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What is Drug Compounding?

Drug compounding is the preparation of medication by a professional that changes the medication in some way to make it easier to take or more efficient. This can be anything from adding flavoring to make a medication taste better to combining two or more medications into a single delivery system. Although these medications can be quite helpful in ensuring that the horse gets the proper treatments, they should be measured with precision, particularly when multiple medications are required, as mistakes can be fatal.

Any preparation of medication that changes the ingredient in any way by a veterinary professional for a specific circumstance is referred to as drug compounding.

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Symptoms of Drug Compounding in Horses

Drug compounding can be used in treating many types of illnesses, which means that the symptoms it treats can be very wide ranging. Each type of medication can have its own symptoms of overdose or sensitivity, and cross reactions should be guarded against. It is important to get as much information as you can from your veterinarian regarding the symptoms that are possible from your horse’s specific compounded drugs.

Types

Drug compounding can take several methods, each of which has its own purposes. Although each of these methods can be used individually, they may also be used in conjunction with one another.  

  • Mixing - Individual medications may be carefully blended together in the exact dosage and strength that the patient requires
  • Diluting - Medications that are diluted for use are usually diluted with either water or saline solution
  • Flavoring - In order to make some medications more palatable for horses, special flavorings such as fenugreek, peppermint, or carrot may be added
  • Changing form - Compounding of a drug may be used to change the form of the drug as well, such as creating a transdermal gel for delivery for a horse who is unable to take the medication orally

Causes of Drug Compounding in Horses

There are a few things that can cause compounded drugs to also have compounded risks. These can include:

  • Contamination - If the drugs get contaminated by a bacterial or viral disease it can lead to serious trouble
  • Drug interactions - In certain circumstances, the ingredients used in the compounded drug may have unforeseen negative interactions
  • Incorrect measurements - Every few years there is some sort of an incident involving compounding medications that hits the news

Diagnosis of Drug Compounding in Horses

Ensuring that each diagnosis is accurate is particularly important when compounding medications. The examining veterinarian will typically check the horse’s physical conformation as well as get samples of blood and urine for standard tests like a complete blood count, urinalysis, and a biochemical profile.

The horse’s vital signs are also essential in properly diagnosing diseases and disorders in the horse, and their respiration, heart rate, and temperature will also be taken, and a comprehensive medical and physical history of the horse will help the veterinarian better customize the proper medications to your horse.

It can include information regarding of the horse's daily environment, feeding regimen, preventive measures such as parasite control and vaccination, and medical problems the horse may have had prior to the current situation. Other examinations that may contribute to a final diagnosis include a dental examination, the inspection of the feet and hooves, a fecal float and rectal examination, and a neurological evaluation.

Treatment of Drug Compounding in Horses

The FDA has recently withdrawn Compliance Policy Guide Section 608.400 Compounding of Drugs for Use in Animals and has proposed that a decision-making hierarchy should apply to veterinary medications. The proposed hierarchy is as follows: 

  • Option 1 - Treat the animal with an available FDA approved or indexed medication designed for animals
  • Option 2 - If no drug is available that is approved for animal use for the disorder in question, then an FDA approved human drug may be employed
  • Option 3 - If no drug is available to treat the unique condition of the patient then a veterinary professional can create a compounded medication which uses medications with the correct active ingredients that are formulated either for animals or for humans
  • Option 4 - It may be appropriate to compound a drug using bulk drug substances if there are no available animal or human drugs for the animal’s unique situation in certain “limited circumstances"

Recovery of Drug Compounding in Horses

It is generally best to utilize medications that are approved by the FDA and designed for horses. If these medications are not available, your veterinarian may recommend a medication designed for humans or a compounded drug, which may utilize medications designed for either human or animal. If a compounded drug is sought, it is crucial that the medication is compounded under the guidance of an equine veterinarian who is familiar with your specific horse, and that the pharmacy that does the compounding work is accredited by an independent organization. Although compounding is needed in some situations, it also comes with risks, and these risks should be thoroughly examined and evaluated before any compounded drugs are administered.