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The Confusing World of Drugs

An ongoing concern for both doctor and patient is the use, accessibility, cost and delivery of medications for ourselves and our patients. You can’t go a day without reading in the newspaper about a recall of a drug, an unexpected side effect or misuse of a medication that created significant complication. Whether a drug is for human or veterinary use or both, there will always be questions as to how to treat, when to treat, where to get, what to expect and how cheap can I get it to make life easier for all involved.

Left me wax poetic a bit about these issues as it relates to ophthalmology. First, there are very few medications that are veterinary only. Many of the drugs we use are used in the human population for similar or different disease states. However, different species have different responses and tolerances to the same drug. In the realm of side effects, it is the FDAs job to report all the concerns that may have been noted during the research and development stage of a given drug. If you read the package insert of just about any drug, you would probably not use it! Certainly, safety is important, but one must recall that warnings are placed to show the exceptions as well as the common. And human responses to topical eye medications may not develop in our pets as the life span of our pets may not be long enough to accumulate drug to then result in an unwanted reaction. The point here it, don’t read the drug inserts too critically or at all as the concerns stated may not apply to your dog or cat! Certainly educate yourself but ask questions before stopping a drug because the insert says the drug causes glaucoma and we are using it in your dog that has it!

Drug availabilty and purchase, especially with online pharmacies, has become a big issue in medicine. Many people are trying to access drug to save money by going through these services. A point to note is that what you are getting may not necessarily be the drug in the concentration, sterility and stability that you may get from a known pharmacy or your veterinarian. There are stories out there of people buying drug online only to get pills in almost identical packages that are only placebo and not the real drug. We have had clients that have purchased compounded medications from companies outside the US only to find increased irritation with application or a loss of control that we attribute to the quality of the drug given. I am sure there are some legit services out there but the point is that it is difficult to tell. Is it worth saving a few bucks or delaying treatment when you can access the drug in a trusted form and start immediately? Ease of access, prompt treatment and a drug that is known and supported by your doctor may be worth the additional fee it costs for us to carry it on our shelves.

Compounded drugs are commonly used in veterinary medicine since these same products for use in animals may not be easily accessed in a human form, is not utilized in human medicine or has been replaced by a newer and potentially more costly medication. Different that you and I that may have insurance or a copay to cover a pricey drug, we as veterinarians and you as owners must balance the cost of care with our drug choices. Compounding pharmacies have strict guidelines as to how to create these formulations or change a pill to a liquid, for example, of a drug that may be more easily delivered to your pet. We have a great relationship with a compounding pharmacy in the Carolinas who has been doing this for a long time. There are other reputable companines and we are hopeful that they practice the same diligence to get drug to you in a safe and accurate formulation. These drugs often require shipping to you directly which creates a lag in treatment but is usually necessary as there may not be an alternative on the shelf that can be purchased.

We all understand that the cost of health care is going up all over. I honestly understand the pricing of medicine as good as I understand the price of an airline ticket. The guy sitting next to you may have paid half of what you did for the same flight because he got it on a different day from a different vendor. The same is true for drugs and we hope to guide you in the right direction with good choices that are cost-effective that can be given at manageable frequencies to solve the problem!

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