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Much of an animal’s medical treatment will be given to the animal by the owner at home. To do this safely and effectively, owners need information about why and how to use the treatments. This module discusses what sort of information owners need, what is required by law, what is available, and how it can be provided in the veterinary practice, pet store or pharmacy.
If a medicine is not used correctly, the intended benefits of the treatment might be lost. For example, a flea treatment may not work because the pet owner is not using it properly. It’s quite a common belief that flea resistance is the reason why a treatment doesn’t work, but there’s no convincing evidence of resistance in the UK and studies show that lack of effect is most likely due to incorrect or inadequate treatment. For example, the owner might not be using the treatment at the correct intervals, or is using a spot-on product on a dog that gets bathed often, not realising that the effect of the spot-on is being lost. This can lead to dissatisfaction and more money spent on trying different products.
Incorrect use of a medicine can also lead to harm, even death. For example, there are many reports of owners mistakenly giving spot-on products to animals by mouth; in one reported case this led to the death of a dog as a result of the dog inhaling the product. Cats have been harmed by permethrin-containing spot-ons for dogs; and rabbits harmed by spot-on products for cats. There is also a risk of harm to people through incorrect handling or disposal of medicines.
As well as knowing how to use a medicine, pet owners also need to know about adverse effects that might occur even if the medicine is used correctly.
There are many reasons why people may not use medicines correctly. They include:
- interactions between the owner and the professional
- language and communication barriers
- inadequate explanation
- poor information provision
- information not given, not found, or not read
- information not being in plain language
- owner behaviour
- forgetting to give the medicine
- ignoring or being unable to follow advice
- being unable to give the medicine due to poor dexterity
- individual beliefs, concerns or expectations
- competing priorities and costs for the owner
- lack of support and unstable living conditions
- not purchasing enough medicine
- treatment factors
- complicated dosage regimen
- a medicine that is difficult to administer (e.g. ear drops, tablets)
- an uncooperative animal.
There has been little research into what information pet owners need in order to administer treatments effectively and safely and so it seems reasonable to apply what has been learned about the information needs of people in relation to human medicines. People need to know:
- What the medicine is.
- Why it is needed and how it is likely to affect the condition.
- How to give the medicine to the pet and whether it should be given with food.
- How often to give the medicine and how much to give each time. If it is a liquid, whether to shake the container first.
- How long to give it, and whether the course must be finished even if the pet seems to be back to normal.
- How to store the medicine.
- What to do if the pet vomits or spits out the medicine.
- What to do if a dose is missed or too much has been given.
- Whether the medicine could interact with other medicines.
- What adverse reactions to watch for, and what to do if they notice any.
- Whether and when to return the pet for a check-up.
- Whether a further supply of the medicine will be needed, and how to get it.
How the information is given is also important. People will have a better understanding if they are given both written and verbal instructions, rather than verbal alone. The timing is also important. The information should be given when the medicine is supplied, although people are sometimes not ready to take in the information offered at that time. The advantage of written information, given with a medicine, is that it can be read when the owner gets home, when questions and uncertainties may emerge (e.g. if a dose has been missed, or an adverse effect has appeared). It is worth becoming familiar with written information that accompanies medicines you supply and also not assume that an owner will understand it all or that the information will be specific to every patient (e.g. the leaflet of a licensed (authorised) medicine will not mention an unlicensed use). It is important to remind owners to read the label and leaflet. Showing the owner how to use a medicine can also help.
The company that markets a veterinary medicine is required by law to provide certain information with the medicine – for example, what it is used for, the species for which it is intended, and instructions on using it safely and effectively. If this information does not fit on the immediate packaging or outer pack they must produce an accompanying package leaflet. The package and the leaflet of a veterinary medicine are approved by the regulatory authority (either the Veterinary Medicines Directorate [VMD] or the European Medicines Agency [EMA]) as part of the licensing process. There is no online source of package leaflets for products authorised in the UK by the VMD. If a medicine is authorised via the EMA, any package leaflet is published within the European Public Assessment Report (EPAR) on the EMA website.
