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Word of warning on compounding medication
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Michigan


Member Since:
11 July 2016
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3 March 2022 - 7:31 am
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I added to this forum in January on – Compounding Pharmacies

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Our post above was to share we have used Wedgewood pharmacy for years for Saxtons Cisparide, a motility drug to help Saxton’s poop move with success. We used to get a 90 ml bottle of meds delivered, and as we neared the end of Saxton’s meds, we would sometimes have issues where Saxton did not poop on schedule. (our hunch was the medicine is losing its effectiveness towards the bottom of the bottle.) So we told the vet and got a smaller quantity prescribed, and it has not been an issue since! 

We have been using Wedgwood for Purrkins phenobarbitol because his dose is so tiny and to cut a tiny human pill 15 mg pheno to 6.3 mg was not precise. With the pheno, we have bloodwork done to measure Purrkins serum levels to make sure his levels are good, not too high, too low, and proof of the medicine efficiency.🤬 Purrkins levels have been on a downward trend since June, checked again in July, August. His levels were trending lower but still in the ok range. We troubleshoot and can only figure the medicine is losing potency over time as Saxtons did? So we get a smaller quantity bottle prescribed. 

WELL, we went again in February for a recheck and blood draw now, our levels are way too low. Purrkins gets his meds like clockwork at 7 am and 7 pm! When the vet calls us we have to troubleshoot this and Mark looks closely at our meds; we have a fresh, almost full bottle of Pheno Mark see’s crystals at the bottom! So I phoned the Vet & Wedgewood they confirmed the crystals should NOT be there that is the critical phenobarbitol crystalized, meaning Purrkins is not getting his dosage. The first pic you can’t see the crystals well but can see it is not evenly distributed.

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Flip the bottle over (this is after shaking)! A LOT OF CRYSTALS! That does not mix no matter how much you shake it!!!

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To be honest and fair. (which is hard for me to do!)

Wedgewood pharmacist said they have never had this issue before with Pheno and this formula, we sent them images, and they took care of the problem asap, got us a new bottle free of charge, and shipped it out that day. If this ever happens again, we call again. We get a smaller quantity bottle hoping it would be more accurate, not lose potency and not crystalize.

A new bottle comes, and it looks good no crystals! (we do shake the poop out of the medicine before pulling the meds). 16 days into our fresh bottle of meds! Purrkins starts to have whisker twitches, and we see our new bottle of meds is now crystalizing AGAIN GRRR !!!!

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I called Wedgwood again and got a different pharmacist, I sent her photos, and she said yes, they had seen this before! I do appreciate HONESTY, but yeah! She troubleshoots with us on where we store the meds a kitchen cupboard away from any heat or light source, Temp, we keep the house at 70 – 71 degrees, Did we rinse the syringe out after each use – No. She confirmed it’s not our fault! This pharmacist thinks it’s the cold weather & happening in shipping from Arizona to Michigan, but why does it come fine? 

We discuss in great detail our options and what other formulas would be accurate and stable. This pheno is a suspension mixed in water. The pharmacist says they do have oil-based, which would be more durable. Ok, great, we will do that. She called back and said she is sorry she misspoke pheno is not available thru them in oil-based. Options: We can do a chew, but if Purrkins does not like it for some reason, there is no way I can crush it and dissolve it in liquid form to give it to him. So not an option. We could do a capsule, but it would need to be specially ordered, and the dosage would have to be changed! The pharmacist wanted to send out another bottle of the same formula asap, so we had something as this medicine is CRITICAL! 

This time the customer service is not the same, and the meds DO NOT get prepared and shipped out asap. This was on a Friday morning, and as of Monday afternoon, the order was still processing; Purrkins has more whisker twitching, and I’m terrified he will have a seizure! (We are almost to one-year seizure-free) We tell them to cancel the order wtf? This is crazy!

THANK HEAVENS, WE ARE NOT ALONE. THRU THIS Dr. Rr is in the loop the entire time, and we discuss & try to figure out a solution over the WEEKEND! 

