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Why are animal patients prone to dispensing errors?

  • Pharmacists are the only HCP that can provide care to humans and animals, but often don’t have proper training in veterinary pharmacy
    • NABP Resolution No: 110-5-14 – encourages pharmacists to have the competency and education necessary to appropriately dispense medications and provide care for veterinary patients
  • Insufficient info for proper verification – prescription may not include species, size, breed, meds, comorbidities, etc.
  • Look-alike, sound-alike drugs


Common Veterinary Dispensing Errors

  • Counseling Errors dosing, frequency, and indications can be different (different PK and PD between species)
  • Toxicity/ingredient errors- some excipients, sweeteners, inactive ingredients used in human drugs can be toxic for animals
    • Xylitol, alcohol, polysorbate 80, benzocaine, cremophor, azo dyes
  • Inappropriate substitutions- different dosage forms can include different excipients or mistakenly be substituted for a product that is not equivalent
  • Prescription misinterpretation- different SIG codes and allometric (weight-based) dosings are used in veterinary prescriptions compared to human prescriptions
Common Error
Levothyroxine Human dose is a lot smaller than the dose for canines (differences in PK)
Phenobarbital Grain and gram errors; weight-based dosing = higher doses for canines
Bactrim/TMS Used in equine patients, usually see doses of 30+ tablets a day. Also dose is based on combination of trimethoprim/sulfamethoxazole
Augmentin Different ingredient ratio compared to veterinary product (Clavamox); veterinary dosing based on combination of amoxicillin/clavulanic acid
Hydrocodone Hydrocodone/homatropine (Hycodan) is used to treat canine cough, but can be mistakenly written as hydrocodone, causing acetaminophen toxicity
Insulin Inappropriate insulin substitutions (all insulins are not equal in veterinary patients)


How to Avoid Veterinary Dispensing Errors

  • Consider all pertinent patient information
    • Species/breed, weight (and when the weight was taken), sex and reproductive status, age, jobs/activities, medication indication, allergies, concurrent medications and comorbidities
  • Avoid common pitfalls
    • Don’t be afraid to reach out to the veterinarian!
    • Final verification when counseling – ask for indication
    • Always use a reference for prescription verification, drug-drug interactions and counseling
  • Utilize veterinary drug resources
    • Plumb’s Veterinary Drugs
    • Saunders Handbook of Veterinary Drugs
    • Merck Veterinary Manual
    • Exotic Animal Formulary