THE PCCA BLOG

Cats with No Pants: Feline Atopic Skin Syndrome

Wed, 13 Sep 2023 13:45:51 GMT

by Deborah H. Clark, RPh, PCCA Clinical Compounding Pharmacist

Canine atopic dermatitis, or allergic skin disease, is one of the main reasons dog owners visit their veterinary (vet) clinic.¹ Much less is known about allergic skin disease in feline patients.

Compared to human patients with eczema or canine patients with atopic dermatitis, cats typically present varying clinical signs. Testing cats for serum allergen-specific immunoglobulin E (IgE) does not always indicate IgE prominence; skin barrier function in cats is not well known and even clinical signs can vary from cat to cat and from year to year.

Feline FASS

Feline atopic skin syndrome (FASS) is a subclassification of a broader condition: feline atopic syndrome (FAS). FAS contains a spectrum of hypersensitivity disorders with various presentations that may affect the skin, gastrointestinal and respiratory tracts.² FAS affects 12% of cats, usually within the first three years of life; 22% of these cats may exhibit onset of signs after age seven.³

FASS involves inflammatory reactions that are like those seen in canine patients. T cells are involved as well. The most commonly affected areas in FASS cats are the head and the ventral area (the belly or chest). In 70%, allergen specific IgE was detected, suggesting involvement of an allergic component; 50% of FASS cases have no secondary bacterial infection.

Secondary bacterial infections in these cats may be challenging for a vet to diagnose because they present very differently from dogs and humans. In many cases, the presenting signs are so close to those of other allergic types that a secondary bacterial infection may get overlooked. Adding to the complexities, fungal dysbiosis with Malassezia can also be present.

Clinical Signs

Regardless of the cause of the allergy — be it fleas, other parasites, food or environment — FASS cats may present a variety of reaction patterns. For example, FASS can present allergic rhinitis, asthma or conjunctivitis; in some cases, all three. Cutaneous signs can include head and neck pruritus, self-induced hair loss or “fur-mowing.” Fur-mowing can involve the entire ventrum down through the inside of the legs, giving the appearance of “cats with no pants.”

Other cutaneous signs include eosinophilic granuloma complexes and miliary dermatitis (eosinophilic papulocrustous dermatitis). Some FASS cats exhibit indolent ulcers around the mouth, while others may show granulomas inside the mouth or within the throat. As stated earlier, these signs can occur alone or in combination, can change from season to season or simply appear as signs worsen.²

Once other conditions are ruled out and diet or environmental modifications tried and failed, medical therapy is normally instituted to gain control of the condition. After clinical signs are controlled, the vet may offer the option to conduct allergy testing and institute allergen-specific immunotherapy. Some cat owners, however, are not willing to commit to this.

Medical Therapy

Cyclosporin is the only FDA-approved medication for the treatment of FASS. Cyclosporin is dosed at 7 mg/kg PO every 24 hours for 4-6 weeks or until resolution of clinical signs. Once achieved, medication is typically tapered to the lowest effective dosage due to the increased risk of developing diabetes mellitus (DM) and gingival hyperplasia.⁴

A manufactured product, Atopica®, is available for cats and, per the FDA’s Guidance for Industry (GFI) #256, must be considered first by a vet. The vet may choose a compounded formula if they have a valid reason that Atopica cannot be used in the individual feline patient. Fixed oil suspensions with this API are not recommended.

Antihistamines may be given as a treatment adjunct due to their steroid sparing effect but have limited efficacy.² Corticosteroids, such as prednisolone, may also be administered.

When cats cannot be pilled, prednisolone oral solution or suspension is an option. Several manufactured human oral solutions and suspensions exist and, per GFI #256, must be considered before compounded preparations. However, some of these products contain alcohol — which is toxic to cats — while others contain flavoring that a cat may reject.

Another potential issue is the high-volume dosing required with commercial medications, which many cat owners find impractical and/or impossible to administer.

Remember to also look at excipients for species toxicities when considering manufactured drug products as a therapeutic option.

PCCA members with clinical services access may contact our Clinical Services team for help with compounding for FASS patients and other compounding concerns.

A version of this article originally appeared entirely in PCCA’s members-only magazine, the Apothagram.

