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For Equine Vets Everywhere

Veterinary Medicines and the cascade

The prescribing cascade & "specials"

The cascade empowers veterinary surgeons to prescribe medications other than authorised medications (including those commonly referred to as "specials") in certain circumstances and in the interest of animal welfare. 

The manufacture and use of specials is regulated by the The Veterinary Medicines Regulations 2013.

Decision making flowchart

Use our simple, interactive flowchart to consider the appropriate decision making for us of the cascade in equine clinical practice. 

Obtaining consent, client information and labels

When using the cascade there is an expectation that key information relevant to the species being treated is included, providing the information that would be included in the package insert were it licensed for use in that species. Such documents will also form the basis of informed client consent, a requirement of the RCVS code of professional conduct.

View resources


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.

BEVA's view of specials

BEVA believes that 'Specials' have a limited but important role in the treatment of the horse given the limited availability of licensed medicines and the challenges of formulation when using either animal or human medical products. 

We believe veterinary surgeons should only make use of specials only where no suitable product exists using the principles of the Cascade, or in exceptional cases where the supply of licensed products is interrupted. 

Veterinary specials should not be used where a veterinary medicine licensed for use in horses or food animal species is available containing the same active substance unless the available route of administration is inappropriate in a specific animal.

In some cases, veterinary specials may be appropriate where human or veterinary medicines licensed for use in small animal are available, but their strength or formulation is inappropriate for use in specific cases.

Veterinary specials should be ordered directly from the manufacturer and not via a third party or wholesaler. Clients should be made aware that such products cannot be obtained from online veterinary pharmacies.

Clients should be made aware of the unauthorised status of the product and should be provided with detailed client information leaflets that detail potential adverse events as well as details about the limitations of veterinary specials. Examples are included on these pages.

Veterinary surgeons should ensure that they obtain specials from a reputable specials manufacturer that holds a Manufacturing Extemporaneous Products (Specials) Authorisation from the VMD and is compliant with principles of GMP