Yes, agree. (Just got this from the student via FB, will delve deeper…)
[QUOTE=Dr. Doolittle;6960085]
And I have yet ANOTHER student whose vet will NOT prescribe it (for her older mare to make her more comfortable) nor are they willing to write a script for it. Argh!
And Adequan IS on back order, so is not an option…
Very, very frustrating. And yes, I think we–the general we of responsible horse owners–are well aware that there are “some risks” associated with any drug. The student who took her horse to Morven for a workup was prescribed a course of Bute for 2 weeks (as an anti-inflammatory–if it works, the horse and the owners can avoid doing an expensive bone scan for a MILD lameness.) I asked the vet whether the mare should also be on something “stomach buffering” during this course of Bute, and he said “no, not if her routine isn’t changed and she gets plenty of forage” (she is out 24/7 on pasture.)
So there are ALWAYS potential side effect to be considered, but if the benefits outweigh the side effects, isn’t it usually worth taking that small risk?
How many equine fatalities happen at BN/N level from bleeding out–as a result of (any) medication?
I’m just cranky because this is the third student of mine, who despite a reasonable need, has been unable to get Pentosan for their horse from the local vet. How is it that Morven Park (and my own vets, and other student’s vets) have no problem with this?[/QUOTE]
Will the vet prescribe PentAussie? I can get that from my vet, but she won’t write a script for the compounded Pentosan PS.
Recently, a fellow boarder found out about a study that Atlanta Equine Center is doing on Pentosan. They were looking for horses that have been on Adequan in the past to try Pentosan. They send you the pentosan to administer and you are required to provide information on your horses performance as compared to Adequan. My older horse has been on Adequan for years. She was accepted into the study and we have just started on the Pentosan loading dose (1 injection per week for 4 weeks, then every 2 weeks).
My vet had to approve the prescription (which she did after reviewing the study). I am very interested to see how my mare does on Pentosan vs. Adequan. I will post here to update as we go. She is 19 and is still happy to do her job. But she raced and then evented–so she has had plenty of mileage on her legs. Any support I can provide to make her a little less creaky is well worth it!
[QUOTE=reay6790;6960094]
Will the vet prescribe PentAussie? I can get that from my vet, but she won’t write a script for the compounded Pentosan PS.[/QUOTE]
Yes, apparently–$65 a vial! :eek: I am toggling back and forth between this thread and her FB thread (am going to forward her this thread 
[QUOTE=Dr. Doolittle;6960085]
And I have yet ANOTHER student whose vet will NOT prescribe it (for her older mare to make her more comfortable) nor are they willing to write a script for it. Argh!
And Adequan IS on back order, so is not an option…
Very, very frustrating. And yes, I think we–the general we of responsible horse owners–are well aware that there are “some risks” associated with any drug. The student who took her horse to Morven for a workup was prescribed a course of Bute for 2 weeks (as an anti-inflammatory–if it works, the horse and the owners can avoid doing an expensive bone scan for a MILD lameness.) I asked the vet whether the mare should also be on something “stomach buffering” during this course of Bute, and he said “no, not if her routine isn’t changed and she gets plenty of forage” (she is out 24/7 on pasture.)
So there are ALWAYS potential side effect to be considered, but if the benefits outweigh the side effects, isn’t it usually worth taking that small risk?
How many equine fatalities happen at BN/N level from bleeding out–as a result of (any) medication?
I’m just cranky because this is the third student of mine, who despite a reasonable need, has been unable to get Pentosan for their horse from the local vet. How is it that Morven Park (and my own vets, and other student’s vets) have no problem with this?[/QUOTE]
You can get it without a script at Horse Prerace.
Love Pentosan on older horses but tough to find at good price. Anyone have any recommendations?
Is it available or used for arthritic dogs?
