Hopping on the Mirataz question, do you have any idea why we don't have transdermal versions of Gabapentin or Trazodone? I'm a (new) vet tech who has worked in critical care and emergency, and it feels like even though it may work at reduced efficiency, it would be helpful in long term hospitalization cases to avoid repeated force-pilling for stressed animals.
Sueanoi here,
For seizure control by medicine injection, we have diazepam available. It's not the same, but the intended result of reducing anxiety and seizure control works.
Gabapentin has an additional effect of nerve-related analgesia, while at hospital, if the animal is resistant to pilling to the point that it's distressful, I'd prescribe another injection analgesia, or even fentanyl patch if needed.
The downside is, pills are often the cheapest form of medications available in the market. Using injections long term can accumulate cost to hazardous levels to the owner's wallet. (With well communication, this can still be a choice available if the owner is willing to pay)
Also, if animals are well familiarized with pilling, it is often the LESS stressful method of medication, comparing to getting restrained and injected with needles twice a day. (So please, owners, train your pets to take pills early in life.)
gettingvetted here.
Sueanoi practices in Asia, so I wanted to give a North American perspective here.
Transdermal formulations of pretty much anything is available these days. Find the right compounding pharmacy (typically Wedgewood or Roadrunner, but there are plenty of others including human pharmacies) and they can make you just about anything in transdermal form.
Here’s the issue - FDA approval of 99.9% of drugs (and 99.9% of studies surrounding drugs) is either for oral or injectable forms. There is no guarantee that transdermal formulations work in the same way as the drug’s other forms (or any guarantee that they work at all).
Plus, there is a veeeeery gray area surrounding compounded drugs (those that are taken from their original form and turned into another form, like an oral capsule/tablet into a liquid or transdermal), at least in the US: - Technically speaking, I am allowed to compound a drug for a patient if its approved form is unsuitable for the patient (for example, the only doses available are too large or the approved drug is mixed with another drug that I don’t want to use on the patient, like codiene with tylenol). - It is illegal to compound a drug for price purposes, for instance. - It is *technically* illegal to compound a drug if there is anything else that’s approved for the desired use and we haven’t tried that yet. For example if I want sedation for a vet visit in a cat, and the owner has tried but can’t give gabapentin capsules, I am technically supposed to have them try giving acepromazine, trazodone, etc prior to compounding gabapentin into a liquid or transdermal for the owner. - It is also illegal to compound drugs in bulk to keep in the hospital and then dispense individual doses of said compounded drugs to patients. So in a case like an ER, it would be illegal to order a bunch of transdermal gabapentin and trazodone to have on hand for individual patients. Each compounded drug is supposed to be used on one patient and one patient alone.
Those last two items are pretty much ignored by everyone... nobody is going to make a cat owner with difficulty pilling their cat, try acepromazine or trazodone pills prior to just prescribing them the gabapentin in an easier formulation. And pretty much every hospital has *something* sitting around that is compounded in bulk and dispensed in individual doses to patients (for example my hospital keeps compounded ponazuril and pimobendan in stock). Even the FDA has come out and said “listen we are just trying to keep randos from compounding and illegally selling potentially dangerous formulations of different medications, we’re not going to come after you for prescribing liquid gabapentin or keeping a stock of compounded dewormer in your hospital.”
So, long story short - it’s doable, but technically illegal and probably doesn’t work as well as you want it to.