We went back to the pills, and Dr. R. found us a way to compound the medicine ourselves and get the precise dose. In the meantime, Dr. R has phoned Purrrkins neurologist and her vet colleagues and found a compounding pharmacy in Michigan that has had success with pheno in an oil base formula. She called in a script, and as scary as this is, we will try it and have the backup recipe to use if needed. Our new compounded meds (oil-based) arrived last night and will come back after a month of use. Have a blood draw and let you know if our serum levels are in line?! I’m hopeful & we will switch Saxton meds and tell a particular pharmacy all of my mind. You guys can well imagine!💨😡😤🤬😖😭

This long-winded post is a word of caution with compounding medicine and one of the worst-case scenarios when we put all our trust in a company with our animal’s health. We cant always test the medication in the blood!

I’m not saying don’t compound medication but be informed of the risks involved and wisely choose the company. I THOUGHT we did our vet routinely USED ( yea past tense now)Wedgewood. 

Is this a fluke and one in a million? I have no idea. It could be? It may be the weather difference and happening in shipping?!?(either way, it should never happen) But I wanted to revise my original post to say that we have NOT always had success in compounding & and hope to spare another furmily. Purrkins has suffered. We have suffered. I’m not done with Wedgewood yet…smiley7

I’ll update when we know more, and if you want to send some tripawd power Purrkins way, we would appreciate it.🙏🏻🙏🏻🙏🏻 We can keep checking off no seizure days as we get these levels back up!

Hoppy Triday all! 

Holly & Purrkins (not happy to say the least)

🫂🫂🫂🙏🏻🙏🏻🙏🏻💝💝💝

Virginia




Member Since:
22 February 2013
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3 March 2022 - 10:31 am
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SENDING TRIPAWD POWER TO PURRKINS!!  And on TriDay, that’s  a lot of pawsitive power!!!  Plus loading her up with our loce too!♥️

Reading this just put my stomach in knots for you.  Cannot imagine  the level of frustration you and Mark have been through to get this figured out.   The fact that you figured it out is a small miracle in itself!!  To question the bottled meds and to see those minuscule crystals jad ro ve quite discerning.   And then to shake the bottle and really see them….scary moment!!

Soooo glad you have another source now and can get things back on track.  And I have no doubt the bloodwork will show improvement!!

STANDING OVATION for all your investigative  work and your determination  to get this rectified 👏👏👏  I shudder to think what could have happened to our sweet Purrkins without  you advocating  for the cause and the solution.  To think other dogs and cats may have had  negative  results  from something  like this, and never even knew the cause could have been the compoundding.

Thanks for taking  the time to ppst this.  You are ALWAYS so informative.   Extra ear scritches to Purrkins. 

(((((((((((((((Hugs)))))))))))

Sally  and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

On The Road


Member Since:
24 September 2009
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3 March 2022 - 11:03 am
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WOAH! Not at all what I was expecting from a pharmacy like Wedgewood. They have always had such a good reputation. Such a bummer and I’m really, really sorry that you guys have been through the wringer! And Purrkins is paying the price more than anyone, YIKES! Wow. Just so glad you caught it in time so he’s OK.

Dr. R is a smiley10, she really worked hard to get this figured out so Purrkins can get those numbers where they need to be. You BET we are sending Tripawd Power your way! PURRKINS YOU’VE GOT THIS!!!!

Thank you for sharing the details. It’s another reason why we all need to be really good about staying in communication with our vet, do regular labs, and don’t take anything for granted when it comes to medication for our pets. We owe it to them! 

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

Michigan


Member Since:
11 July 2016
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3 March 2022 - 3:10 pm
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Thanks, Sally; yes, it’s a lot of pawsitive power, and we appreciate it. 😘🫂
Yep on the knots in the belly plus some. We have been worried sick! I’m STILL nervous with any compounded right now.

We know there are risks in compounding and know to find accredited trusted sources, but even so, there can be issues! Saxton’s meds were just a hunch, and we could prove nothing. Purrkins is anohter story. We had many years of success with the same company with Saxton meds.

Yes, this could be way worse, so we hold onto the pawsitives here Purrkins has not had a spell on such low levels, but he does have whisker twitching, and he does not feel himself. It breaks my heart! We are back to 24/7 watch detail, and we hope we sail thru this even if the sea was a bit bumpy.

