Q: My veterinarian won’t approve my dog’s online prescription for meloxicam, even though it’s approved for dogs when you buy it through veterinarians. That’s unfair and illegal, right?
A: It might be unfair, but it’s technically not illegal under most circumstances. That’s because it’s not the online issue your veterinarian is objecting to (veterinarians can’t legally deny your prescription if it comes from an approved pharmacy). In this case, it’s probably the drug itself your doctor questions. Meloxicam, after all, is used “off label” in its generic preparation. And that’s a point consumer advocates and drug manufacturers like to quibble over.
Let me explain:
Using drugs for indications or in preparations not approved by the FDA in species not listed on the label is a fine gray line many of us in the veterinary profession are uncomfortably forced to straddle. We call that kind of drug use, “off label” or “extra label.”
According to the FDA, it’s OK to use products off label if there’s no other way of achieving the same effect and if it conforms to the standard of care of your industry. Therefore, veterinarians who use the human drug Lipitor in dogs to reduce their cholesterol levels can do so because no other cholesterol-reducing drugs are approved and lots of other veterinarians use the drug for the same reason.
Off-label usage is good for patients because it encourages physicians and veterinarians to be judiciously creative in their clinical decision making. This way we effectively get new drugs without their having to undergo the onerous and expensive drug approval process for a new indication or a new species.
In the case of your dog’s meloxicam, however, we run into a snag. Because a drug manufacturer has successfully undertaken the FDA-approval process for meloxicam use in dogs, this drug is, legally, available to dogs only in the nongeneric liquid form called Metacam.
The problem is that large dogs, in particular, require a large volume of this liquid drug per dose. Some dogs will simply not tolerate such large amounts of liquid without a fight. Some owners may find a pill to be much easier (and far less expensive, too).
Legally, that’s why veterinarians can make an exception for very large dogs who won’t tolerate the liquid Metacam. If that’s your issue, too, I recommend you plead your case to your veterinarian.
Dr. Patty Khuly has a veterinary practice at Sunset Animal Clinic in South Miami. Her website is drpattykhuly.com. Send questions to firstname.lastname@example.org.