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Grind

Crikey!

As I think I may have mentioned elsewhere, one of my dogs (Annie, the one on the left, assuming the same avatar is there) started to have seizures a few months ago - typically at the rate of about one a week, usually on either Friday or Saturday night (I need to see if something else is going on then that I'm not picking up upon).

These are very disturbing to watch, especially when she eventually comes around and you can see that she's not entirely sure what's going on and isn't 100% sure you're a friend or a foe. It usually takes a few hours for her to "be herself" again as she goes through wobbly, I need a serious dump, hungry/thirsty and then yappy phases. Can't be fun for her either, obviously.

Anyway, there apparently isn't much in the way of medical options because she already needs to be on a low dose of daily steroids because of blood issues that have been with her for at least seven of her ten years.

The pills - with discount - currently cost $213.97 for a thirty day supply, which could become even more expensive should higher doses become needed (ideally, these seizures shouldn't occur more than once every six weeks or so) and it is fully expected that she will be on them for the rest of her life.

We can (and will) afford this expense (the older dog is also on less dramatic pills that cost around $75 a month), but I was wondering how people on tighter budgets approach such things here. Do they just let "stuff" happen and go for the "it's only a frickin' dog" approach?

Once the flea/tick and heartworm medicine is factored in, I would guess my two dogs cost at least $350 a month to own.

Obviously the choice is entirely mine, but it seems as if the pharmaceutical companies are taking the piss.

Don't get me started on the price of human medications.....
Plastic Man

Have you the option of requesting generic versions of the medicines (non-branded medicines e.g. paracetamol vs Panadol (UK), acetaminophen vs Tylenol (US))?

Quite a lot of human medicines are also used for animals. While there may not be a generic for the animal product, there may be a human version.

Investigate the possibility of using a "compounding" pharmacy, who may be able to transform human medicines into forms suitable for administering to animals (same active drug, formulated differently e.g. grinding up tablets and putting the appropriate dose for your dogs into capsules).

http://www.fda.gov/Drugs/Guidance...PharmacyCompounding/ucm339764.htm

However, I have no idea what vets may or may not legally prescribe for animals, or if compounding for animals is legal in the US. No harm asking.

Then again, there is always Canada. The savings on a few months treatment may make the trip worthwhile. Again, you would need to investigate the legal situation.
Grind

Plastic Man wrote:
Have you the option of requesting generic versions of the medicines (non-branded medicines e.g. paracetamol vs Panadol (UK), acetaminophen vs Tylenol (US))?

Quite a lot of human medicines are also used for animals. While there may not be a generic for the animal product, there may be a human version.

Investigate the possibility of using a "compounding" pharmacy, who may be able to transform human medicines into forms suitable for administering to animals (same active drug, formulated differently e.g. grinding up tablets and putting the appropriate dose for your dogs into capsules).

http://www.fda.gov/Drugs/Guidance...PharmacyCompounding/ucm339764.htm

However, I have no idea what vets may or may not legally prescribe for animals, or if compounding for animals is legal in the US. No harm asking.

Then again, there is always Canada. The savings on a few months treatment may make the trip worthwhile. Again, you would need to investigate the legal situation.


Good ideas: I may see what there is out there.

The "problem" medicine is for the seizures:

I believe the "brand" version is called Keppra, but we get it as Levetiracetam in the form of 250mg tablets.

The poor thing has to take 2.5 of the feckers every eight hours. We're getting through quite a bit of peanut butter to sneak them in under the radar which, apparently, you also have to be careful of from a pooch standpoint - it's not as bad as dark "cooking" chocolate, but it mustn't contain xylitol, which the cheaper brands seem to do.

To be honest, I thought she was going to be gone very quickly when I saw the first seizure, so I really don't begrudge the expense and hassle, but I hate to think of some poor old biddy with little income in the same position having to deal with the same issues.

She's a good doggie. Grind loves her.    
Heyho

Would it be a similar expense in the UK for the treatment?
Plastic Man

Heyho wrote:
Would it be a similar expense in the UK for the treatment?


The NHS price for 60 levetiracetam 250mg tablets is... 3.18

So 7.5 tablets a day for 30 days (225 tablets), would make it just under a 12 quid. The manufacturers clearly still make enough profit on this to make it worthwhile.

The way NHS prices are calculated is complicated, and don't necessarily bear much relation to the recommended retail price, which you'd pay for a private prescription, especially for drugs still on patent.

