The compounding controversy: what veterinarians should know to protect themselves and their patients.

Abstract

While the controversy over compounding for animals is contemporary, the practice of compounding for animals is not. Pharmaceutical compounding is an ancient art and science. Compounding has been an integral part of the practice of veterinary medicine since the first cures were blended together to help an animal patient. Skilled healers have utilized compounds for both human and animal patients for thousands of years. With hundreds of species requiring treatment and dozens of new diseases emerging, the half-life of truth in veterinary medicine is particularly short. As a result of a complex and lengthy approval process, the veterinary pharmaceutical industry can never be expected to adequately supply labeled products to treat every disease encountered in every species. Consequently, in order to provide state-of-the-art veterinary therapy, the veterinarian must frequently alter commercially available dosage forms to meet needs for individual patients. This activity is defined as compounding by the major veterinary drug regulatory agencies in North America, the Canadian Bureau for Veterinary Drugs (BVD) and the United States (US) Food and Drug Administration Center for Veterinary Medicine (FDACVM). In some cases, as with potassium bromide and cisapride, there are no commercially available products for any species, and these life-saving therapies must be compounded from raw chemicals. Often, the safety of the caregiver also depends on the ability to get medications into the animal in the least invasive, most palatable manner possible. Compliance is paramount in achieving successful therapeutic outcomes, but many owners will not administer unpalatable or invasive therapies if they perceive that their pet will “hate” them as a result. Compounding based on individual patient need is an ageless solution for all of these problems.