It is important that package leaflets are well-designed and clearly-worded so that the information can be read and understood by most people, including those with poor literacy skills or poor eyesight. Since 1998, medicines law has ensured that the package leaflets provided with human medicines are understandable to aid safe and appropriate use. There are strict rules on how the information on human medicines is presented and all leaflets must be tested with real patients to ensure that they are legible and clear, and medical terms are translated into language that most patients can understand. The rules on producing package leaflets for veterinary medicines are not so strict, so for example, leaflets do not have to be tested with users. This means that package leaflets that accompany veterinary medicines, particularly prescription-only medicines, often contain a lot of detail and highly technical language that many pet owners will not understand or attempt to read. This makes it more important that the people supplying medicines talk to pet owners about medicines.
By law anyone prescribing or supplying veterinary medicines must be satisfied that the person who will use the product is competent to use it safely and intends to use it as authorised. The prescriber or supplier must also advise on the medicine’s safe administration, and any warnings or contraindications. There is no legal requirement to label medicines supplied in their authorised packing; however it is considered good practice for all prescription medicines to have a dispensing label attached containing the following information:
- Name and address of the animal owner
- Name and address of the premises supplying the medicine
- Date of supply
- Name, strength and quantity of product
- Dosage and directions for use
- The words ‘For animal treatment only’
- For topical preparations ‘For external use only’.
If a medicine is repackaged in a container other than its original packaging (e.g. tablets dispensed in smaller containers), the person supplying the product must give enough written information for the medicine to be used safely. For example, if parasiticide products are split for supplying or administering single doses in the veterinary practice (e.g. at puppy parties), pet owners must be given a copy of the package leaflet. In reality, it can be difficult to get spare copies of package leaflets for licensed veterinary medicines because they are not readily available online. Many practices photocopy the leaflets that come with large boxes of tablets that will be split up, if not enough leaflets have been supplied in the original pack. An alternative is to print the product’s summary of product characteristics from the VMD product database or the NOAH data sheet, although these will not contain specific wording directed at pet owners (e.g. on reporting side effects and on medicines disposal) that is included in package leaflets. Vets must ensure that any person handing out the medicine is competent to do so but there is no legal requirement for staff that dispense medicines in a veterinary practice to have formal training.
Online stores that sell veterinary medicines must ensure that a suitably qualified person (SQP) has assessed the details provided by the customer and advised them on how to use the medicine safely. The VMD runs a voluntary ‘Accredited Internet Retailer Scheme’ (AIRS) for UK websites selling veterinary medicines. This aims to reduce the risk of people buying unauthorised, inappropriate or ineffective veterinary medicines. Accredited websites can display a logo to indicate that the VMD has assessed how veterinary medicines are sold on that site and that it complies with the AIRS requirements and the Veterinary Medicines Regulations.
If an unlicensed medicine is supplied under the prescribing ‘cascade’, by law the following information must be supplied:
- Name and address from which the product is supplied
- Name (or initials) of the veterinary surgeon who prescribed it
- Name and address of the animal owner
- Identification (including the species) of the animal or group of animals
- Date of supply
- Expiry date of the product, if applicable
- Name or description of the product (at least the name and quantity of active ingredients)
- Dosage and administration instructions
- Any special storage precautions
- Any necessary warnings for the user, target species, administration or disposal of the product
- Withdrawal period, if relevant
- The words 'Keep out of reach of children’ and ‘For animal treatment only’.
The product must be labelled with this information, but it is reasonable to place some of the required information on a separate sheet.
The British Small Animal Veterinary Association (BSAVA) publishes client information leaflets on commonly-prescribed unlicensed medicines (currently on 61 individual drugs and three drug groups: antibacterials, topical eye treatments, steroids).
- People will have a better understanding of how to use medicines if they are given both written and verbal instructions.
- Remind owners to read the label and the leaflet (if there is one). Encourage them to ask questions at the time or to contact you if any questions arise.
- Become familiar with the available written information and do not assume that an owner will read it, understand it all, or that the information will be specific to every patient (e.g. the leaflet of a licensed medicine will not mention an unlicensed use).
- The law requires that owners are given information on the safe and effective use of cascade medicines.
- If parasiticide products are split for supplying or administering single doses in the veterinary practice (e.g. at puppy parties), give pet owners a copy of the package leaflet.
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