Veterinary versions of human medicines are higher prices, with some justification for some increase, but usually ridiculously mucher higher.

Grind - instead of peanut butter, how about grinding/breaking the tablets up (assuming they are not some kind of extended release formulation) and mixing into jam or maybe yoghurt instead?
Grind

Plastic Man wrote:
Heyho wrote:
Would it be a similar expense in the UK for the treatment?


The NHS price for 60 levetiracetam 250mg tablets is... 3.18

So 7.5 tablets a day for 30 days (225 tablets), would make it just under a 12 quid. The manufacturers clearly still make enough profit on this to make it worthwhile.

The way NHS prices are calculated is complicated, and don't necessarily bear much relation to the recommended retail price, which you'd pay for a private prescription, especially for drugs still on patent.

Veterinary versions of human medicines are higher prices, with some justification for some increase, but usually ridiculously mucher higher.

Grind - instead of peanut butter, how about grinding/breaking the tablets up (assuming they are not some kind of extended release formulation) and mixing into jam or maybe yoghurt instead?


Whoa! So the very same 225 pills (30 day supply) I just bought for $213.97 would be 11.93 - about $18 - in the UK?

What makes this potentially more obscene is the fact that the price of the same prescription without any discounted insurance is $621.19.

That's about 35x the UK pricing which, as you suggest, is still acceptable from a profit standpoint.

Obviously doggie medicine isn't covered under our "regular" family medical insurance (again, don't get me started on that), but the big pharmacy chain we use (Walgreens - similar in ubiquity to Boots) offer a $25 per year "total" family plan that extends some discounts to include pets.

"Saving" $407.22 every thirty days for a $25 per year outlay seems  reasonable, but if the pills involved should be pennies a time in the first place, well, my gast is totally flabbered.

Were I to rename Annie, I would probably call her Dyson (she's not very selective about what goes into her gob), so I could easily sneak her pills into her regular food without even crushing them.

However, I think she likes the peanut butter ritual and her internal clock has been set so that she comes and "tells" me when it's time for her medicine.

Ripped Off of New Hampshire
Dalek

If you go ahead,you will have to be extremely careful about the mg/kg ratio administered and the difference in method of delivery to ensure that it will be suitable for the canine digestive system. Also, the formulation may not be appropriate.


There is some info available online for generally available drugs.

Sounds a little too risky unless supported by a suitably qualified professional.
Plastic Man

Grind - The price is not quite right, but it gives you a good idea of how cheap it could. The NHS have fixed prices they will reimburse pharmacists for dispensing generic (non-branded) drugs. (It's complicated how the prices are agreed).

For a multitude of reasons I would say that there is some justifcation for animal medicines being a reasonably significantly higher price than human medicines (e.g. very high development costs vs much smaller potential market), but the difference can be ridiculous vs the extra cost involved.

Dalek - Good points for consideration, and well made. From a pharmaceutical point of view, assuming it is an immediate release tablet/capsule (i.e. not sustained release) this would be relatively straightforward compounding.

However, I have no idea about the legalities in the US whether vets can prescribe licenced human drug products to be compounded into animal medicines. And I anticipate that they might unwilling to do so, especially if they were a dispensing practice selling the manufacturer's original products, given the huge loss in revenue.

Grind- Perhaps you could find an altruistic vet (the sort that helps out at pet rescue centres) to provide you with prescriptions, then get them compounded? You'd have to factor in the additional compounding pharmacy fees.
Grind

After help and prompting from you lot, I may have found some possible solutions (well, tablets):

https://www.healthwarehouse.com/levetiracetam-250mg-tablets-6.html

Sticking to the current 250mg and buying in volume, 225 tablets works out to 225/270*$78=$65. Already much betterer!

However, a more cunning strategy might be to get 45x500mg and 45x750mg and use half of each every eight hours to achieve the equivalent 2.5x250mg=625mg dose required (I suspect this dosage might go up at a later date anyway).

This way, the equivalent of 225x250mg tablets would be (assuming 180 tablets of each higher strength tablets were bought at a time):-

45/180x$55.80+45/180x$36.00=$22.95. Get in!

Both examples are before shipping.

Result!

I'm assuming these must be slow release tablets simply because they're intended for maintenance rather than for reactive purposes - i.e. maintaining a given level of the drug in the system.

I'll have a chat with the vet, see what she thinks.

* I'm typing this all out here as much to make a note as anything else! *
Grind

Shipping is supposedly $2, so $93.80 would get me the equivalent of 120 days.

