The laws and regulations surrounding drug licensing, dispensation and prescription are complicated, and can often seem to be counter-productive.  However, they are in place for good reasons, and we are legally bound to comply with them.  The information below gives an overview of the legislation with which me must comply, but if you have any further queries please speak to your vet, or to one of the office staff.

Drug Licensing

In the UK, the licensing of veterinary products is carried out by the Veterinary Medicines Directorate (VMD), and this organisation also regulates the dispensing and prescribing of veterinary products.  In general, a particular drug is licensed for specific diseases in specific species of animal.  For example, the antibiotic Cobactan is specifically licensed for use in foals with septicaemia.  Unfortunately, the process of licensing a drug is extremely time consuming and expensive, and many drugs that are commonly used in horses are actually licensed for use in other animals, or for other diseases.  For example, Dectomax is an injectable cattle wormer.  In horses this product is frequently used for the treatment of mite infestations.  In addition, we also use some human drugs where no animal product has been licensed, an example being the topical steroid cream Betnovate.

The situation is therefore not as simple as whether a drug is licensed or not – we must take into account which species the drug is licensed for, and for what disease.  Your vet will always be happy to discuss any particular drug that may be used in your horse.

The Cascade

Any animal that receives treatment in the UK must be treated in accordance with the cascade.  This is a system that defines which drugs we are legally allowed to dispense/prescribe in which situations.  If a drug is licensed for a particular disease in the horse, then we must use this drug unless there is good reason to use an alternative.  If no product is available fitting this description, then we must use a drug licensed for use for a different disease in the horse, or a similar condition in another species.  If still no product is available, only then may we turn to using human drugs.

Although the cascade exists to define which drugs should be used in which situations, the veterinary surgeon’s judgement can overrule this, as long as we feel that using a different drug, further down the cascade will be of clinical benefit to the animal.  For example, in a horse with a resistant bacterial infection then a different antibiotic may chosen to the licensed products, as they could be ineffective.

Unfortunately, the VMD have stated that we may not use an alternative drug based solely on the cost of product.  Recently this has become an issue due to the licensing of Prascend, an equine formulation of pergolide, used for treating Cushing’s Disease.  Previously, a cheaper human drug was used, however it would be illegal for us to now dispense or prescribe the human product.

Long-Term Medications

We see many patients with conditions that will require long-term, and even permanent medication.  For example, older horses with arthritis will often need some form of anti-inflammatory medication on a daily basis.  The VMD have stated that in order for us to legally dispense or prescribe medication to these horses, they must be “under our care“.  Obviously this phrase is open to interpretation, however, the regulatory body of the veterinary profession, the Royal College of Veterinary Surgeons (RCVS), has stated that it will be taken to mean that the animal has been examined within the previous 6 months.

This means that horses receiving long term medication must be examined at least every 6 months in order for us to continue dispensing or prescribing their treatment.  We understand that this expense is frustrating to many owners, and these examinations are seen by some as unnecessary, however they are important for several reasons:

• Monitoring for any side-effects of long-term drug usage
• Maintaining an appropriate dose of medication
• Ensuring no other diseases have developed that could interfere with treatment

If we were to dispense or prescribe treatment without having examined the animal in the last 6 months, then the vet who authorised this could face disciplinary proceedings from the RCVS, with serious implications on their career.  It is for this reason that we take this rule so seriously.  We also have experience of finding other diseases at these examinations, and being able to make positive changes to the horse that meant it no longer needed the long-term treatment!

If possible, these checks are ideally scheduled at the same time as other routine care, such as vaccinations and dental checks.  Please note that a vaccination alone does not fulfil the legal requirement to examine your horse, so please let the vet know at the time so they can conduct a full examination.

Prescriptions

In the majority of cases we see, the vet formulates a treatment plan and dispenses medication while at the horse’s yard.  However, in some horses, particularly those on long-term medication, repeat medications are requested over the phone.  In these cases, you may ask for a prescription and we will happily do this for you.  We currently charge £xx for a prescription, which is for the time taken by office staff and vets in preparing and producing the prescription.

The laws regarding which drugs we may prescribe, for which conditions, and when we must have examined the horse are exactly the same for prescriptions as for dispensing medication.  If we are unable to dispense medication legally, then we will not be able to write a prescription for it either.