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Pharmaceutical Care of Canines: Practitioner Summary

 

Pharmaceutical Care of Canines

Disease State

Clinical Pearls
 Hypothyroidism
  • Levothyroxine
    • Dosed 0.1 mg per 10 pounds body weight
    • Administration should be consistent
      • With or without food
      • Do not co-administer with dairy, antacids, sucralfate, or iron supplements
    • Levels should be checked 4-6 hours after dose
    • HIGHLY RECOMMEND NOT TO COMPOUND – not an accurate product
 Hyperadrenocorticism (Cushing’s Disease)
  • Trilostane
    • Liquid compounds – use FDA-approved capsules (Vetoryl) as API source1,2
    • Administer in the morning with food
  • Mitotane
    • Not as commonly used – very hard to find
    • Administer with a high fat food to increase bioavailability
    • Monitor water consumption –  goal is 80mL/kg/day
 Hypoadrenocorticism (Addison’s Disease)
  • Desoxycorticosterone Pivalate (DOCP)
    • Injectable – shake vigorously for 2-3 minutes
  • Fludrocortisone acetate
    • Pill burden is very common
 Diabetes Mellitus
  • Oral agents are not effective – limited to insulin therapy
  • Insulins must be given with the appropriate insulin syringe
    • U-40 vs. U-100
  • OTC insulins still require a prescription for canine patients
  • Hypoglycemia emergency treatment – corn syrup or 50% dextrose – apply along the gumline
 Idiopathic Epilepsy
  • Seizure or Cluster seizures 
    • Emergency medication options include rectal diazepam or intranasal midazolam. Based on recent literature, intranasal midazolam has better results.3
 Cardiovascular
  • Pimobendan compounding considerations
    • When Vetmedin is on backorder, it is recommended to compound pimobendan into capsule form for best stability and bioavailability.4
  • Hydrocodone/Homatropine – Schedule II medication 
    • Need to follow all DEA and state regulations regarding Schedule II drugs
 Pain
  • Galliprant
    • 100mg tablet is NOT homogeneous – should not cut into halves for administration5
  • Tramadol 
    • Efficacy concerns – Most canines lack or have a limited number of the enzyme needed to metabolize tramadol into its active metabolite.6
    • Still has some benefit anecdotally
 Urinary Incontinence
  • Diethylstilbestrol
    • No longer available in human medicine and currently does not have a veterinary commercial product – must be compounded
 Dermatological
  • Cyclosporine
    • Must use modified formulations in animals
    • Sandimmune is not bioequivalent to Atopica, Neoral or Gengraf
  • Atopica
    • If vomiting occurs, clients can freeze the dosage form for 30-60 minutes before administration
 Infectious Disease
  • Amoxicillin/Clavulanate (Augmentin, Clavamox)
    • Dosed/expressed in veterinary medicine in terms of both components 
  • Itraconazole
    • Should not be compounded – bulk powder is not bioavailable in mammalian species

 

References:

  1. Food and Drug Administrastion Center for Veterinary Medicine. Vetoryl (trilostane) capsules letter-pharmacist. September 11, 2009. https://www.avma.org/sites/default/files/resources/fda_vetoryl_pharm_Itr.pdf. Accessed June 1, 2021. 
  2. Cook AK, Nieuwoudt CD, Longhofer SL. Pharmaceutical Evaluation of Compounded Trilostane Products. J Am Anim Hosp Assoc. 2012;48(4):228-233.
  3. Charalambous M, Bhatti SFM, Van Ham L, et al. Intranasal midazolam versus rectal diazepam for management of canine status epilepticus: a multicenter randomized parallel-group clinical trial. J Vet Intern Med. 2017;31(4):1149-1158.
  4. Helms S, Fox S, Mixon W, Vail J. Compounded Pimobendan for Canine Chronic Degenerative Mitral Valve Disease and Pulmonary Hypertension. Int. J. Pharm. Compd. 2012;16(1):34-37.
  5. Galliprant [US Package insert]. In: Elanco; 2016.
  6. Budsberg SC, Torres BT, Kleine SA, et al. Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. J Am Vet Med Assoc 2018;252(4):427-432.