Compounded and Alternative Veterinary Medications

You’ve searched for a medication that may be supplied under the veterinary prescribing cascade. This usually means the treatment isn’t available as a standard licensed veterinary product, or a specific formulation has been prescribed.

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What is a compounded medication?

Compounded medications are specially prepared by a veterinary surgeon, pharmacist, or appropriately authorised manufacturer for use under the veterinary prescribing cascade. They are typically used when:

• No licensed veterinary medicine is available
• A different strength or formulation is required
• A patient cannot tolerate standard products

These medications are prescribed under the veterinary prescribing cascade, which allows vets to use alternative treatments when appropriate.

Common examples include:

• Cisapride
• Gabapentin 25mg and 50mg tablets
• Some transdermal medications, such as methimazole
• Amantadine 25mg, 50mg and 75mg tablets
• Tylosin formulations prepared for specific dosing requirements
• Other specially prepared strengths and formulations

These are unauthorised medicines rather than standard licensed veterinary products. Some veterinary practices may hold stock of commonly used compounded formulations, while others may need to order them from a specialist manufacturer or pharmacy.

Compounded medications are often more expensive than standard authorised medicines because they require specialist preparation and are usually produced in smaller quantities. However, a suitable UK-authorised medicine or alternative formulation may sometimes be available and can be used instead where clinically appropriate. Your prescribing veterinary surgeon will be able to advise whether an authorised alternative is suitable for your pet.

If your pet has been prescribed a compounded medication, your veterinary practice may already hold an appropriate formulation or may need to order it from a specialist authorised manufacturer.

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Special Import Certificate medicines

Some medicines used in veterinary treatment are not authorised in Great Britain and may need to be imported under a Special Import Certificate. This may apply where a veterinary surgeon has determined that there is no suitable authorised veterinary medicine available and use is justified under the veterinary prescribing cascade.

These medicines are different from licensed veterinary medicines that are available through normal UK distribution channels.

Examples may include:

• Sucralfate
• Capromorelin oral solution for dogs (there is a licensed version in the UK for cats - See EluraCat)
• Other imported medicines where no suitable UK authorised alternative is available

The availability of veterinary medicines can change over time. A medicine that previously required importation may later become available as an authorised veterinary medicine in Great Britain.

Due to regulatory requirements, Special Import Certificate medicines must be handled in accordance with the Veterinary Medicines Regulations and the prescribing veterinary surgeon’s responsibilities under the veterinary prescribing cascade.

Owners who have been prescribed an imported medicine should contact their veterinary practice for advice regarding supply arrangements.

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Why can’t some medications be supplied online?

In the UK, compounded medicines and certain imported medicines are subject to specific regulatory requirements.

• Compounded medicines must be prescribed for use under the veterinary prescribing cascade and for an animal under the prescribing veterinary surgeon’s care
• Specialist manufacturers must supply compounded preparations directly to the veterinary surgeon who ordered them, rather than through a third-party retailer or wholesale dealer
• Veterinary practices may hold limited quantities where justified by an immediate clinical need, but this does not make them standard licensed or routinely stocked medicines

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Looking for a different medication?

Some prescriptions may not require compounding and may be supplied as licensed veterinary medicines or alternative authorised formulations where appropriate.

If you are unsure whether a medication is licensed, compounded, or supplied under the veterinary prescribing cascade, speak to your veterinary surgeon for advice specific to your pet.

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This page is provided for general educational information about veterinary medicines and the veterinary prescribing cascade in the UK. Veterinary medicines are regulated under the Veterinary Medicines Regulations and prescription medicines require a valid veterinary prescription.