References

Apostolopoulos, N. Miller, C. (Published online April 14, 2023; Issue May/June 2023) The Canine Skin and Ear Bacterial Microbiota. Today’s Veterinary Practice. Accessed May 2023 at https://todaysveterinarypractice.com/dermatology/the-canine-skin-and-ear-bacterial-microbiota/
Griffin, J. (2023) Pruritic and Purring: How Feline Allergy Differs From The Dog. Fetch DVM360 Conference
Bajwa J. (2018). Atopic dermatitis in cats. Can Veterinary J. 59(3), 311–313. Accessed April 2023 at https://pubmed.ncbi.nlm.nih.gov/29599562/
Plumb’s Veterinary Drugs Online. Accessed May 2023 at https://plumbs.com/

5 Crucial Insights I Discovered from Compounding for Zoos

Wed, 08 Jul 2020 14:51:12 GMT

By Mark Gonzalez, PharmD, PCCA Clinical Compounding Pharmacist

Recently, I read that the United States Department of Agriculture has licensed approximately 2,400 zoos or “animal exhibitors.” These can include general zoos, aquariums, safari theme parks, nature centers and aviaries. Most of the larger and more well-known facilities are members of the AZA (Association of Zoos and Aquariums) which has licensed 240 facilities around the world (217 in the U.S. alone), and these facilities care for approximately 800,000 animals belonging to 6,000 species. When you see the immensity of those numbers, you may be asking yourself, “Why am I not providing custom medication options for those facilities?”

From personal experience, I can share that I was very intimidated by the thought of marketing to practitioners that have reached the top of their professional games. My pharmacy was located in Southern California, and within a 90-minute driving radius, I had four world-renowned zoological facilities: the Sea World Aquarium, the San Diego Zoo, the San Diego Wild Animal Park and the Los Angeles Zoo. As a new startup pharmacy in 1999 filling just a handful of prescriptions my first year, I thought, “Why would any of these powerhouses want to do business with me?” After marketing to them for two years, I was able to get in, build relationships and serve them consistently for the remaining 17 years that I owned my pharmacy. Here is what I learned through the process, and I hope it helps tear down the walls of intimidation that you may have regarding this subspecialty of veterinary compounding.

1. Zoo veterinarians are some of the nicest practitioners you will work with.

I thought it would have been the opposite. I honestly expected this elite group of veterinarians to be rather pretentious, but I was wrong. Zoo vets love their job, the challenges that it brings and the patients they work with. Because of this love for their patients, and ultimately the responsibility of taking care of rare, endangered and often very expensive patients, they need to have a relationship with a compounding pharmacist who will help them meet their patient-specific needs.

2. Even if a zoo has a relationship with another compounding pharmacy, they still may want a relationship with you.

Do not be intimidated by other colleagues that may have marketed before you. Most zoos have relationships with multiple pharmacies. Each pharmacy may have a few specialties that set them apart. That does not mean that you should not be included in that list. Market your services no matter where you are located and what your current volume may be. You might just fill a void that other pharmacies never identified.

3. Zoo veterinarians are not interested in how big your pharmacy is. They just want trust and fast response time.

Trust is a given for any relationship to work, but especially when providing patient care services. Trust is built by being honest and providing these special patients with unique and viable options. And it’s OK if you don’t always have the right answer at the tip of your tongue as long as you research the right answers (which also builds trust).

Response time is crucial when you are dealing with large groups of animals in urgent situations. I was called by a local aquarium to formulate a phenobarbital injection (which was on backorder at the time) when there was an algae bloom that resulted in the release of domoic acid, a neurotoxin for dolphins. The aquarium needed the compound ASAP, or many of the dolphins they were working with would die. Our quick response time built our reputation due to an increase in trust between the aquarium and our staff. That moment solidified our relationship for years to come. This demonstrates that it is not the size of the pharmacy that matters; it is your ability to come by their side at a moment's notice that really counts.

4. Zoos require and crave creativity.

“How do you make a wound-care gel for an eight-ton elephant?” “What can you do to help us medicate 200 penguins with an anti-malarial every other day?” “I have a walrus with 10-inch nostrils that needs a nasal spray for a fungal infection. Can you help?” These are all real questions that local zoos posed to me. As compounders, we take pride in our creativity, and zoo/aquarium compounding allows us to put that skill to practice. Do not be afraid to think outside the box.

5. Relationships with zoo trainers and lab staff are just as important as the ones you build with veterinarians.

The trainers are actually the ones working with the animals. Most vets are not even allowed to work on an animal without the trainer. The lab staff are usually the ones placing orders and checking stock on compounded agents for the zoo. Do not disregard these crucial members of the team.

