Ethical Dilemma: Rimadyl Chewables

1 Feb

It was a very unfortunate accident. One of our clients at the vet hospital also has a dog. The dog is on Rimadyl for arthritis pain. Rimadyl works very well for its intended purpose of reducing joint pain–but it is very expensive! We’re talking around $1.78 per tablet.  The owner dropped several tablets in the sink, getting them wet. To salvage them, she placed them on a paper-towel on the counter to dry out. . .

During the night her older cat began to vomit.  The owner noticed at least 5 of the Rimadyl chewables were missing.  Cat’s can’t have Rimadyl.  It causes severe kidney failure to the point of death.  And this was a huge dose for even a large cat.  Five (or more) 75mg chewables is a big dose for even a dog.  So the cat was rushed to Pet Emergency.  IV fluids, blood work, injectable medications, etc, etc. . . and more than likely a ton of money later, the cat was transferred to us.

Mid-morning the owner called me and calmly said the younger cad had vomited a little bit last night.  The owner was SO laid back!  She said the younger kitty was running around and seemed to be feeling well, but I said we should see him and do blood work just in case.  His numbers turned out worse than his older buddy’s.  He must have eaten most of the “treats.”

I thought it was a really sad situation.  I could see how a mistake like that could happen.  And there’s just not that much to do.  Kidney damage is irreversible.  Of course, the owner was upset.  We all were.  Grieving (which is perfectly justified) she began looking to assign blame somewhere. It’s a part of the grieving process, but as professionals I don’t think we should jump on any emotional bandwagon. The owner thought Pfizer as manufacturer of Rimadyl should have to label the bottle that the chewables are very tasty and toxic to all animals in excess (or at all, as the case may be).

The vet on duty went along with that line of thought.  She said Rimadyl shouldn’t be made in the chewable form, no medications should be palatable, the company should label the product with a courtesy warning that the NSAID is very tasty, but harmful in large amounts, and the pharmacy should have warned the owner to keep the prescription locked away before doling it out.

I disagree–on most counts.

There are a lot of nice-tasting medications.  Grape Dimatap cough syrup for kids.  Flinstone vitamins.  Bubblegum flavored amoxicillin for kids and cats.  The animals love the probiotic powder and the lysine treats.  We even have a marshmellow-flavored liquid on the pharmacy shelves at work!  If a company succeeds at making their medicine less yicky-to delicious to better administer it–should they be punished?  These are labeled as prescription items–which have specific indications, dosages, and safety caps.  Even if they are delicious people should know this and take precautions just like with any med.

Again, Rimadyl is prescription-only.  To reiterate, owners should realize it is not a treat and some common sense should be employed to keep it from animals for which it is not indicated.  The (perscription) bottle clearly says it is only FDA-approved for use in dogs.  Any more of a warning would probably hurt sales of a good product that actually works well for its intended purpose.  It would also cost money.  This expenditure would not be shouldered by Pfizer–but passed on to customers, no doubt.  It would make (already expensive) Rimadyl too costly for most people.

The one point I DO agree with the owner and our vet about is the Rimadyl hand-off.  Every prescriber should go over meications with the client.  The owner should leave knowing the indications, possible ill-effects, the proper and current dosage, and the medicine’s expiration date.  The prescription label right on the bottle often goes over these things again.  Whenever I hand someone a medication at work, whether it’s the first or billionth time they’ve gotten it, I take a moment to read the label to them.  Every time.  To break tension I say “you already know this, but” or “You could tell me the dose” or “You know the story, *read directions*”  EVERY time, every client.

BUT just because I don’t think the company is to blame, doesn’t mean I’m heartless, as the vet tried to make me feel.  I thought HER opinion was idealized.  The company complied with the rules.  I think having a palatable, chewable medication is still ethical.  Yes, I think it’s a terrible thing that happened to those cats.  And blame, if there is any, rests squarely with the owner.  That said, I don’t want to blame anyone.  It’s not me looking to blame.  These kitties are sick (we had to euthanized the older one after a week) and that’s sad.

 

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