Exactly Rene!
I know on the pharmacy anyone can have issues, it appears. However, I did check reviews after this and see there are other issues we were not aware of that never affected us before.

Yes, Purrkins is the one suffering, and it is devasting!

We could not ask or wish for a better vet! Dr.R. needs an award for the best, attentive, caring vet in the universe! She has always gone above and beyond with the boys! It makes all the difference in these stressful situations. She promised we would find a solution to this issue, and we had a couple of options in a day and a half. Again this was over the weekend! We are blessed to have her! She is as upset about this as we are! We would have been scrambling with our old vet and left on our own. No comparison!

Yep take nothing for granted and always stay in close contact with your vet and follow up with labs! I’m so thankful we can & do all of the above, and poop still happens! 🥺

Thank you both for the Tripawd Power; it is magical and more so today!
Loads of Love❣️❣️❣️
🫂🫂🫂😘😘😘💝💝💝🙏🏻🙏🏻🙏🏻

On The Road


Member Since:
24 September 2009
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3 March 2022 - 6:25 pm
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Wow Dr. R did that over the weekend? Amazing! She gets a gold star and medal of honor!

A while back I read an article about dangers of compounding pharmacies. Remember several years ago when a bunch of people died because of bad medicine with some type of bacteria that was coming from a compounding pharmacy? There’s just not a lot of oversight in many of them. I’m not opposed to using compounding pharmacies ever again, but this experience of yours will stay with all of us forever. We must not be complacent, ever!

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet


Member Since:
22 August 2008
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3 March 2022 - 11:07 pm
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This is very interesting; I have usually had good luck with Wedgewood but it sounds quite frustrating!  I am just wondering why you do not use the human phenobarb elixir? It is pretty cheap and most of my feline patients take it quite well. Maybe Purrkins already tried it and hated it or the volume needed was too high. It is 20 mg/5 mls.

Good job tracking down the problem and getting it fixed.

Pam

Michigan


Member Since:
11 July 2016
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4 March 2022 - 7:06 am
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Rene, I also read that contamination can be an issue in some compounding. I did not read on the deaths, and OH MY, that’s beyond TRAGIC.!
Wedgewood said these formulas should not degrade like this! I will find out what they are doing about this in the future; is this being investigated further? I know all of our photos & info of both bottles went from both pharmacists to the quality control department. I’ll post if I get more updates on that.
💝💝💝

Michigan


Member Since:
11 July 2016
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4 March 2022 - 7:09 am
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Thanks so much for chiming in, Dr. Pam! We appreciate your input🫂

We did discuss the liquid human formula, and our vet called that into CVS last Friday. It also had to be ordered, CVS could get that n the next business day, and we ordered it. It was to come in on Monday.

Dr. R had never used the liquid formula in cats but had in dogs, and I was concerned about the ethanol content. She asked the neurologist about the ethanol, and we never heard his response as she gave me a way to compound our 6.3 mg dosage. I could find next to nothing on the human liquid formula for cats in the little time I had to search, and what I did find stated the ethanol content to be too high?

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https://veterin…..id=4951404

Plus, all the extra ingredients in the human liquid.

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When I spoke to the CVS pharmacist, I asked if an alcohol-free version could be ordered(for babies’ children). He checked and said all the liquid had alcohol in it, and until the bottle came in, he could not give me an exact percentage of ethanol.

In the meantime, our vet found this compounding pharmacy that had success with pheno and called that script in. We called CVS on Monday and told them thanks, but we would not be picking that script up because of the ethanol content.

We know human formulas are more regulated and precise if the alcohol content is not too high, we can try that as an option. I’m so thankful to know & hear you have used in cats with success!

As I told our vet, we find this crazy in today’s day and age with such a critical med. To have the above issue and have few choices! Another live and learn experience, I guess on the books.
💝💝💝


Member Since:
22 August 2008
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4 March 2022 - 7:27 am
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Our local neurologist uses the human form so I assumed the other ingredients were safe. I know that cats are not people and it can be hard to find meds that are tested just for cats. Even some of the dog medications aren’t safe for cats.  I have had cats taking the human product for years and one in particular is now almost 18 years old if that helps. Plus we monitor labs every 6 months.

