Important Alert For Consumers Of Veterinary Medicines

[Do No Harm]

Does anyone here share my concern about veterinarians' method of dispensing medicines/drugs in tablet form?

Veterinarians do not and are not required by law to supply the Expiry Date or Batch Number information on labels of medicines they dispense nor are they required to enter this information on the animal's veterinary record. Also, they are not required to ensure that medicines are dispensed in appropriate containers. I discovered all of this only recently. Here's how...

My dog was prescribed some tablets on a 'Use as Needed' basis, with the expectation these would be on hand, should they be required, over an extended period of time, i.e. months. Knowing that medicines, if they are used after their expiry date, can loose their effectiveness or even become harmful, I asked the dispensing veterinary practice about the expiry date. Their response was that they are not required by law to provide that information on the label. I accept that actual label sizes will not allow for the provision of much information, but when I asked about any other source of this detail, e.g. through their auditing, they said they do not record it.

Being concerned, I later called the manufacturer (Merial) to ask whether there was any risk to my dog in event these tablets were given after their expiry date. The manufacturer's veterinarian inquired further about the dispensing method. Specifically he wanted to know whether the tablets were individually foil wrapped. I replied they had been supplied loose in a transparent plastic container "the same way that vets dispense all tablets". He sounded alarmed and told me to "Get rid of them". He explained the dispensed tablets are photosensitive and they would have been 'adversely affected' just from driving home from the veterinary clinic through exposure to light.

Regarding the Expiry Date and Batch Number information. Even mild over the counter medicines are required to have this information marked on the label. In respect to medicines/chemicals/products for animal use; worming tablets, heartworm preventatives, shampoos, commercial pet food, etc. the Expiry Date and Batch Number information is required to be marked on their label. Why is it that Scheduled drugs - which are Poisons, are exempt only if they are dispensed by a veterinarian? Pharmacists are regulated in this regard!

The Adverse Experience Reporting Program (AERP) of the APVMA monitors the use of veterinary medicines after they become widely used in the community. It is a safety measure! If an owner has cause to suspect their animal may have suffered an adverse reaction to any veterinary medicine, they are encourgaed to file a report - and the AERP requires the Expiry Date and Batch Number information for its investigation. How can this be supplied if it is not a requirement that this information be provided on the label or even recorded on the animal's veterinary record and how can a thorough and complete AERP investigation result?

Edited August 10, 2009 by Do No Harm

[goldielover]

That is a huge concern DNH. I've often wondered about this myself. Perhaps a letter to the AVA may be in order to see their response? Even non-prescription medications which are available at pet stores are often stored incorrectly eg. 'store in a dark, cool place' whereas they are directly in the sun over the summer months. If i'm using anything long term i refuse to accept any medication not in the foil pack. I have been lucky though and if the expiry date happens to be on another section of the pack, the vet has always informed me of the date (AFTER me asking, mind you).

[stormie]

DNH, a lot of your posts lately seem to be quite negative towards the veterinary profession. I appreciate you may have had a negative experience, but your opening line questioning vets in general about their dispensing methods, I find a little offensive.

I'm not sure why your vet in particular dispensed the particular tablets you received in that manner, but I can assure you it is not common practice to remove tablets from their foil casings to dispense them.

All our drugs are routinely checked for expiry dates - and this would be the case in most clinics. Most of our commonly dispensed drugs also have a relatively high turnover rate too, meaning they only sit on the shelf for a couple of weeks at the most, and most of these have atleast a 2 year expiry from when they come in from our supplier.

So whilst I appreciate that you may have had a negative experience with your vet, it doesn't mean that all vets in general are dodgy in their dispensing techniques.

[Staff'n'Toller]

What tablets were they?

[stormie]

We're guessing Previcox?

[Do No Harm]

DNH, a lot of your posts lately seem to be quite negative towards the veterinary profession.

The subject of this, like my previous topic, is something that everyone who purchases veterinary medicines should be aware of. It is about purchasing, storing and using Scheduled drugs. We are not talking about placebos! It is a health issue and it is a safety issue.

Is it 'responsible' if, on becoming aware of a potential risk, one doesn't then try and ensure others are informed of something they probably took no notice of before?

