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November 2017 - AAEP is on Stall Rest

AAEP is taking the month of November off from "Ask the Vet", but will be back in December to answer your equine health questions concerning winter weather care for your horse with expert, Dr. Christine Tuma.



Click here to read this month's questions and answers.
  1. I would like to know if the success rate varies with the different RX that are currently available for treating EPM.

    (View Answer)

    Thank you for your question. Equine Protozoal Myeloencephalitis (EPM) is always a hot topic since it is arguably the most important neurologic disease in the United States. The Journal of American Veterinary Medical Association (JAVMA) published a reference point article in 2013 titled “Current therapeutic approaches to equine protozoal encephalitis.” The January 2013 American Association of Equine Practitioners (AAEP) ASK-THE-VET also covers questions specifically addressing EPM. These two resources provide extensive information on EPM treatments and I recommend referencing them for more detailed information. Upon reading your question I did a literature search for multicenter double blind placebo controlled comparative studies of EPM prevention and treatment. The results of this search did not provide adequate quantitative data to compare success rates of approved and unapproved EPM treatments. Some veterinarians will prescribe compounded EPM treatment formulations due to an individual horse’s unique medical needs. All horse owners should know medication expense is not a justifiable reason for prescribing a compounded formulation when a commercial product is available. AAEP recommends veterinarians and horse owners obtain their compounding formulations from pharmacies accredited by the Pharmacy Compounding Accreditation Board (PCAB). Accreditation by PCAB signifies to veterinarians, trainers and horse owners that only the highest-quality medications are utilized in the compounding process while adhering to the strictest national standards. To determine if your compounding pharmacy is PCAB accredited I recommend visiting www.pcab.org and speak with your horse’s veterinarian. Drew Olson, DVM, Omaha, Nebraska

  2. Would it be possible for an ingredient in a componded drug to cause Lymphoma? I gave my horse a compounded drug (pentosan) for years and then he grew a patch of scarring (possilby at an injection site) that turned out to be Lymphoma. He died last August.

    (View Answer)

    I am sorry to hear about your horse. Upon reading your question, I did a brief literature review to search for documented cases of lymphoma induced by various medications including pentosan. The results of this search identified no evidence of such a relationship. If you are concerned about a potential drug interaction, you and your horse’s veterinarian are encouraged to report the situation to the FDA (www.fda.gov) as a suspected veterinary adverse drug reaction. Drew Olson, DVM, Omaha, Nebraska

  3. In recent years, we have seen some favorite injectables disappear for months or longer. Examples include adequan and pentaussie. Compounded substitutes appear to be the only option. Do you have any other ideas or thoughts on this issue? Do you have any insight as to why these products disappear so suddenly?

    (View Answer)

    Thank you for the excellent question! Indeed it is one that all of us in the profession wrestle with each day. I can only speculate on why products are becoming more difficult to attain. Some possible reasons that have been proposed are challenges finding medication ingredients, production costs and market demand. The American Association of Equine Practitioners (AAEP) and the American Veterinary Medical Association (AVMA) have both acknowledged this issue through publications and are actively in communication with pharmaceutical industry partners to address these issues as efficiently as possible. Drew Olson, DVM, Omaha, Nebraska

  4. Currently, I have a 15-year-old horse on 3 mgs of compounded pergolide daily. I cannot afford to use the alternative. I am now trying to get the compounded drug every 30 days, but it is in capsule form. Am I on the right track if I have to purchase compounded pergolide due to the cost?

    (View Answer)

    As you know, pergolide is commercially available as Prascend® and can be financially straining for many horse owners. Nevertheless, Prascend® is the only FDA-approved medication for Equine Cushing’s disease. Some veterinarians will prescribe pergolide as a compounded formulation due to an individual horse’s unique medical needs. All horse owners should know medication expense is not a justifiable reason for prescribing a compounded formulation when a commercial product is available. The American Association of Equine Practitioners (AAEP) recommends veterinarians and horse owners obtain their compounding formulations from pharmacies accredited by the Pharmacy Compounding Accreditation Board (PCAB). Accreditation by PCAB signifies to veterinarians, trainers and horse owners that only the highest-quality medications are utilized in the compounding process while adhering to the strictest national standards. To determine if your compounding pharmacy is PCAB accredited I recommend visiting www.pcab.org and speak with your horse’s veterinarian. Drew Olson, DVM, Omaha, Nebraska

  5. What companies, if any, can be trusted? I had bute paste from a California company that had been found to have blue barrels from China full of counterfeit drugs! MY horse's veterinarian still used them! I stopped using the vet over it.

    (View Answer)

    These types of situations provide me continued motivation to advocate for and help educate horse owners like yourself about compounding best practices. The American Association of Equine Practitioners (AAEP) recommends veterinarians and horse owners obtain their compounding formulations from pharmacies accredited by the Pharmacy Compounding Accreditation Board (PCAB). Accreditation by PCAB signifies to veterinarians, trainers and horse owners that only the highest-quality medications are utilized in the compounding process while adhering to the strictest national standards. To determine if your compounding pharmacy is PCAB accredited I recommend visiting www.pcab.org and speak with your horse’s veterinarian. Drew Olson, DVM, Omaha, Nebraska