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For Equine Vets Everywhere

Cascade FAQS

IS IT ILLEGAL TO USE SPECIALS? 

No, specials can be lawfully used under the prescribing cascade. Please see the other resources on this page for guidance on the use of the cascade. 

WHEN IS IT APPROPRIATE TO USE SPECIALS? 

The following table sets out more detail regarding the circumstances in which a special may be preferred: 

Dosage The veterinary surgeon considers that optimal treatment requires a dosage regime that is different from an authorised product’s labelled specifications.
Individual Characteristics Particular characteristics of the patient animal (eg, age, general condition, sensitivity to a particular substance, etc) contra-indicate the use of an authorised product.
Animal Owner Considerations Particular characteristics of the patient animal’s owner mean that an authorised product would not be optimal for treatment (eg, an elderly or disabled owner may have difficulty in crushing and administering tablets, etc).
Chronic Infections A condition persists following treatment with an authorised product.
Complex Conditions The patient animal has multiple conditions (eg, pneumonia with fluid retention) and the veterinary surgeon considers that an extemporaneous preparation is required in order to minimise incompatibilities and side effects.
Unavailability of Product An authorised product cannot be obtained in a reasonable time (eg, one does not exist or supply is interrupted). Please note that the VMD publishes a list of known supply issues online

IS COST A REASONABLE JUSTIFICATION FOR THE USE OF SPECIALS? 

BEVA do not believe that cost is a valid justification for the use of veterinary specials, unless in exceptional cases where animal welfare would otherwise be compromised. It is difficult to predict situations where this may occur and therefore veterinary surgeons  are urged to keep extensive records to justify their decision making in case of future audit. 

WHAT SHOULD I TELL CLIENTS?

Clients should be made aware of the unauthorised status of the product and should be provided with detailed client information leaflets. 

CAN I HOLD SPECIALS IN STOCK? 

Veterinary specials can be held in stock but stock levels should be justified by clinical needs under the cascade, taking into account the shelf-life of the relevant product. 

WHERE SHOULD I OBTAIN SPECIAL MEDICINES? 

Veterinary surgeons should obtain specials only from reputable specials manufacturers that hold a Manufacturing Extemporaneous Products (Specials) Authorisation from the VMD.  Such licensed manufacturers are required to comply with the principles of Good Manufacturing Practice (GMP).  Specials should be ordered directly from the manufacturer and not via a third party or wholesaler. It is important to note specials are not available for sale except through veterinary surgeons; they cannot be dispensed against a prescription by a client.

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