Why vet prescriptions are vital for effective and safe treatment *H&H VIP*

Do you ever feel that your vet has a “can’t do” attitude when it comes to medicines? The human version of an equine treatment may cost far less, yet you’re billed for the more expensive veterinary brand. And why must you pay for yet another examination of your veteran, just to renew his prescription?

While the cheapest or easiest option may seem attractive, the reality is that vets working in the UK are governed by strict legislation that dictates how they prescribe and dispense medicines. These regulations are there for good reason — giving a horse an untested or inappropriate product could result in treatment failure or toxicity, and may also endanger the vet, owner or environment.

To make sense of the system, Richard Hepburn FRCVS answers some frequently asked questions…

While prescribing medicine for my horse, my vet mentioned “the cascade”. What is this?
The responsible use of medicines is one of the major skills of a veterinary surgeon. Vets working with horses face a challenge. Because of the small commercial value of equestrian market, and the time and effort it takes to license products for specific conditions, many drugs do not have an equine licence. The fact that horses are classified as food-producing animals further complicates the situation.

To resolve this, the European Commission created the cascade system, which in the UK is administered by the Veterinary Medicines Directorate (VMD), to allow vets to use drugs at different dosages, access drugs licensed in other species, import licensed drugs from abroad and use “specials” that are not yet tested to licensing standards. An unwell horse can be treated safely and appropriately within this legal, step-by-step framework.

Why was I asked about my horse’s passport “status”?
Prescribing starts with your horse’s passport, where section IX allows an owner or vet to declare the horse as “not intended for human consumption”. If this is not signed, only medicines licensed for use in food-producing animals can be used.

Your vet must ask to see the passport or check their practice records for section IX status before they administer, supply or prescribe anything. Similarly, you must know your horse’s status if you collect medicines — even wormers — from a pharmacy, saddler or feed merchant, to ensure they can legally be used.

Can my vet practice prescribe medicine over the phone?
To prescribe medicine responsibly, a vet must examine a horse or have seen him often or recently enough to have sufficient knowledge of his condition to make a diagnosis and formulate a treatment plan. This may include a hands-on examination, communication with the owner or assessment of the clinical history.

Even if your horse has been on medication long-term, for a chronic condition, your vet may be legally required to give him a check-up before issuing you with a repeat prescription. Regular assessments are also in your horse’s best interests, as any developments or side effects can be considered and an ongoing treatment plan discussed.

What did my vet mean by going “off label”?
The initial choice of medicine should always be a product authorised for use in the UK for a particular condition in the horse. Licensed drugs have undergone rigorous tests to ensure that they are safe and effective, and so for the horse’s welfare should be the first option.

In most situations, the medication will be administered following the authorised dosage regime. Your vet may inform you, however, that they are going “off label” — meaning that while the medicine is licensed for your horse’s condition, they may use it differently. The label dosage of an oral antibiotic is once daily, for example, but there is good research evidence to support twice-daily dosing. Going off label also refers to your vet going further down the cascade, step by step.

What if there is no licensed equine drug for the condition?
Provided the horse has been declared as not intended for human consumption, your vet may then choose a suitable medication in this sequence:
• A veterinary medicine authorised in the UK for use in horses for a different condition, or for use in another animal species.
If there is no such medication, or no clinically suitable medication, then:
• Either a medication authorised for human use in the UK, or a medicine authorised for veterinary use in another EU member state via an import certificate.
Again, if there is no such medication, then:
• A medicine prepared extemporaneously (mixed for an individual patient) by a vet, pharmacist or manufacturer holding authorisation to produce specials or, in exceptional circumstances, medicines may be imported from outside the EU.

The cascade is used for an individual horse, not on a herd basis. It must be repeated for each prescription, as drug availability and licensing can change.

A human medicine contains the same ingredients as my horse’s — and it’s cheaper. Why won’t my vet prescribe it?
Legally, vets are not allowed to prescribe a human drug if a licensed equine version is available and suitable for your horse. This is really important; the active ingredient may be the same, but the formulation will differ. While the equine version will be consistently effective and safe, the human version may not even be absorbed from the horse’s gut.

It may appear that a vet is choosing a costly product, but that’s because we are legally required to — and because it is better for your horse if we do.

Can I buy medicines online?
You can ask your vet for a prescription to order equine licensed medicines online, but this does not change the legal requirement for a clinical assessment of the horse. Ensure that the pharmacy is UK based, that the product you are ordering has a legible product label and the seller is suitably qualified to dispense the drug. A VMD logo and a retailer ID number will indicate membership of the accreditation scheme.

Can I use overseas medicines?
It is illegal to try to use a UK prescription to order medicine from an overseas source, by any means — the internet, telephone or while travelling. If your horse needs a treatment that is only available abroad, your vet must apply for a suitable VMD import certificate. They should order the drug themselves and are then responsible for dispensing it and recording its use.

Ref Horse & Hound; 18 July 2019