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By Linda Bren
"Discount pet drugs—no prescription required."
This message, and others like it touted by many Internet sites, may sound appealing to pet owners, but the Food and Drug Administration says buying drugs online from such sites can be risky.
Some of the Internet sites that sell pet drugs represent legitimate, reputable pharmacies, says Martine Hartogensis, D.V.M., promotion and advertising liaison for the FDA's Center for Veterinary Medicine (CVM). But others are fronts for unscrupulous businesses operating in violation of the law.
"Some of these Internet companies are overseas, and there is a risk of the drugs not being FDA-approved," says Hartogensis. The FDA has also found companies that sell counterfeit pet products, make fraudulent claims, dispense prescription drugs without requiring a prescription, and sell pet drugs that have expired.
Pet owners who purchase drugs from these companies may think they are saving money, says Hartogensis, but in reality they may be short-changing their pet's health and putting its life at risk.
The FDA's CVM regulates the manufacture and distribution of animal drugs, while individual state pharmacy boards regulate the dispensing of prescription veterinary products.
Some foreign Internet pharmacies are advertising that veterinary prescription drugs are available to U.S. citizens without requiring a prescription. Or a foreign or domestic pharmacy will claim that one of its veterinarians on staff will "evaluate" the pet after looking over a form filled out by the pet owner, and then prescribe the drug.
A veterinarian can make a diagnosis and determine the appropriate therapy for an animal only by physically examining it, says Hartogensis. Prescribing sight unseen and without follow-up monitoring "is not a valid veterinarian-client-patient relationship."
The FDA's CVM is especially concerned that pet owners are looking to the Internet to buy two types of commonly used prescription veterinary drugs—nonsteroidal anti-inflammatory drugs (NSAIDs) and heartworm preventives. "Both drugs can be dangerous if there is no professional involvement," says Hartogensis. "It's not a concern if the owner uses a legitimate online pharmacy and mails in a prescription from their veterinarian, who is monitoring the animal," she says. "But if there is no veterinarian–client–patient relationship, it's a dangerous practice."
NSAIDs are often prescribed for pain relief in dogs with degenerative joint disease (osteoarthritis) or with pain after surgery. As recommended on NSAID labeling, dogs should undergo blood testing and a thorough physical examination before starting NSAIDs and should be monitored during NSAID therapy. In addition, each NSAID prescription should be accompanied by a Client Information Sheet that explains important safety information to the dog owner.
Heartworm disease is a potentially fatal condition transmitted by the bite of a mosquito that is carrying the larvae (infective stage) of the heartworm parasite. "It only takes one infected mosquito to transmit heartworm disease," says Sheldon Rubin, D.V.M., secretary of the American Heartworm Society (AHS) and veterinarian in private practice in Chicago. The larvae enter the bite wound and migrate through the tissue of the animal, where they grow into adult worms that live in the arteries of the lungs and in the right side of the heart. Dogs, cats, ferrets, and some other mammals can get heartworm.
Heartworm preventives, administered daily or monthly depending on the product, kill the larvae before they become adult worms.
All 50 states have reported heartworm disease, says the AHS, which recommends using heartworm medication for dogs year-round, nationwide, and getting dogs tested yearly to make sure they're not infected with heartworm.
"Testing is important even in dogs regularly treated with heartworm preventive products due to the occasional reports of product ineffectiveness," says Hartogensis. If the animal is infected, a yearly test can ensure an early diagnosis and maximum benefit from treatment.
An Internet pharmacy veterinarian, of course, cannot perform the heartworm test because it requires drawing blood from the animal. If the test isn't done, a pet owner could be giving heartworm preventives to a dog that has heartworms, leading to severe reactions.
"The manufacturers of heartworm medicine do not sell to Internet pharmacies unless they are owned by a veterinarian and have a pharmacy license," says Rubin. "There is no better source for heartworm preventive than your own veterinarian. It's fresh, it came directly from the manufacturer, and it's 100 percent supported." This means if a dog or cat is on heartworm preventive and gets heartworm disease, the manufacturer works with the veterinarian, says Rubin, which significantly reduces the cost to the client. If you purchase preventives on the Internet without having your pet seen by your veterinarian, "nobody stands behind them—the veterinarian doesn't, the manufacturer doesn't."
Cats are at risk for developing heartworm disease, too, says Hartogensis. "Even one heartworm can kill a cat." Testing for heartworm infection in cats is more complex and not as accurate as the test for dogs. The AHS does not recommend yearly testing of cats, but does suggest testing prior to starting a preventive to establish a baseline reference. If heartworms are found in dogs in the area and mosquitoes get into the house, cat owners should consider putting their cat on a heartworm preventive, says the AHS. Your veterinarian will know the risk in your area and can guide you on whether a preventive is indicated.
The FDA recommends making sure a Web site is a state-licensed pharmacy within the United States before buying online. Consumers should check with their state board of pharmacy or the National Association of Boards of Pharmacy (NABP) to see whether an online pharmacy has a valid pharmacy license and meets state quality standards.
The NABP has established a voluntary certification program called Verified Internet Pharmacy Practice Sites (VIPPS). The NABP certifies online pharmacies that comply with state licensing and inspection requirements, along with other criteria.
Only pharmacies that sell human drugs are VIPPS-certified at this time. The NABP and the American Association of Veterinary State Boards (AAVSB) are considering expansion of the VIPPS program to accredit veterinary pharmacy practices.
Some veterinary hospitals have valid relationships with state-licensed Internet pharmacies known as outsourced prescription management services. These pharmacies usually stock more medications than the veterinary hospital is able to do, and they work directly with the veterinarian, require a prescription be written by the veterinarian, and are supportive of the veterinarian-client-patient relationship.
This article has been condensed from the original article as it appears in FDA Consumer magazine and edited for the FDA Web site. The print version of FDA Consumer is available by subscription.