Inexcusable Negligence

[Alyosha]

Is giving off-label recommendations, over the phone - for veterinary use of human medications - part of being a "country vet" now?

No - but it shows that the vet is thinking outside the box in order to provide relief for the animal until it can be seen by a vet during business hours. Country vets understand people not being able to drop everything and get their animal to a clinic at all hours.

This vet advised a dosage of ibuprofen that would not be dangerous to give to the cat in question, and would give it some pain relief. Remember that the OWNER was the one to quadruple the dose... not the vet.

T.

It's also not quite legal though T. Vets shouldn't be cutting corners and their legal responsibilities. I'm well aware of the sort of issues country animal owners deal with sometimes. But that doesn't excuse professionals from legal responsibility.

[tdierikx]

It is legal to prescribe medications off-label as long as the dosages are not likely to cause harm... as far as I understand it it anyways...

I will reiterate... The vet advised a dosage of ibuprofen that would not be dangerous to give to the cat in question, and would give it some pain relief until the owner could get it to a vet clinic during business hours. Remember that the OWNER was the one to quadruple the dose... not the vet.

T.

[Alyosha]

Prescriptions involve more than over the phone advice. Seemingly for good reason. A prescription involves a consultation with the animal.

[RazorBlade]

She hardly gave him a prescription though did she?

[Christina]

So if the vet gave this at a consult & the owner made the same mistake giving 4 times the dose who would be responsible ?

Bear in mind that 4 times the dose of many drugs could be lethal to a cat.

[Alyosha]

If the drug had been correctly prescribed and the owner made the error then it woukd be a ase of owner error. A pretty simple way to practice legally and avoid any accusations and complcations really.

Whether or not the owner made an error, a professional should be aware of their legal requirements, and of the dangers involved in off-label use of human medications in animals.

With a tiny dose like that it seems pretty reasonable to expect a normal person could have difficulty in administration.

[Rebanne]

It is legal to prescribe medications off-label as long as the dosages are not likely to cause harm... as far as I understand it it anyways...

I will reiterate... The vet advised a dosage of ibuprofen that would not be dangerous to give to the cat in question, and would give it some pain relief until the owner could get it to a vet clinic during business hours. Remember that the OWNER was the one to quadruple the dose... not the vet.

T.

What did the owner say the vet told them to give? I have read the vet said to give 0.5, I have read the owner gave 2 but what was said between vet and owner?

[tdierikx]

The owner hasn't disputed the vet's account of the conversation...

T.

[sandgrubber]

Just came across an old article endorsing the use of Ibuprofen as temporary pain relief for dogs. The claim is that it more or less the same as Rimdyl, but a damn site cheaper.

http://terriermandotcom.blogspot.com/2008/05/rimadyl-relief-for-swollen-wallet.html

Here's an extract:

Rimadyl is a non steroidal anti inflammatory drug (NSAID) called Carprophen.

Car-prophen. Look at that name closely. It it reminds you of the name of another drug -- Ibu-profen -- that is not an accident.

In fact, Ibuprofen (aka Motrin, Advil, Nuprin) is also a non steroidal anti inflammatory (NSAID), and Ibuprofen and Carprophen are chemically very similar. One is is Cox-1 drug (Ibuprofen), and the other is a Cox-2 drug (Rimadyl).

What's the difference between a Cox-1 and a Cox-2 drug? In the real world, not a damn thing unless you are taking the drug daily and for a very long period of time (i.e., more than 3 weeks of daily dosing).

Cox-2 drugs, such as Rimadyl, have NOT been shown to be more effective at alleviating pain than Cox-1 drugs such as Aspirin and Ibuprofen.

So, to put a point on it, almost all Rimadyl sales by veterinarians for short-term use are a rip-off; you could be using buffered children's Apirin or a low-dosage of Ibuprofen for a lot less money.

[Xyz]

Just came across an old article endorsing the use of Ibuprofen as temporary pain relief for dogs. The claim is that it more or less the same as Rimdyl, but a damn site cheaper.

http://terriermandotcom.blogspot.com/2008/05/rimadyl-relief-for-swollen-wallet.html

Here's an extract:

Rimadyl is a non steroidal anti inflammatory drug (NSAID) called Carprophen.

Car-prophen. Look at that name closely. It it reminds you of the name of another drug -- Ibu-profen -- that is not an accident.

