Prescribing Cascade

Question 1

What is the prescribing cascade?

Answer 1

Risk based decision-tree to help veterinary surgeons decide which product to use when there is no authorised veterinary medicine available.

Question 2

What are the steps in the Prescribing Cascade?

Answer 2

1. Medicines authorised for the species and condition in the UK
2. Medicines authorised for the species and condition in Northern Ireland
3. Medicines that are authorised for veterinary use in UK/NI
   ○ May be for a different condition in the same species
   ○ Or same condition in a different species
4. Either
   ○ A veterinary medicine authorised outside the UK
   ○ Or a human medicine authorised in UK/NI
5. Extemporaneous preparations (veterinary specials)
   ○ Not authorised medicines
   ○ May be from authorised manufacturers
   ○ You can make your own ‘veterinary specials’ in your practice

Question 3

Why would we use human medicines?

Answer 3

• Not necessarily tested for use in animals
  
  • Might have a good body of evidence to show these active ingredients are effective to treat the condition
  • Not yet brought to veterinary market
  • Example:
    ○ Gabapentin to treat neuropathic pain in dogs
    If analgesic protocol is not effective (treatment failure) - then reach for gabapentin?

Question 4

What can you do outside of the prescribing cascade?

Answer 4

• Ability to import human medicines from another country
  
  • Only in exceptional circumstances
  • Requires import certificate
  • Must justify staps in cascade that have been considered prior to requesting import