As it happens, I have raised this particular issue with the AVA, the state Veterinary Surgeons Board and the APVMA. The AVA confirmed that vets are not required to provide this information to consumers and said it is nothing to do with them. The VSB says it is nothing to do with them and I've learned this is the case with all VSB's. The APVMA acknowledges that not providing this information "has implications with Registration, Compliance and Good Manufacturing Practice (GMP)".

But no one does anything!

This then leaves it up to owners of companion animals to try and raise public awareness, because with there being no independant authority to ensure veterinarians are accountable (they are self regulating), the practice continues. If consumers never challenged it then no regulatory authority ever will!

It is fine to prefer being on the side of the fence which is most crowded because that's where it's most comfortable, but this forum appears to be one where people are sharing information they trust will be helpful to others and I'm assuming that everyone using this forum has their dog's health and wellbeing as their primary concern.

Edited August 11, 2009 by Do No Harm

[stormie]

I get what you are saying, but you are generalising all vets here because of something one vet did!

The whole thing sounds weird to me - the fact that the vet supplied you with enough of the drug to last you months, yet also broke up a sheet of pills by taking them out of the foil. Doesn't make sense to me.

Most vets, well I know we do, just cut up the foil sheets should we not want to dispense a whole sheet. I have never heard of a vet removing the tablets from their foil sheets and then placing them into a dispensing bag/container. It simply doesn't make sense.

And depending on the situation, we also wouldn't supply that amount of drugs to be used 'as needed' over a period of months. Those who are on regular NSAIDS, perhaps, but again, these have a long shelf life at the time of dispensing and we also know that the course will run out well before they expire.

Edited August 11, 2009 by stormie

[Dogsfevr]

Most vets, well I know we do, just cut up the foil sheets should we not want to dispense a whole sheet. I have never heard of a vet removing the tablets from their foil sheets and then placing them into a dispensing bag/container. It simply doesn't make sense.

Totally agree with this & working in the kennel industry we havent had one client bring meds that where out of the foils except for the common ones (prednil,tribacterialetc )

Even ourselves have never had a vet do so & we have used a number of clinics over the years.

The only thing we find vet practices arent doing is placing the sticky label from vaccs on the cards or print outs & we are telling our clients to insist the sticker is placed on.

[Do No Harm]

I get what you are saying, but you are generalising all vets here because of something one vet did!

No!

Please refer to the full content of my posts.

I did indicate the responses from the AVA, the VSB and the APVMA.

Those responses are indicative of an important and relevant underlying situation that should be of great concern to us all.

There is no independant authority that regulates veterinarians operating in small animal veterinary practices to ensure that they are accountable to their clients.

Until this situation (hopefully) changes, owners of companion animals need to be aware of what they could be exposed to - hence the posting of this Topic.

Edited August 11, 2009 by Do No Harm

[~Anne~]

I agree with the point you raised and the danger it presents....but I also find it odd that your Vet would remove tablets from their foil packaging?

[stormie]

I still don't quite understand what your issue is. Is it purely because there are no laws stating there needs to be an expiry date? Or is it because your vet removed pills from a foil packaging?

I just had a quick look at our drugs on the shelf that get prescribed during a consult (NSAIDS, Antibiotics etc) and all of them have expiry dates starting from atleast 09/11. About 2/3 of them are dated until 2011. The manner in which these things SHOULD be prescribed, as a course, would mean that nothing we would prescribe would be used beyond it's use-by date, unless of course an owner didn't finish the described course and used the tablets themselves 12months later. But our labels are all dated, so one wouldn't expect a normal person to use tablets that were dated from 12months ago.

It is NOT common practice to remove tablets from their foil sheets to dispense them and I'd be VERY worried about a vet who is doing this. From my experience, the tablets do not maintain their proper form and tend to break down into powder when they have been removed from their foil and left for a period of time.

If a customer is given out of date medication, or medication dispensed inappropriately (such as removing it from foil), then I'm sure the Vet Surgeons Board would be more than willing to investigate the said vet.

I've never really seen a direct need for clients to have an expiry date on their dispensed tablets. It's the responsibility of the staff to ensure all medication has an adequate used by date when they take the pills from the bottle. Most of the medications that are put into dispensing bags/containers are done so because obviously only a small proportion of the full bottle of pills is being used, and so the course of those medications is likely to only be days to weeks.

Those clients who's pets are on long term medications like Metacam and Rimadyl buy a full unopened bottle, which has the expiry date printed clearly.

