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For Equine Vets Everywhere

Veterinary Medicines and the Cascade 

an essential part of equine practice in the UK

The prescribing cascade is an essential part of equine practice in the UK. It applies some basic prinicples that allow veterinary surgeons to treat animals using drugs not licensed for that condition in that species. The below resources aims to support veterinary surgeons using the cascade.

Interactive flowchart to consider appropriate decision making for use of the cascade in equine clinical practice

Guidance on the cascade



Obtaining informed consent for the use of medicines under the cascade

Informed consent should be obtained whenever medicines are used under the cascade. While consent can be given orally, members are encouraged to obtain signed consent for the use of these medicines. Extemporaneous clinical notes can be made to record how clients have been informed and how consent was obtained. Client information leaflets form an important basis of informing clients about the use and adverse events that may be seen with medicines used under the cascade. 

If you are part of the RCVS Practice Standards Scheme, assessors will expect to see completed written consent forms 


Special considerations for the responsible use of antibiotics under the cascade

The VMD have special guidance relating to the use of antibiotics under the cascade that mean it is justified to prescribe an antibiotic on the cascade in the interests of minimising the development of resistance to ensure the most appropriate antibiotics are used. 

Further details are encapsulated in BEVA's responsible use PROTECTME toolkit

Guidance on the cascade