for use is also different, Gastrogard being designed to treat equine gastric ulcer disease (a condition requiring care from a medical professional) and Ulcergard being intended to prevent the formation of stomach ulcers in the healthy horse.  Gastrogard is a legend drug while Ulcergard is available OTC.

So, why can’t I just use an OTC drug all the time?  Why do I need to have a prescription for some drugs?

Several reasons:

1. Many drugs are not available OTC.  For horses, this list includes most antibiotics and all commonly used anti-inflammatories.
2. When both and OTC drug and a prescription drug exist, the OTC drug may or may not be suitable for addressing the horse’s condition.  Depending on the formulation, simply increasing the dose may not be appropriate.  Drugs are absorbed differently by the body depending on the formulation used.  This is why a drug formulated for a dog may not work for a horse even at the correct dosing.  The carrier used may affect absorption by the horse’s body.
3. Without an examination and a diagnosis, giving your horse medication is akin to playing roulette.  You might get lucky, or you may just be throwing your money on the table.
4. The dose listed on your friend’s horse’s prescription, the internet, or the book that you found may not be appropriate for your horse.  Medication in the wrong amount is either useless or poison.  Neither will help your horse.

So, while you can find information on medications in many places these days (even here), the best source for information on the drugs for your horse is always …drumroll, please…

YOUR VETERINARIAN.

And when your veterinarian tells you that he or she cannot dispense Bute to a horse that hasn’t had an exam in 3 years or that the drug your trainer’s vet gave the horse two stalls down for a snotty nose won’t work for your horse, understand that your veterinarian isn’t being difficult.  There are reasons.  Ask about them.  The more you know, the better you care you can provide for your horse.