In fact, Ibuprofen (aka Motrin, Advil, Nuprin) is also a non steroidal anti inflammatory (NSAID), and Ibuprofen and Carprophen are chemically very similar. One is is Cox-1 drug (Ibuprofen), and the other is a Cox-2 drug (Rimadyl).

What's the difference between a Cox-1 and a Cox-2 drug? In the real world, not a damn thing unless you are taking the drug daily and for a very long period of time (i.e., more than 3 weeks of daily dosing).

Cox-2 drugs, such as Rimadyl, have NOT been shown to be more effective at alleviating pain than Cox-1 drugs such as Aspirin and Ibuprofen.

So, to put a point on it, almost all Rimadyl sales by veterinarians for short-term use are a rip-off; you could be using buffered children's Apirin or a low-dosage of Ibuprofen for a lot less money.

Oh, it's on the Internet so it must be true .

Also physiologically dogs and cats are NOT the same..

[raineth]

Not familiar with this vet but I think any vet should make an assessment of the client's ability to follow instructions especially regarding fiddly doses.

Are you serious

Well yes - should have phrased differently - so far as a medical professional who supplies medications directly to a client will go over the dosages etc with them and ensure they have an accurate understanding.

I agree, I do think it is important, especially in a situation like this, that the vet makes a very thorough effort to make sure the owner understands the dosage to be given, as well as explaining what could happen if the dosage is wrong.

Maybe she did, and he didn't get it right anyway. It could have been that the cat was being difficult and he thought it hadn't injested the nurofen when it had, and gave it another dose or something.

I feel sorry for him. It doesn't look like he was blaming her, just wanting to raise public awareness.

[sandgrubber]

Just came across an old article endorsing the use of Ibuprofen as temporary pain relief for dogs. The claim is that it more or less the same as Rimdyl, but a damn site cheaper.

http://terriermandot...len-wallet.html

Here's an extract:

Rimadyl is a non steroidal anti inflammatory drug (NSAID) called Carprophen.

Car-prophen. Look at that name closely. It it reminds you of the name of another drug -- Ibu-profen -- that is not an accident.

In fact, Ibuprofen (aka Motrin, Advil, Nuprin) is also a non steroidal anti inflammatory (NSAID), and Ibuprofen and Carprophen are chemically very similar. One is is Cox-1 drug (Ibuprofen), and the other is a Cox-2 drug (Rimadyl).

What's the difference between a Cox-1 and a Cox-2 drug? In the real world, not a damn thing unless you are taking the drug daily and for a very long period of time (i.e., more than 3 weeks of daily dosing).

Cox-2 drugs, such as Rimadyl, have NOT been shown to be more effective at alleviating pain than Cox-1 drugs such as Aspirin and Ibuprofen.

So, to put a point on it, almost all Rimadyl sales by veterinarians for short-term use are a rip-off; you could be using buffered children's Apirin or a low-dosage of Ibuprofen for a lot less money.

Oh, it's on the Internet so it must be true .

Also physiologically dogs and cats are NOT the same..

I would have said the same thing if my mother, in her last decade, hadn't had an arthritic dog. Her vet, who was thoughtful and recognized she was on fixed income, told her more or less the same thing, and she used buffered children's aspirin on and off for many years with no ill effects. I also worked with a country vet in Australia who basically said, sure, low dose aspirin is fine for pain relief. Of course you have to get the dose right.

Also, in deciding what sources to trust, I would always prefer something with a handle, such as the Cox-1 and Cox-2 terms in the above, that permits easy search for confirmation or refutation, than something flossy like 'All Natural'.

The opposite, ie, that these things are deadly, is also on the internet. But when it comes to motive, almost no one wants to poison pets, while drug companies have big incentive to get vets to prescribe, and people to use, expensive drugs like Rimdyl.

I agree, cats are different from dogs. I am not a cat person and have only skimmed the following, but as I read the conclusions, short term use of a Cox-1 NSAI on a cat is not ill advised IFF dosage is correct. So the argument comes down to the dose. The vet has science behind her in the naming of a drug for short term use. We don't know how specific or emphatic she was about the dangers of over dosing. For extensive, definitive, discussion from the Feline Vet Science community see:

Journal of Feline Medicine and Surgery (2010) 12, 521–538 doi:10.1016/j.jfms.2010.05.004

ISFM AND AAFP CONSENSUS GUIDELINES

SPECIAL ARTICLE

Long-term use of NSAIDs in cats

(I found this by Googling "cats nsai" ... for reasons unknown I can't copy the URL . . . but if you want to find it I'm sure you can find it with Google).