Common Dispensing Errors: Student Summary
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
Drug |
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