As of now, that would be $855.88 from my friendly local pharmacy.

If I haven't said crikey yet, I probably should.

Crikey!
Grind

Meisie, the dog on the right, cost me $700 (admittedly, nearly 13 years ago), so I could even get another puppy with the money saved! *

* Probably NOT what the Grindstress wants
Grind

Or renew my season ticket.....
Plastic Man

Grind wrote:
I'm assuming these must be slow release tablets simply because they're intended for maintenance rather than for reactive purposes - i.e. maintaining a given level of the drug in the system.


No - it doesn't work like that.

Quote:
I'll have a chat with the vet, see what she thinks.


Best of luck, but your biggest difficulty might be to get a vet to write a prescription to get hold of human medicines for animals. As I've said before, you would need to clarify the legal situation.
Grind

Plastic Man wrote:
Grind wrote:
I'm assuming these must be slow release tablets simply because they're intended for maintenance rather than for reactive purposes - i.e. maintaining a given level of the drug in the system.


No - it doesn't work like that.

Quote:
I'll have a chat with the vet, see what she thinks.


Best of luck, but your biggest difficulty might be to get a vet to write a prescription to get hold of human medicines for animals. As I've said before, you would need to clarify the legal situation.


Just shot her an email - we'll see what she says.

Either way, I probably owe you several (generic) beers.  
Grind

Everything looks good - I just placed the order online and am forwarding the prescription from the vet.

Sadly, Annie had another seizure late last night/early this morning.

Still, at least it was ten days from the previous one (eight days after the one before), so the interval between them does seem to be getting longer.
Grind

So much for that good news then: she had another about half an hour ago.

Very depressing.

I think I'll stop posting on this thread.
Late Doors

Aww man, that's saddening and uplifting at the same time. Funny how some people treat animals so kindly and some so terribly.
Grind

Here she is, taken earlier today.

Grind

And, before anyone asks, that is a whale bone - I found it while diving off of the coast of Dorset many moons ago.

* Hopefully no-one has noticed that he also own a mannequin. *
Late Doors

And a nice Leeds united door mat to wipe your feet on
Grind

Not forgetting the stuffed Leeds United hippo door stop.

* Don't ask. *

** Just don't. **
Grind

Well, the cheapskate "online" pills have just arrived and the price savings described earlier in the thread seem to have happened. Yay!

Many Thanks to Plastic Man in particular for making me even think to question whether I was being ripped off by the local chain pharmacy.

The other good news is that Annie has been seizure-free for over a week now. Long may it continue!
Late Doors

Splendid news
smiling badger

My dog, Ted has little 'fits' as such. Goes a little wobbly and seems a tad confused for a few moments but seems to come around quite quickly.
I once took him to the vets about the issue and all the vet was interested in was getting him scanned.
It seemed to me that i was going to be fleeced of lots of money and then told that Ted would be put on medication for the rest of his days not really knowing if the medication was actually doing any good or not.
He still has the odd fit now and again but im not too concerned at the moment. If it continues more often then i shall go to the vet again.
The same happens to my neighbours dog and they are spending a fair bit on the medication for it but are unsure if it is really helping the dog. To the point where they are thinking of stopping the medication and seeing how it goes.
I really do think that we get ripped off big time by vets. Just given medication too bump up your bill wether its needed or even doing any good.
Grind

I think they do the same with humans too.

She's never been what I would call a healthy dog (a weird thing to say for a dog that's already got to ten!) but hopefully these meds are doing something useful for her.

Let's hope so - she does plenty that's useful for me.

I can completely understand people who choose not to take everything offered to them - my vet was pretty upfront about the benefits of MRIs etc on a dog developing seizures at a relatively advanced age.

She reckoned they could help rule out a couple of the nastier possible causes, but she didn't think they could do anything particularly positive about them even if they were found.

It was her way of saying "Don't bother" without actually saying it, which I certainly appreciated.
Plastic Man

smiling badger wrote:
I really do think that we get ripped off big time by vets. Just given medication too bump up your bill wether its needed or even doing any good.


If your dog does need medicine, then it may be worth asking just for the vet to write a prescription (rather than them supplying the drug) and hawk it around a few pharmacies to see who will do you the best deal.

While opticians are obliged to give you prescription for glasses, and you can then get them dispensed anywhere, I don't know whether vets are similarly obliged to give a prescription.

It probably wouldn't  be worth it for a one-off prescription, but it certainly would be if long-term medication is required.

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