Practitioner Updates

Pharmacist’s Corner: Pentobarbital Problems

What happens when all pentobarbital products go on backorder? That’s what a lot of us found ourselves asking a couple months ago.

A raw ingredient shortage from the end of 2020 led to backorders on all marketed pentobarbital products by May. However, we can’t elect to delay euthanasia until a commercial product becomes available again. Therefore, we need to have a backup plan in place when our first line agent is unavailable.

Thankfully, the shortage seems to be resolving and pentobarbital products are becoming available again. However, this is the second time in five years where there have been supply issues, so it is worthwhile to have a plan in place for if/ when this happens again.

General Tips for Backorders

  • Put items on backorder to reserve your spot in line. Keep in mind that you will want to check and make sure backorders are still active from time to time. Different companies have different policies for how long they keep backorders active, but legally, CII orders expire 60 days after they are placed.
  • Use only the amount of medication needed and consider combining medications to decrease the amount needed.
  • Check alternative sources and have controlled substance ordering setup with multiple companies. When controlled substances go on backorder, your ability to pivot sources quickly can be beneficial to securing a much-needed vial of medication. Because ordering controlled substances involves additional paperwork, it’s a good idea to get this in place before you need to utilize the company.

Pentobarbital-Specific Tips

  • Determine a backup plan before it’s needed. Consult the AVMA Guidelines for Euthanasia of Animals: 2020 Edition for an overview of what is considered acceptable for different species.
  • Think through all aspects of the alternative plan and create a clear standard operating procedure (SOP) that can be used by all doctors in a practice. While it is often assumed that euthanizing a patient with pentobarbital doesn’t require prescriptive directions to be developed, veterinarians are often much less familiar with alternative methods, so a clear process specifically addressing concerns in your practice is important.

An Example

According to AVMA, KCl is an acceptable alternative when pentobarbital is not available. However, it requires that the animal be under a surgical plane of anesthesia prior to administration. An SOP for this should address the following points:

  • What is a possible anesthesia protocol prior to administration?
  • Which product will be used? The commercially available injectable solution may not be concentrated enough. If that’s the case, will a more concentrated solution be compounded in house?
  • What dose/volume of solution should be prepared for administration?
  • If a client is present, are any additional warnings needed?

Hopefully this particular backorder issue is behind us. However, backorders seem to be becoming more frequent and more significant, so it’s prudent to learn from close calls and have a plan in case the issue arises again.

This month’s column is from Lauren Forsythe, PharmD, DICVP, FSVHP.