Your client credibility: are your pharmacy practices helping or hindering?

When recommending a specific pharmaceutical, more has to be taken into account than whether the API is indicated for the illness in question. Based on the preceding discussion, product source can have a tremendous impact on efficacy, on therapeutic success, and on practitioners' credibility in the eyes of their clients. However, product source goes beyond simple credibility, encompassing professional ethics and liability. In answering the Ethical question of the month--December 2001 "Should private veterinary practitioners be allowed to produce autogenous vaccines or compound antimicrobial products for use in food producing animals?" Rollin concluded, "one cannot envision a clearer case of unethical behavior." The reality is that quality assurance, efficacy, potency, and safety are not defined for compounded products, and should veterinarians choose to script or dispense one, the responsibility for its quality, efficacy, potency, and safety falls squarely on their shoulders. Ultimately, this also translates into 100% liability should an ADR, illness, or lack of effect, befall the patient. While having access to ELDU and compounded products is crucial in facilitating the treatment of the various diseases that veterinarians face, the regulatory freedom that gives them this choice carries heightened responsibilities when electing this option. In a nutshell, ethical and responsible principles of pharmacy dictate that a veterinarian's first choice should be a veterinary-licensed pharmaceutical for the indication in question. Should this not exist, ELDU of a licensed product with clinically derived therapeutic protocols should be the next choice. Compounded pharmaceuticals should only be used when no licensed (those sporting a DIN) product exists, and extreme cautions should be exercised when using transdermal formulations. Liability dictates that this decision be undertaken with informed consent of the owner and with appropriate due diligence when selecting a compounding service provider. Various articles have been written that provide the veterinarian with guidance when making this decision.