[Do No Harm]

I agree with the point you raised and the danger it presents....but I also find it odd that your Vet would remove tablets from their foil packaging?

I don't know that they did remove the tablets from foil. The veterinarian didn't count out and place the tablets into the container. It was a vet nurse who did that as I was still speaking with the vet and preparing to pay the account. I certainly didn't witness anything to indicate that foil wrapping was removed. Some tablet medicines are supplied by the manufacturer in dark colored glass containers which usually indicates they should not be exposed to light. Given this, it seems strange that veterinarians do not stock similar containers for dispensing purposes. The container which seems to be universally used by veterinarians in my area is a transparent plastic one with a non screw top plastic lid. The latter seems a bit risky too when the tablets are to kept out of reach of children. If the container were to be knocked over whilst on a bench top the tablets would all fall out onto the floor.

[~Anne~]

I agree with the point you raised and the danger it presents....but I also find it odd that your Vet would remove tablets from their foil packaging?

I don\'t know that they did remove the tablets from foil. The veterinarian didn\'t count out and place the tablets into the container. It was a vet nurse who did that as I was still speaking with the vet and preparing to pay the account. I certainly didn\'t witness anything to indicate that foil wrapping was removed. Some tablet medicines are supplied by the manufacturer in dark colored glass containers which usually indicates they should not be exposed to light. Given this, it seems strange that veterinarians do not stock similar containers for dispensing purposes. The container which seems to be universally used by veterinarians in my area is a transparent plastic one with a non screw top plastic lid. The latter seems a bit risky too when the tablets are to kept out of reach of children. If the container were to be knocked over whilst on a bench top the tablets would all fall out onto the floor.

*just a quick note* - when you are quoting ensure this is at the end of the quote [/quote[ - except use the corresponding bracket and not the reversed one like I have... and then the words will be wrapped in the quote correctly. (whoops, where's Raz...don't wanna get into trouble for straying off topic....)

Back to topic - to be honest, most Vets are quite intelligent and are also very aware of the shelf life and care needed for drugs. For example, liquid valium is one such drug with a short shelf life and needs to be kept out of light and heat. The only reason I know that is my Vet informed me.

Whilst I think you bring up a good point, and a very valid one when it comes to dispensing and record keeping, I think you might be judging the majority on the actions of the minority. I feel personally that if it were an issue that was commonly reported then something would have been done about long ago. In having said that, it really isn\'t the right attitude to have to think that a dog should be put at rsik or die beofre something is done.

Perhaps you need to take a slightly less personal view or a bigger view of it all and then you mmight end up with more support? I feel that the way in which you phrase some of your posts makes people feel you have a vendetta against Vets rather than an issue with the way thins are done.

Edited August 11, 2009 by PugRescueSydney

[Staff'n'Toller]

You still haven't stated the name of the medication.

As far as light proof containers, another company supply their non-steroidals in white containers but supply us with clear containers so obviously it does not matter if they are exposed to light.

I can understand what you're saying about the expiry dates, but packaging advice goes back to the manufacturer. If it's imperative that whatever you were dispensed is kept away from light it's the manufacturers responsibility to ensure everyone knows- that's what drug reps are for.

It could be that the Vet Clinic have never been told and storage advice is not in the animal mims...don't assume they are doing the wrong thing on purpose.

Mel.

[Do No Harm]

I still don't quite understand what your issue is. Is it purely because there are no laws stating there needs to be an expiry date? Or is it because your vet removed pills from a foil packaging?

Please see my reply to PugRescueSydney.

Veterinarians vary, veterinary support staff vary, protocols in veterinary clinics/hospitals vary and cultures in different regions/states vary.

My fundamental 'issue' is that such variations occur only because there is no independant regulator to ensure uniformity and Best Practice by all providers of veterinary services.

Only yesterday I consulted a (specialist) veterinarian who shared with me his view that veterinary practice is no longer a profession. It is an industry. In his view, it became an industry when it started promoting unnatural feeding, more vaccinating of individual dogs than is needed to promote an immune status, and individually and collectively, allowing itself to become an extension of pharmaceutical sales representatives.

It's such a pity!

[puggy_puggy]

Pills that come in foil have always been dispensed in foil by the vets I have used. These have been antibiotics mainly.

