If you have an epileptic patient that runs out of medication over the weekend, or your clinic is out of a particular seizure medication, here are medications that can be found at human retail pharmacies and some tips on prescribing them.
Levetiracetam. Retail pharmacies should carry both immediate-release (IR) and extended-release (ER) tablets, as well as the oral liquid formulation. Be aware that IR levetiracetam is usually dosed twice daily in humans and ER once daily, so be prepared to receive a call from the pharmacist to verify the frequency.
Phenobarbital. Retail pharmacies may carry more strengths of phenobarbital than are typically used in veterinary medicine. This is because phenobarbital was originally prescribed in grains (a unit of measurement in the apothecary system), which is variously rounded to 60 mg, 64.8 mg, or 65 mg. Be sure to write “dispense as written” to indicate that you want the exact strength you’ve written. Phenobarbital is a Schedule IV controlled substance, so a prescription is good for 6 months and up to 5 refills are allowed for a one-month supply.
Clorazepate. Clorazepate should be available at retail pharmacies. It is a Schedule IV controlled substance, so a prescription is good for 6 months and up to 5 refills are allowed for a one-month supply.
Midazolam/Diazepam. Midazolam intranasal seizure kits and diazepam rectal seizure kits are usually made using the injectable formulations of these drugs. These will not be available at a retail pharmacy. Be sure to advise your clients to refill their kits before they have run out.
By Lauralei Fisher-Cronkhite, PharmD, DICVP, FSVHP
