Prescribing cascade and utilizing ‘veterinary specials’

The cascade is a provision within the UK Veterinary Medicines Rules that enables a vet to prescribe medicines that will not in any other case be permitted. The cascade additionally varieties a part of the VMD and is utilized throughout Europe.

The precept of the cascade is, if no appropriate veterinary medication is authorised within the UK to deal with a situation, the vet answerable for the animal can, to keep away from inflicting unacceptable struggling, deal with the animal within the order of consideration within the panel under.

Extemporaneous preparations

In distinctive circumstances, medicines can also be imported from outdoors Europe by means of the VMD’s import scheme.

It is very important notice using an extemporaneous preparation, or “veterinary particular”, is the final resort within the prescribing cascade. Subsequently, it follows that use of such merchandise ought to be by exception and solely after the above previous choices have been exhausted.

Animal homeowners knowledgeable consent and the cascade

The RCVS Code of Skilled Conduct for Veterinary Surgeons states the next concerning knowledgeable consent and the cascade: “A choice to make use of a medication that isn’t authorised for the situation within the species being handled the place one is accessible shouldn’t be taken evenly or with out justification. In such circumstances, purchasers ought to be made conscious of the meant use of unauthorised medicines and given a transparent indication of potential uncomfortable side effects. Their consent ought to be obtained in writing.”


Animals want medicines to assist stop illness and deal with them in the event that they do fall unwell. All species deserve the advantage of medicinal merchandise which were particularly developed and authorised for his or her therapy. The cascade ensures this occurs wherever attainable, but additionally provides flexibility for vets to make use of their scientific judgement to prescribe a medication the place no authorised veterinary medication exists.

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The cascade defined

  • 1. A veterinary medication authorised within the UK to be used in one other animal species or for a unique situation in the identical species.

If no such product exists, use both

  • 2. A drugs authorised within the UK for human use.
  • three. A veterinary medicinal product (VMP) not authorised within the UK, however authorised in one other European nation to be used in any animal species (within the case of a food-producing animals, the medication have to be authorised in a meals producing species) in accordance with an import certificates issued by the VMD.
  • four. The final possibility is a medication prescribed by the vet answerable for treating the animal and ready particularly on this event (generally known as an extemporaneous preparation, or particular) by a vet, pharmacist or an individual holding an acceptable producer’s authorisation.

Conditions the place the prescribing cascade can and can’t be used

  • If the prescriber has actual considerations about lack of efficacy for the licensed product, primarily based on real previous expertise when utilized in that animal, it’s acceptable to make use of the cascade to deal with the animal.
  • If the animal has had a suspected adversarial occasion following use of the licensed product up to now, it’s acceptable to make use of the cascade to deal with the animal.
  • Price or comfort are usually not acceptable justifications to make use of imported merchandise/human merchandise/veterinary specials forward of licensed merchandise.

Some sensible examples

  • 1. A veterinary surgeon needs to prescribe an antibiotic injection to a horse. Two VMPs can be found with the identical lively substance and focus – one is licensed for horses, the opposite for cattle. Though the cattle product is cheaper, the licensed equine product ought to be used.
  • 2. A veterinary surgeon needs to deal with a cat for a dermatological situation. No VMP is licensed for that indication in cats. A VMP is licensed for this indication in canines, and a VMP containing the identical lively substance licensed in cats, however for a unique indication. The vet can select which product she or he needs to prescribe as they’re equally weighted on the cascade.
  • three. A veterinary surgeon has been made conscious of an injectable product produced by a “specials” producer (due to this fact, the product might be unauthorised) she or he wish to attempt. An oral preparation containing the identical lively substance is in the marketplace licensed to be used within the goal species already.

To adjust to the cascade, the licensed VMP ought to be used first

  • four. The affected person didn’t reply properly to the licensed therapy (for that indication and species) and the veterinary surgeon needed to maneuver on by utilizing the injectable specials product. Nevertheless, on additional investigation, the vet found a human pharmaceutical product licensed with the identical lively substance on the UK market and, due to this fact, prescribed this therapy to his affected person. Unauthorised merchandise (specials) fall under human pharmaceutical merchandise and EU VMPs imported beneath a Particular Import Certificates on the cascade; due to this fact, the human product ought to be used first, if appropriate.

Why extemporaneous preparations/specials are backside of the cascade choices

  • These merchandise are usually not authorised veterinary medicines. Whereas the ability that produces them is required to be licensed by the regulatory authorities, the merchandise themselves are usually not authorised or in any approach assessed and, due to this fact, are usually not assessed for security, high quality and efficacy in the way in which authorised veterinary medicines are.
  • Animal welfare – greatest for animals to have licensed merchandise the place attainable.
  • No security and efficacy knowledge, though there could be publications made obtainable giving that impression to prescribers.
  • No pharmacovigilance monitoring for specials.

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