If the most recent numbers from the Fédération Cynologique Internationale (FCI) – equivalent to the World Canine Organization – are any indication, you are likely never to encounter two dogs with identical physiology. FCI figures note 360 canine breeds in existence. Kennel clubs in many countries do not recognize a portion of these breeds, yet the number of recognized breeds is still somewhere in the three-digit range.

Dogs of different breeds are often organized into ten major groups, each with several subgroups based upon the dog’s purpose, function, or upon its appearance or size.  Regardless of how canines are grouped or organized, one thing is clear, the variety of sizes, shapes, functions, and the particularities associated with each category is overwhelming.

So, the chances are, no two dogs are identical. Their health issues manifest in different ways, and their precise and successful treatment requires an individualized approach. The commercial veterinary drug market is not equipped to meet this demand.

What can veterinarians do to treat their canine patients? In most scenarios, the answer to this question is obvious: compounded veterinary medication.

Advantages of Pharmaceutical Compounding

Pharmaceutical compounding has many advantages both for you and your client, the pet owner. One core advantage when using compounded medications is the ability to personalize the care for your canine patients. Providing a personalized therapeutic option for your canine patient will have the immense advantage of improving compliance. You can accomplish this by:

• Prescribing the exact dose your unique patient needs based on its size, shape, age and weight – hard, if not impossible, to do using only commercially-approved drugs.
• Avoiding inactive ingredients that may be toxic to your canine patient. The artificial sweetener, xylitol, is a common inactive ingredient toxic to dogs. It is incorporated in many medications commonly approved for humans or for off-label use in veterinary patients. It is considered safe for many animal species other than dogs. Additionally, there are some preservatives, flavors, dyes, and surfactants such as Thimerosal, aromatic amines, ethanol, polyethoxylated castor oil, polysorbates, and others that must be avoided.
• Replacing off-label use of certain human drugs that your canine patient cannot metabolize properly due to its inability to acetylate with compounded medication options. Some examples of such drugs are sulfonamides, isoniazid, dapsone, and procainamide.
• Choosing the most appropriate compounded alternative for breeds with genetic mutations. Many canine breeds are affected with a mutation in their ABCB1-1 Delta allele gene that alters the p-glycoprotein transport mechanisms. Drugs like loperamide and certain chemotherapeutics and insecticides given to the breeds affected with this mutation can lead to severe neurotoxicities.
• Adding the canine patient’s choice of flavor – bacon, beef, poultry, peanut butter, etc. – to the medication to make it more palatable.
• Choosing a specific size or shape for the compounded medication to make it look and taste like a treat.

The advantage of our ability to manipulate so many aspects of a drug’s preparation is that your client, the pet owner, can administer a customized medication with more confidence and ease, knowing that their pet is getting a therapeutic option best suited for his or her pet’s medication needs.

When prescribing compounded medication for dogs, you and your compounding pharmacist must consider all the canine-specific criteria in selecting and preparing medication that is safe for dogs, avoiding drugs and inactive ingredients listed in the official veterinary data sources that may be toxic to dogs. Species and breed specific anatomical differences, pharmacokinetics, pharmacodynamics, pharmacogenetics, are some of the factors that influence the process of prescribing compounded veterinary medications.

Providing the Condition-Specific Counseling

Appropriate counseling for different conditions must be offered to the pet owner by both the veterinarian and the compounding pharmacist.

For many of the common conditions for which canine patients are brought into your office, the veterinary-approved drugs come in limited strengths and dosage forms. Prescribing compounded veterinary medication fills a vital need in cases where the compounded drug is the only treatment option available. Remember that off-label use of approved human drugs is considered compounding in veterinary medicine! By providing the appropriate counseling, you are better able to customize the treatment that, as we have mentioned, comes with so many advantages.

In the case of canine hypothyroidism, one of the most common canine endocrine diseases, Thyro-Tabs Canine is the only FDA approved drug. Even though it comes in many strengths, the existing form of the drug may not suit the needs of all canine patients. For instance, the dog may not like the taste and refuse the medication. This is very important because hypothyroidism is a chronic condition and compliance with prescribed medical treatment is critical. When a compounded option is chosen, a few additional factors must be considered when comparing one animal to another:

• Higher glomerular filtration rates
• Lower oral bioavailability due to shorter gastrointestinal tract
• Significantly higher gastric pH

Chew treats, capsules, oral oil suspensions, and oral pastes are just a few of the alternative options that can be offered with the preferred choice of flavor, whenever applicable.

Canine idiopathic epilepsy is the most common cause of seizures in dogs. Some breeds are thought to have a genetic predisposition for it. Once clearly diagnosed, however, treatment of epilepsy requires a commitment of both time and money by the dog’s owner. As another chronic condition that benefits from maintenance therapy, compliance to medication is of the utmost importance. Despite the availability of a wide variety of therapeutic options for this condition, the majority of the successful treatment options come in the form of compounded medications.

• Phenobarbital – as the drug of choice – comes in many strengths. Tablets approved for humans are used off-label in dogs.
• Potassium Bromide is the drug of choice for add-on therapy in dogs treated with phenobarbital. There are no FDA approved commercial products for humans or animals. It must be compounded. The USP has developed a validated compounded preparation monograph as oral
• Zonisamide capsules approved for use in humans can be used off-label in dogs with epilepsy.
• Levetiracetam – available as standard release tablets, extended-release tablets, or an oral solution – is also approved for humans and can be used off-label in dogs with epilepsy.
• Gabapentin is another treatment option whereby an oral solution without xylitol can be compounded for dogs with epilepsy.

We could mention many more examples, as the possible combinations are virtually endless, but doing so would defy the purpose of this post. Look for more information on compounded medications for your canine patients in our upcoming blogs.

If you have any questions about these possibilities or need help with specific cases in treating your canine patients, we invite you to contact one of our experienced compounding pharmacists at HALDEY.