I have been dispensed prednil, rimadyl, valium & antibiotics in either clear plastic bags or plastic containers.

Antibiotics and something else have also been dispensed in either manafacturers white bags with writing all of them or manafacturers stiff paper envelopes with writing all over them.

The only drugs that have been prescribed as to be used when needed have been the prednil and the valium both of which were dispensed in quantities of less then 20.

[~Anne~]

I would think though that the Specialist was merely venting a personal view. One view.

[sandgrubber]

Vets are damned if they do and damned if they don't. Buying a bottle of 100 tabs and dispensing them in envelopes or whatever is a lot cheaper than buying the individual foil wrapped bits. As a consumer, I am happy to benefit from this economy, as I hate throw-away foil wrap things, whether it's lollies or pills. I curse the vet who sells me Clavulox at $5/tab instead of Amoxiclav at $3/tab -- so far as I've been able to tell, they're exactly the same thing.

BUT, chemistry is clear. Things degrade a lot less rapidly if they are kept cold. What's called the Q10 principle says the decay rate halves for every 10 degrees. A good first guess for organics. Many inorganics (like, say, asparin sp?) and some organicsdon't decay for donkey's years and you could store them at 40 C for years with no loss of potency. If you want your pills to keep longer, store them in the fridge.

Expiry dates are inexact, and I seem to remember a lawsuit in the US against drug companies for giving unrealistic expiry dates, resulting in people (mostly doctors) throwing out perfectly good meds and making people afraid to buy in bulk.

[Do No Harm]

Whilst I think you bring up a good point, and a very valid one when it comes to dispensing and record keeping, I think you might be judging the majority on the actions of the minority. I feel personally that if it were an issue that was commonly reported then something would have been done about long ago. In having said that, it really isn\'t the right attitude to have to think that a dog should be put at rsik or die beofre something is done.

Perhaps you need to take a slightly less personal view or a bigger view of it all and then you mmight end up with more support? I feel that the way in which you phrase some of your posts makes people feel you have a vendetta against Vets rather than an issue with the way thins are done.

Fair observation. Members of Forums don't necessarily know why someone is coming from the perspective they obviously are, and typed words are not accompanied by visible gestures. For the record, my perspective is not vindictive. I only encourage others to be aware of risks vs benefits and not assume their vet is the ultimate authority on what is best for their dog. For the record, too, my own dog (an Assistance Dog) almost died and so did I only because I had believed and trusted our vet who had misrepresented the necessity of a booster vaccination and insisted it was not only "essential" but "perfectly safe". That was one vet, but then all the others rallied in support of that vet. Subsequently hearing that similar instances have happened to others - and not infrequently, has an affect.

[stormie]

Whilst I think you bring up a good point, and a very valid one when it comes to dispensing and record keeping, I think you might be judging the majority on the actions of the minority. I feel personally that if it were an issue that was commonly reported then something would have been done about long ago. In having said that, it really isn\'t the right attitude to have to think that a dog should be put at rsik or die beofre something is done.

Perhaps you need to take a slightly less personal view or a bigger view of it all and then you mmight end up with more support? I feel that the way in which you phrase some of your posts makes people feel you have a vendetta against Vets rather than an issue with the way thins are done.

Fair observation. Members of Forums don't necessarily know why someone is coming from the perspective they obviously are, and typed words are not accompanied by visible gestures. For the record, my perspective is not vindictive. I only encourage others to be aware of risks vs benefits and not assume their vet is the ultimate authority on what is best for their dog. For the record, too, my own dog (an Assistance Dog) almost died and so did I only because I had believed and trusted our vet who had misrepresented the necessity of a booster vaccination and insisted it was not only "essential" but "perfectly safe". That was one vet, but then all the others rallied in support of that vet. Subsequently hearing that similar instances have happened to others - and not infrequently, has an affect.

It's only in the last couple of weeks that the AVA has started to acknowledge that vaccines last longer than 12months.

As has been said, vets are damned if they do and damned if they don't. You want regulations to be enforced, but you have just blamed your vet for what happened to your own dog, when the vet was merely following the guidelines of the vaccination - created by the manufacturer of the vaccine. How is a vet supposed to win? You want vets to promote off label use of vaccines (which I'm all for now that's its been formerly accepted) but expect them to follow strict guidelines elsewhere?