[QUOTE=slp2;6960133]
Recently, a fellow boarder found out about a study that Atlanta Equine Center is doing on Pentosan. They were looking for horses that have been on Adequan in the past to try Pentosan. [/QUOTE]
This sounds really interesting. It looks like horses that have been on compounded Acetylglucosamine are also eligible. My horses aren’t (either already on Pentosan or on nothing) but I’m going to pass it on to a couple of people I know.
I’m going to send you a PM asking how much they charge. I notice there is a Wedgewood bottle on their page. For others, here’s the site -
http://www.atlantaequine.com/pages/aec_research_pentosan.html
[QUOTE=Dr. Doolittle;6960159]
Yes, apparently–$65 a vial! :eek: I am toggling back and forth between this thread and her FB thread (am going to forward her this thread :)[/QUOTE]
I get my PentAussie from Allivet for $49 a vial
[QUOTE=deltawave;6959555]
I think people are confusing RISKS with SIDE EFFECTS. A “side effect” is an unintended reaction or effect of a drug, like getting drowsy from an antihistamine when what you wanted was to stop sneezing. Even if they’re common and predictable, they’re still side (not the primary) effects of a drug.
RISKS are things like anaphylaxis or infection from the injection of a drug, etc. You could argue that bleeding would also be a “side effect” of a drug like Pentosan, as it is unintended but in the nature of the drug to produce bleeding.
In humans, where the drug is used oral, the most common side effects are nausea and diarrhea. But that may be unique to the oral formulation.[/QUOTE]
Deltawave, you’re giving us some great info. Could you tell me what the side effects/risks of Adequan are as compared to Pentosan?
Adequan has a longer and more “available” track record of published data, and the side effect profile is pretty darn low. It is also (surprise!) a heparinoid, but its effect on the clotting system is much smaller. I couldn’t give you a “how much smaller” off the top of my head, but probably in the range of . . . “much”. 
I’d wager the mechanical risks just from giving it (we’re talking IM here) are the same and would have to do with pain, swelling, possible infection, etc.
And ANY drug has the outside chance of causing an anaphylactic reaction.
The product insert for Adequan would give a lot of detail. If one could track one down for Pentosan (Pentaussie probably comes with one, compounded drugs usually do not) then a direct side-by-side would be easy.
As an aside, just the fact that a drug can be gotten without a prescription doesn’t make it “safe”. Ibuprofen is a really, really dangerous drug for many people and you can buy it OTC, for example. Especially when thinking about embarking on a course of injectable meds, I cannot fathom just doing it without at least running it by a vet. I am fairly certain I have a minority opinion here in listening to how many people around our barn and on these forums think about and use pharmaceuticals. :eek:
Call me a conservative. 
(my political friends would bust a gut laughing)
My regular vet would not prescribe Pentosan because it is compounded. They would happily prescribe PentAussie. The PentAussie I could get from them was $55/12mL vial or $200 for a box of four 12mL vials.
I went with vet number two that thinks Pentosan is great and was happy to write me a prescription for it. This vet, by the way, spent a lot of time practicing in Australia and is VERY familiar with Pentosan.
My regular vet would not prescribe Pentosan because it is compounded
I guess that’s any practitioner’s prerogative, but IMO the decision on whether to use a compounded drug is the OWNER’s.
After reading some of the incredibly over-the-top “infomercial” type publications put out by the makers of “brand name” Pentosan recently, the 1% of me that harbors conspiracy theories is wondering if there is some sort of smear campaign going on with compounded drugs among vets, paid for by the brand-name drug makers.
[QUOTE=deltawave;6960644]
I guess that’s any practitioner’s prerogative, but IMO the decision on whether to use a compounded drug is the OWNER’s.
After reading some of the incredibly over-the-top “infomercial” type publications put out by the makers of “brand name” Pentosan recently, the 1% of me that harbors conspiracy theories is wondering if there is some sort of smear campaign going on with compounded drugs among vets, paid for by the brand-name drug makers.[/QUOTE]
Agree.