Pam

Michigan


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11 July 2016
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4 March 2022 - 7:44 am
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I have had cats taking the human product for years and one in particular is now almost 18 years old if that helps.

YES, this DOES HELP us immensely! THANK YOU! 😘
Your insight and experience are invaluable! We follow up with labs at least every six months, so that is not an issue.

I get so frustrated with the lack of info for cats; things have changed but not nearly enough yet.

Much appreciation💝💝💝

On The Road


Member Since:
24 September 2009
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4 March 2022 - 10:35 am
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Holly that was a fast and excellent catch about the ethanol. Wow! I do know that it’s used in processing many CBD products for people, cats and dogs, but have now idea how it’s used for pheno. You are such a great advocat! And I agree, there just isn’t enough info for cats yet. It’s coming, but too slowly!

Dr. Pam THANK YOU, your experience is always so helpful.

All I can say is labs labs labs. Do them! It’s so easy to brush them off when our pets seem fine, but you never know what’s beneath the surface.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

Michigan


Member Since:
11 July 2016
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4 March 2022 - 4:45 pm
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Thanks, Rene,
My never-ending questioning mind lead me to look further into the liquid pheno. At first, I was frustrated we had the delay in ordering the human liquid as we needed meds asap, but as it turned out, it gave me time to look into it and find comfort or not in what I was going to put down Purrkins throat!

Ditto on the labs!!! It is even more critical in cats as we can detect little things sooner—Saxton goes every six months & Purrkins more frequently. 
💝💝💝

Virginia




Member Since:
22 February 2013
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4 March 2022 - 8:18 pm
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    advocat  

🤣😂😁     

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Michigan
Member Since:
2 April 2013
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9 March 2022 - 7:38 am
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Holly ~

Are there any compounding pharmacies near you?

We have one near our house, actually right down the street from our vet’s office.  Our vet didn’t even know they were there, I had a co-worker tell me about them.  We have Racal’s Budesonide compounded there, it’s chicken flavor & he loves it!  lol It was $110 through the vet & $46 at the pharmacy.  Now we also get a cream Elavil for our other cat that we can put on her ear & rub in, much better than trying to cut a tiny pill into 1/4’s and get her to take (she wouldn’t!  no matter what we tried).  

We’re on the other side of the state from you, but maybe there’s something near you.

donna

Donna, Glenn & Murphy 

Murphy had his right front leg amputated due to histiocytic sarcoma at 7 years old. He survived 4 years, 2 months & 1 week, only to be taken by hemangiosarcoma at 11 1/2 years 6/12/17  
Read about Murphy's Life on Three Legs

Donna.png

Michigan


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11 July 2016
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9 March 2022 - 11:02 am
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Hi Donna,
Thanks for chiming in! Good to see you!!! 😘

Yes, our vet found a pharmacy in Michigan. She heard about Jensen’s community pharmacy from her vet colleagues, who have successfully used them. They are in Saline (86 miles from us); they have one in Dexter (63 miles). Might be near you, Donna? Could it be the same pharmacy, for that matter?

They needed 48 hours for compounding. It only took 24 hours this time. They shipped and got us to us in one day. This is oil-based, and Purrkins is not a fan. It is a smokey chicken flavor. We use a churu treat – syringe as a chaser. We will try another flavor next refill if Purrkins labs show his numbers are where they should be. We see a massive improvement in 6 .5 days already!

I’m glad to see you got meds you can get in the kitties. Thankfully, it is not an ordeal for us as the boys are used to it, Gave them supplements for years before meds were needed. It makes all the difference when they like the meds & are easily given.

I’m mia in many ways – my Dad is in the hospital, another scare, another er trip! He is getting a pacemaker put in right now! Dad and Purrkins always do scary things in sync for some reason! I can only take so much. 🥺 🥴

Sally, I’m past stone-cold nuts now. Send some good juju, please.🙏🏻🙏🏻🙏🏻
Love to everyone🤝🫂😘💝💝💝

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