The veterinary prescribing cascade (part 2): Small Animal
Welcome to the Bova UK Podcast, where we explore diseases and treatment protocols from diagnosis through to management. In today’s episode, we’re focusing on the veterinary prescribing cascade in small animals—a vital tool that helps veterinary surgeons prescribe the most suitable medications when no authorised option is available. Joining me is Dr Mark Bowen, who will walk us through recent post-Brexit updates and real-life prescribing scenarios in small animal practice.
Overview
By Dr. Mark Bowen BVetMed MMedSci(MedEd) Ph.D. Cert VA Cert EM(IntMed) Dip ECVSMR Dip ACVIMLAIM PFHEA FRCVS.
What this episode includes:
- Understanding the Veterinary Prescribing Cascade in Small Animals
- Step-by-Step Guide to the Cascade for Small Animal Practice
- Case Examples: Applying the Cascade in Small Animal Medicine
- Common Pitfalls in Cascade Prescribing for Small Animals
- Ensuring Compliance When Prescribing Unauthorised Medicines
If you wish to contact Bova UK please email us at office@bova.co.uk
Transcripts
The veterinary prescribing cascade (part 2): Small Animal
Host
Welcome to the Bova UK Podcast, where we discuss diseases from diagnosis through to management. These podcasts are aimed at registered veterinary surgeons and veterinary nurses. If you’re listening as a pet owner, we always advise that if you have any concerns about your animal, please consult your local veterinary surgeon.
Today, we’re demystifying the veterinary prescribing cascade and exploring how it allows veterinary surgeons to prescribe medicines that ensure the best outcomes for their patients. I’m joined by Mark Bowen.
Emma
Mark is an RCVS Specialist in Equine Internal Medicine. He spent 25 years in UK academia, was a founding member of Nottingham Vet School, and now works in specialist postgraduate education across Europe. He is also Director of Education for EBVS and VetCEE, and runs a specialist consultancy in the Midlands. Mark has in-depth experience of the veterinary medicines regulations, contributed to BEVA’s Protect Me toolkit, is a member of both BEVA and FVE’s medicines committees, and serves on the VMD’s Veterinary Products Committee.
Emma
Thanks for being here, Mark. Could you start by summarising the steps of the cascade as they currently stand?
Mark
Certainly. The cascade changed after Brexit, so it’s worth recapping. The cascade applies when there’s no suitable authorised medicine for the target species and condition.
- First, consider another veterinary medicine authorised in another species or for another condition.
- Second, consider UK human medicines or authorised veterinary medicines from another country (note: importing human medicines from outside the UK is not allowed).
- Third, consider specially prepared veterinary medicines (“specials”). These should ideally be from a specialist manufacturer to ensure quality.
- There is one step outside the cascade—in exceptional cases, you can apply for a special import certificate for a human medicine for a named animal.
Emma
Let’s make it more practical. Can you give an example?
Mark
Take a vomiting dog needing a proton pump inhibitor. There are no authorised products for dogs. You might consider equine omeprazole paste, but the syringe is designed for horses and the dosing isn’t safe or accurate for dogs—so it’s not suitable. The next step would be a UK human product. However, omeprazole capsules are enteric-coated and splitting them ruins the effect. In hospitalised dogs, IV formulations are fine, but for outpatients, I might opt for a special.
Emma
Are there other common examples where suitability is a concern?
Mark
Paracetamol is another. The authorised formulation includes codeine, which isn’t ideal. There is a porcine product in 5L drums, but it’s impractical. Human paediatric paracetamol often contains xylitol and poses risks. Also, using recognisable human brands can promote self-prescribing by owners. A flavoured special is often better.
Emma
Speaking of cats, what about palatability and compliance?
Mark
If an owner can’t medicate their pet, the product isn’t suitable. Human tablet sizes are often inappropriate for cats or small dogs. Specials come in flavoured or novel formulations, like transdermals, and improve compliance. Better compliance means better outcomes.
Emma
And antimicrobials?
Mark
Antimicrobial stewardship is a priority. Using a special to improve compliance is justified if it helps complete the course or avoid critical antibiotics. For example, doxycycline: the hydrochloride salt causes oesophagitis in cats. Doxycycline monohydrate is less risky and can be compounded into palatable, safe formulations.
Emma
How do you justify going straight to a special?
Mark
It’s about suitability. Follow the cascade: is there an authorised product? Is it suitable? Human or imported vet product? Again, is it suitable? Specials can be justified when others aren’t practical or safe. Don’t write blanket protocols. Instead, use a decision tree for each patient.
Emma
What about consent?
Mark
We need informed consent. The RCVS expects a signed form, especially when using unauthorised medicines. Your PMS can generate one, or use the VDS template. The VMD also expects clients to receive the equivalent of a package insert. BSAVA’s Client Information Leaflets are great for this—they include handling, storage, and side effects info.
Emma
And your take-home message?
Mark
You’re doing this for the benefit of the animal in front of you. The cascade is there to support your decision-making, not punish you. As long as you work through the steps and consider suitability, your decisions are valid, even if others would choose differently.
Emma
Thank you, Mark. That’s a brilliant summary and very reassuring for vets trying to navigate cascade use compliantly in practice.
