NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING FOR VETERINARY MEDICINE

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1 DECEMBER 2011 NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING N ORLANDA VENUEP HARMACY. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Feline Hypoadrenocorticism 2 Canine Epilepsy 3 PRESCRIPTION COMPOUNDING FOR VETERINARY MEDICINE Feline Anti-Tumor Agent Norland Avenue, Suite 105 Chambersburg, PA Phone: (717) Fax: (717) Web:

2 Page 2 FELINE HYPOADRENOCORTICISM The following case report discusses the use of fludrocortisone to treat feline hypoadrenocorticism - A case of feline primary hypoadrenocorticism (J Feline Med Surg Dec;1(4):257-60). ABSTRACT: A 2-year-old entire female British Shorthair cat was referred to the University of Bristol for investigation of lethargy, weakness, constipation and hypothermia. Clinical examination revealed a profoundly weak, hypovolaemic and hypothermic cat. Serum biochemistry revealed hyponatraemia, hyperkalaemia and hyperphosphataemia and the urine was isosthenuric. Lack of response to exogenous adrenocorticotrophic hormone confirmed a diagnosis of hypoadrenocorticism. Treatment consisted initially of intravenous fluid therapy and subsequently a combination of fludrocortisone and prednisolone per os. At follow-up, 20 months after the initial diagnosis the cat remained stable and free of clinical signs. PMID: This case report highlights the use of fludrocortisone both as a short and long term treatment for a cat with hypoadrenocorticism - Hypoadrenocorticism in a cat (J Small Anim Pract Apr;42(4):186-90). ABSTRACT: Primary hypoadrenocorticism was diagnosed in an eight-year-old neutered male cat. The predominant presenting complaint was dysphagia. Other historical signs included lethargy, weight loss, polydipsia, polyuria, muscle weakness and occasional vomiting. The signs had waxed and waned over the two months before presentation and had improved when the cat was treated with enrofloxacin and prednisolone by the referring veterinarian. On referral, dehydration, depression and poor bodily condition were found on physical examination. Results of initial laboratory tests revealed mild anemia, hyperkalaemia, hyponatraemia, hypochloraemia and elevations in serum creatinine and creatine kinase. The diagnosis of primary adrenocortical insufficiency was established on the basis of results of an adrenocorticotropic hormone (ACTH) stimulation test and endogenous plasma ACTH determination. Initial therapy for hypoadrenocorticism included intravenous administration of 0.9 per cent saline and dexamethasone, and oral fludrocortisone acetate. Within one week the cat was clinically normal and two years later was still alive and well on fludrocortisone acetate treatment only. PMID: We have the ability to compound fludrocortisone as a flavored oral suspension. Fludrocortisone 0.05mg/ml Give po as directed

3 Page 3 CANINE EPILEPSY The following study found that phenobarbital, given as monotherapy, was effective in controlling or relieving epileptic seizures in dogs - Therapeutic efficacy of phenobarbital and primidone in canine epilepsy: a comparison (J Vet Pharmacol Ther Jun;8(2):113-9). ABSTRACT: The efficacy of phenobarbital and primidone against canine epilepsy was compared in a controlled study. Thirty-five dogs showing generalized tonic-clonic seizures (grand mal), treated for a minimum of 6 months, were included in the study; fifteen of these were treated with phenobarbital, the other twenty with primidone. Both drugs were dosed according to the clinical requirement; the daily doses ranged from 5-17 mg/kg phenobarbital and from mg/kg primidone. The plasma concentrations of phenobarbital, or of primidone and its metabolites phenobarbital and phenylethylmalondiamide (PEMA), were routinely monitored. Complete control of tonic-clonic seizures for 6 months, at least, was attained in six out of fifteen dogs of the phenobarbital group, and in five out of twenty dogs in the primidone group. A further six dogs on phenobarbital, and seven dogs on primidone, were classified as 'improved', i.e. the rate of seizures was reduced by at least 50%. The rest of the dogs were not improved by the treatment. The difference between the efficacy of phenobarbital and primidone was not significant, but primidone gave rise to signs of liver toxicity in fourteen out of twenty dogs, as indicated by considerable elevations of liver enzyme values (alanine transferase, glutamate dehydrogenase, alkaline phosphatase). Phenobarbital is, therefore, regarded as the drug of first choice for the treatment of canine epilepsy. PMID: With our state of the art compounding lab and pharmaceutical knowledge and experience, we can compound phenobarbital into a flavored oral suspension; in doses that meet the unique needs of each of your animals. Phenobarbital 100mg/ml Give po as directed

