How we gave the dagger to internet pharmacies (Proceedings)

Internet pharmacies are well funded, very profitable and have cannibalized our customers and there's no sign of stopping. Metzger Animal Hospital has utilized several strategies to minimize the staffing problems and financial impact of this formidable threat to veterinary medicine. We will share our successes and failures in hopes to help practices with similar problems.

Some of the Internet sites that sell pet drugs represent legitimate, reputable pharmacies, says Martine Hartogensis, D.V.M., Promotion and Advertising Liaison for FDA's Center for Veterinary Medicine (CVM). But others are fronts for unscrupulous businesses operating against the law.

FDA has found companies that sell unapproved pet drugs and counterfeit pet products, make fraudulent claims, dispense prescription drugs without requiring a prescription, and sell expired drugs.

Pet owners who purchase drugs from these companies may think they are saving money, says Hartogensis, but in reality, they may be short-changing their pet's health and putting its life at risk.

CVM regulates the manufacture and distribution of animal drugs, while individual state pharmacy boards regulate the dispensing of prescription veterinary products.

When ordering online

     1. Order from a Web site that belongs to a VIPPS-accredited pharmacy.

     2. Mail the prescription provided by your veterinarian to the pharmacy after your pet receives a physical examination.

     3. Order from an outsourced prescription management service that your veterinarian uses.

Red flags

Some foreign Internet pharmacies advertise that veterinary prescription drugs are available to U.S. citizens without a prescription. Consequently, there is a risk of the drugs not being FDA approved.

A foreign or domestic pharmacy may claim that one of its veterinarians on staff will "evaluate" the pet after looking over a form filled out by the pet owner, and then prescribe the drug

CVM is especially concerned that pet owners are going online to buy two types of commonly used prescription veterinary drugs—nonsteroidal anti-inflammatory drugs (NSAIDs) and heartworm preventives.

Both drugs can be dangerous if there is no professional involvement. It's not a concern if the owner uses a legitimate online pharmacy and mails in a prescription from their veterinarian, who is monitoring the animal. But if there is no veterinarian–client–patient relationship, it's a dangerous practice.

NSAIDS and heartworm preventives

Veterinarians often prescribe NSAIDs to relieve pain in dogs. NSAIDs should not be purchased on the Internet without a veterinarian's involvement because

     • Dogs should undergo blood testing and a thorough physical examination before starting NSAIDs

     • Dogs should be monitored by a veterinarian while they are taking NSAIDs

     • Veterinarians should discuss possible side effects of NSAIDs with the owner

     • The prescription should be accompanied by a Client Information Sheet that explains important safety information to the owner

Heartworm disease is a potentially fatal condition transmitted by the bite of a mosquito that is carrying infected larvae of the heartworm parasite. Dogs, cats, and ferrets can get heartworm. Heartworm preventives, given daily or monthly depending on the product, kill the larvae before they become adult worms.

The American Heartworm Society recommends

     • using heartworm medication for dogs year-round, no matter where you live in the United States

     • getting dogs tested yearly to make sure they're not infected with heartworm

Testing is important even in dogs regularly treated with heartworm preventive products due to the occasional reports of product ineffectiveness; An Internet pharmacy veterinarian cannot draw blood from the animal to perform the test. If the test isn't done, a pet owner could be giving heartworm preventives to a dog that has heartworms, potentially leading to severe reactions.

Tips for buying pet drugs online

     • Order from a Web site that belongs to a VIPPS-accredited pharmacy.

     • VIPPS—the Verified Internet Pharmacy Practice Sites—is a voluntary certification program of the National Association of Boards of Pharmacy (NABP). NABP gives the VIPPS seal to online pharmacies that comply with stringent licensing and inspection requirements. Only pharmacies that sell human drugs are VIPPS-certified at this time, but sometimes veterinarians will prescribe human drugs to pets when there is no animal drug approved for the pet's illness. Check with NABP at www.nabp.net to find out if a pharmacy is VIPPS-accredited.

     • Order from an outsourced prescription management service that your veterinarian uses.

     • These state-licensed Internet pharmacy services work directly with the veterinarian, require that a prescription be written by the veterinarian, and support the veterinarian-client-patient relationship. Ask your veterinary hospital if it uses an Internet pharmacy service.

For more information

Veterinary NSAIDs

www.fda.gov/cvm/nsaids.htm

Buying Medicines and Medical Products Online

www.fda.gov/buyonline