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Regarding medication refills

Chris Hardin, DVM

Please be aware that STATE LAW requires that a veterinarian examine your pet at least EVERY  12 MONTHS for a legal ‘doctor-patient-client relationship’ to exist.  If we have not examined your pet in the last 12 months (for non-controlled substances), we cannot dispense or prescribe any prescription medications.   Please understand that this policy is not to inconvenience you, but to adhere to the requirements of law.   If your pet was seen as an emergency, please see your daytime doctor for any refills. 

 Special considerations for controlled substances:   By law we must examine a pet EVERY SIX MONTHS to be able to refill controlled substances, such as phenobarbital and tramadol.   You should allow us to run a phenobarbital level every six months at least to help determine if your pet needs a dosage adjustment.  Schedule III – V controlled substances can only be prescribed for a 30 day supply, with a maximum of five refills. Special rules apply for schedule II substances. 

Special considerations for ear medications containing aminoglycoside antibiotics  such as gentamicin and neomycin.  An otoscopic (ear scope) exam should be performed by a veterinarian before any refills of these topical medications (such as Otomax, Mometamax, Tresaderm,  Panalog, Animax or generics) that are applied into the ear canal are given.   Permanent nerve damage can occur if these products are applied into an ear canal with a ruptured eardrum.   An eardrum can still rupture on a delayed basis though it might look intact and healthy on otoscopy.  Stop use of any of these medications and have your pet seen by your veterinarian on an emergency basis if your pet loses the ability to blink in either eye, develops nystagmus (rapid movement of the eyes back and forth), develops a head tilt, or loses balance. 

Special considerations for eye medications:  Ophthalmic medications containing steroids can worsen a corneal ulcer if one is present.  An ulcer may not be visible to you.  Fluorscein staining is often needed to detect an ulcer.   Patients on ophthalmic steroids for issues such as pannus, anterior uveitis, or keratoconjunctivitis sicca (dry eye), should have fluorscein stains performed regularly, and especially if any squinting, third eyelid elevation, or pupil constriction is noted in the eye being treated, or if a visible lesion is present on the cornea. 

Special considerations for prednisone:  Catabolic steroids such as prednisone and prednisolone have significant side effects when used long term.  Certain conditions such as Addison’s (low cortisol levels) and certain autoimmune diseases such as lupus may require lifelong use of catabolic steroids.   For itchy skin / allergies however, alternative s should be considered if long term use is needed.  Antihistamines, essential fatty acids, topicals, hypo shots, Atopica/cyclosporine, Apoquel, and other medications can be used to help decrease the amount of prednisone used.  An exam may be required before we authorize a refill of prednisone.  Famotidine (Pepcid AC or generic) or other H2 blockers and/ or PPIs (protamine pump inhibitors)  may be advised while your pet is on prednisone to help prevent stomach ulcers.  Calcium supplementation may also be advised due to prednisone’s tendency to cause osteopenia (bone thinning).   Please see the prednisone / catabolic steroid information also on this website. 

Special considerations for NSAIDS:  (Non-Steroidal Anti-Inflammatory Drugs)    Blood testing every three months to assess liver health is advised by manufacturers of veterinary NSAIDS to monitor for liver and kidney problems. As with catabolic steroids, H2 blockers or PPIs may be needed while your pet is on NSAIDS.   Please see the NSAID info also on this website.

Special consideration for antibiotics:    Certain medical conditions benefit from long term use of antibiotics, but these cases are few and far between.   For instance, many patients with ulcerative colitis benefit from long term use of metronidazole or tylosin, while many dogs with chronic staph infections in their skin (bacterial folliculitis or pyoderma) benefit from long term daily use of cephalexin.  Long term antibiotic use should only be used under the advice of a veterinarian, and all pet parents should be aware that antibiotic resistance will eventually occur and side effects are possible with any antibiotic.  An exam may be required before antibiotics are refilled.  Please do not call for a refill of an antibiotic your pet was previously on, expecting to have it refilled without an exam.  Your pet’s safety and well-being is our priority.  

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