Prescribing cascade

• Veterinary medicinal products must be selected in accordance with the prescribing cascade.
• Transition to the next step in the cascade is the basis of there being no such product available in the preceding step and on clinical grounds and must not be on grounds of cost and so on.
• A veterinary medicine authorized in the UK for use in another animal species OR for another condition in the same species ('off-label use').
• A medicinal product authorized in the UK for human use, OR a veterinary medicinal product not authorized in the UK but authorized in another EU member state (with an import certifcate (SIC or STC, see below) from the Veterinary Medicines Directorate).
• A product prepared extemporaneously (ie compounded for immediate use) by an authorized person in accordance with a veterinary prescription on a one-off basis.

Special import and treatment certificates

• The Special Import Certificate (SIC) Scheme is for use by UK veterinarians where there is no suitable product authorized for use in the UK. This scheme allows the veterinarian to import an alternative veterinary medicinal product from another EU Member State.
• The Special Treatment Certificate (STC) Scheme is for use by UK veterinarians where there is no suitable product authorized for use in the UK or no suitable VMP authorized for use in another EU Member State. This scheme allows the veterinarian to import an alternative human product authorized in another EU Member State or an alternative product authorized for veterinary or human use in a third country (outside the European Union).

Off-label use

Off-label use

• May apply to situations such as:
  • Dose.
  • Administration route.
  • Indication.
  • Age range.
  • Physiological status (eg pregnancy, lactation).
  • Different animal species.

UK

• Choice must be guided by the cascade and based on clinical advantage.
• Owner must be informed of the therapautic options and why 'off label use' of a medicine has been selected.
• Reason for 'off label use' must be recorded in case notes.
• Signed informed consent must be obtained.
• Additional labeling requirements.

USA

• There is no equivalent to the prescribing cascade.
• Very few restrictions apply to off label (or extralabel) drug use in companion animals.
• Veterinarians may use or presribe any mediciation approved by the Food and Drug Administration (FDA) for use in either animals or humans.

Small Animal Exemption Scheme

Availability

Prescription writing

Additional requirements for controlled drugs (CDs)

Electronic prescriptions

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.

Other sources of information

• Veterinary Medicines Directorate (VMD):
  • Information relevant to veterinary surgeons and other veterinary professionals.http://www.vmd.defra.gov.uk/vet.aspx
  • Availability of veterinary medicines in the UKhttp://www.vmd.defra.gov.uk/pdf/leaflet_availability.pdf
  • Distribution Category Reviewhttp://www.vmd.defra.gov.uk/vet/dcr.aspx
• British Veterinary Association (BVA):
  • Code of Practice on Medicineshttp://www.bva.co.uk/atoz/Veterinary_medicines.aspx
  • Responsible Use of Antimicrobialshttp://www.bva.co.uk/public/documents/BVA_Antimicrobials_Poster.PDF
• National Office of Animal Health (NOAH) Compendium of Data Sheets for Animal Medicineshttp://www.noahcompendium.co.uk/Compendium/Overview/-21789.html
• Royal College of Veterinary Surgeons RCVS Guide to Professional Conduct.https://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/
• British Small Animal Veterinary Association (BSAVA)
  • Guide to the Use of Veterinary Medicineshttp://www.bsava.com/LinkClick.aspx?fileticket=2vHXNPcpgig%3D&tabid=294
  • Small Animal Formulary, Ed I Ramsey, 7th edition, BSAVA, February 2012.