[QUOTE=deltawave;6960644]
I guess that’s any practitioner’s prerogative, but IMO the decision on whether to use a compounded drug is the OWNER’s.
After reading some of the incredibly over-the-top “infomercial” type publications put out by the makers of “brand name” Pentosan recently, the 1% of me that harbors conspiracy theories is wondering if there is some sort of smear campaign going on with compounded drugs among vets, paid for by the brand-name drug makers.[/QUOTE]
You’re right it is your decision but it’s also the vets license when you turn around and sue the vet for a bad reaction from a compounded drug. That’s what’s messed up about the system.
[QUOTE=deltawave;6960644]
I guess that’s any practitioner’s prerogative, but IMO the decision on whether to use a compounded drug is the OWNER’s.
After reading some of the incredibly over-the-top “infomercial” type publications put out by the makers of “brand name” Pentosan recently, the 1% of me that harbors conspiracy theories is wondering if there is some sort of smear campaign going on with compounded drugs among vets, paid for by the brand-name drug makers.[/QUOTE]
Hmmmm. My husband (who is both wise and cynical) has mumbled something about “it surely having to do with money and drug companies”, some way or another.
If so, what a shame…
A medical practitioner typically does not lose their license if they are sued. Documentation of a discussion of risk vs. benefit means the vet would win a lawsuit (or it would never be brought) if an adverse reaction to a drug takes place, provided the drug is prescribed for a reasonable reason and dosed correctly. This goes for (legal) compounded drugs, as well. And although the veterinary community is far behind in the informed consent process, it is possible to have a dialogue with a client/patient about something like this even without reams of paper. It’s called “communication”, which any lawyer will tell you is the antidote to lawsuits.
If reasonable and appropriate care is being given, a bad outcome is not malpractice.
I’ve tried all three drugs on my two event horses, both with moderate hock arthritis. Best results by far with the pentosan, which I get from wedgewood.
[QUOTE=deltawave;6960874]
A medical practitioner typically does not lose their license if they are sued. Documentation of a discussion of risk vs. benefit means the vet would win a lawsuit (or it would never be brought) if an adverse reaction to a drug takes place, provided the drug is prescribed for a reasonable reason and dosed correctly. This goes for (legal) compounded drugs, as well. And although the veterinary community is far behind in the informed consent process, it is possible to have a dialogue with a client/patient about something like this even without reams of paper. It’s called “communication”, which any lawyer will tell you is the antidote to lawsuits.
If reasonable and appropriate care is being given, a bad outcome is not malpractice.[/QUOTE]
And how do you know this?
The vet is responsible for the drug that gets injected into the horse. Horse has a bad reaction and the vet is the one that goes to court. Vets are the ones held accountable for the compounded drugs.
Umm, I kind of practice medicine for a living. And have malpractice insurance.
A medical practitioner is responsible for following the standard of care, for diagnosing and treating appropriately, for addressing with patient/client the relevant risks and benefits when remedies or procedures are recommended, for doing procedures safely and correctly and for prescribing treatments correctly. This certainly can and does include the use of off-label or compounded drugs.
A horse that has an allergic reaction to (for instance) penicillin and dies does NOT represent a case of malpractice, provided the penicillin was prescribed for an appropriate reason and dosed correctly in an animal not known to be allergic.
If a vet was on the scene and failed to attempt to treat the anaphylaxis that would be a different story, but if the treatment was attempted but the horse still died, or if the owner was giving the injection–no malpractice.
Yes, vets are accountable for all treatments recommended, including compounded drugs. But if a client gives consent for the use of the compounded drug after an appropriate discussion of the risk, benefit, alternatives, then (provided this is documented somewhere) there is no malpractice, even if something adverse happens.
This wouldn’t prevent an angry or litigious owner from threatening a vet, but cases like this never make it past the first phone call to an attorney. Bad outcome =/= malpractice.