4 Page 4 FELINE ANTI-TUMOR AGENT Piroxicam is recognized for its value as a chemopreventative and anti-tumor agent, and appears to be rapidly absorbed following p.o. administration in cats - Single dose pharmacokinetics of piroxicam in cats (J Vet Pharmacol Ther Aug;26(4):259-63). ABSTRACT: Piroxicam (PIRO) is a nonsteroidal antiinflammatory drug (NSAID) recognized for its value as a chemopreventative and anti-tumor agent. Eight cats were included in this study. PIRO was administered in a single oral (p.o.) and intravenous (i.v.) dose of 0.3 mg/kg. The study was designed as a randomized complete crossover with a 2-week washout period. Serial blood samples were collected after each dose and plasma was analyzed for PIRO. Pharmacokinetic parameters of PIRO were determined using noncompartmental analysis. PIRO is well absorbed in the cat with a median bioavailability (F) of 80% (range %). The median i.v. t1/2 was 12 h (range h). The median Cmax was 519 ng/ml with a corresponding Tmax of 3 h. PIRO appears to be rapidly absorbed following p.o. administration in cats with a higher Cmax and AUC than in dogs. PMID: We have the ability to compound piroxicam into a flavored oral suspension, in doses that meet the unique needs of your animals. This study indicates that long-term daily piroxicam is generally well tolerated in cats at conventional doses - Evaluation of adverse events in cats receiving long-term piroxicam therapy for various neoplasms (J Feline Med Surg Apr;12(4):262-8). ABSTRACT: The role of cyclo-oxygenase 2 (COX-2) and prostaglandins (PG) in carcinogenesis has been documented in many species. Piroxicam has shown efficacy against several neoplasms and is frequently prescribed for chronic use. There are no studies investigating chronic piroxicam administration in cats and the chronic use of non-steroidal anti-inflammatory agents in this species has long been cautioned against. This retrospective study aimed to evaluate adverse effects in cats receiving long-term daily piroxicam. Seventy-three cats received daily piroxicam at doses of mg/kg. Treatment duration ranged from 1 to 38 months. Treatment with piroxicam was found to significantly increase frequency of vomiting during the first month of therapy, though this was most significant for cats receiving concurrent chemotherapy. Piroxicam administration was not significantly associated with hematologic, renal or hepatic toxicities. Adverse events were not correlated with dosage. Adverse events were reported in 29% of cats, and were generally mild and transient. Eight percent discontinued piroxicam due to adverse reaction, and 4% due to difficult administration. This study indicates that long-term daily piroxicam is generally well tolerated in cats at conventional doses. PMID: Piroxicam 2mg/ml Give 1ml po QD or as directed

5 Prescriber Name Prescriber Address City State Zip Phone Fax Date Animal Name Animal Type Owner Name Phone Address City/State/Zip Owner will pick up medication Please ship to owner Feline Hypoadrenocorticism All topical compound %s are per 1 ml or 1 gm unless otherwise noted [ ] Fludrocortisone 0.05mg/ml Directions: Give po as directed Canine Epilepsy [ ] Phenobarbital 100mg/ml Directions: Give po as directed Feline Anti-Tumor Agent [ ] Piroxicam 2mg/ml Directions: Give 1ml po QD or as directed Directions Prescriber s Signature Refills: NR 757 Norland Avenue, Suite 105 Chambersburg, PA Phone: (717) Fax: (717)