I hope that these insights and tips are as helpful for you as they were for me. Zoo compounding was one of the most exciting and fulfilling parts of my practice. Step into this marketplace, and you will remember why you entered into compounding in the first place.

Mark Gonzalez, PharmD, is a Clinical Compounding Pharmacist at PCCA. He owned and operated Med Specialties, a pharmacy in Yorba Linda, California, for 18 years before joining the staff of PCCA. His areas of specialty are hormone replacement therapy, dermatology and veterinary compounding.

Flavoring Options for Veterinary Compounding

Wed, 27 May 2020 12:45:43 GMT

By Fabiana Banov, RPh, MS, PCCA Senior Formulation Pharmacist

PCCA has different ways to help compounders when they need to flavor a formulation with an active ingredient that does not taste very appealing for an animal. It can be an oral paste for a cat, a treat for a dog or a suspension for a ferret. We carry different liquid and powder flavors that can potentially make that preparation a success. In this blog post, I provide a list of all the PCCA flavors that are indicated for veterinary use along with optional sweeteners and some information on new flavors that we now offer. I will also cover the oral bases compounders can use that will help to incorporate the substances better and will improve the way they provide medication to their furry patients.

Oil-Soluble Liquid Flavors for Animals

Recommended Concentration: 0.5 – 1% (Maximum 3%)

Beef Grilled, Natural (PCCA #30-4786)
Chicken Grilled, Natural (PCCA #30-4757)
Fish, Artificial (PCCA #30-3839)
Liver, Artificial (PCCA #30-3840)

Water-Soluble Liquid Flavors for Animals

Recommended Concentration: 1 – 5%

Beef, Natural (PCCA #30-3866)
Liver (PCCA #30-2905)

Water-Soluble Powder Flavors for Animals

Recommended Concentration: 1 – 6%

Alfalfa (PCCA #30-3745)
Apple (PCCA #30-2896)
Beef-Ade (PCCA #30-3788)
Cherry-Ade (PCCA #30-3451)
Chicken Broth (PCCA #30-3646)
Pork Liver (New) (PCCA #30-5060)
Molasses-Ade (PCCA #30-3448)
Tuna, Artificial (PCCA #30-3239)

Sweeteners for Animals

Sweeteners are the foundation for many flavors, and a combination of them will provide a better final formulation. Below is the list of sweeteners that you can use in a veterinary compounding formula.

PCCA Product Number	PCCA Product Title	Concentration
30-4398	Acesulfame Potassium FCC	0.1 – 0.5%
30-2628	Magnasweet 110® (Liquid)	0.2 – 1%
30-2629	Magnasweet 135® (Powdered)	0.1 – 0.5%
30-4539	Steviol Glycosides 95%	0.1 – 0.6%
30-4432	Stevioside 15%	1 – 4%
30-4948	Dry Powersweet	0.1 – 1%

New Flavors for Animals

PCCA now carries some new liver flavors. One of them is Pork Liver Powder (listed above). This flavor is replacing the Liver Powder (Porcine) that we used to carry. The new powder flavor contains a strong liver taste that will be beneficial in oral veterinary formulas. We also have a new flavored base, PCCA Animal Treat – Liver^™ (listed below), which is replacing the old Animal Treat – Liver base. The new product has an improved taste.

PCCA Animal Treat Base

These powder bases provide solid treats for animals. They come in three different flavors and a flavorless version. The treats are very easy to make, do not require heat and are ready to use.

Animal Treat – Chicken^™ (PCCA #30-3244)
Animal Treat – Fish^™ (PCCA #30-3245)
Animal Treat – Flavorless^™ (PCCA #30-3446)
Animal Treat – Liver^™ (PCCA #30-5065)

Liquid and powder flavors can be added to PCCA’s animal treat bases. Our animal treat general formulas show the process of formulating the animal treats. PCCA has different general formulas based on the type and size of mold used, the flavor of animal treat base (chicken, fish, flavorless, liver) and the type of any additional flavor you may add (oil, aqueous, powder). This will provide all the information that compounders need to start working with these bases. To be able to medicate all different sizes of animals, there are three different types of molds that compounders can use with the animal treat formulations.

PCCA Product Number	PCCA Product Title	Calibration
35-2410	Animal Treat Mold	1.12 Gm
35-2489	Rectangular Blister Packs (Amber)	4.2 Gm
35-2512	Round Blister Packs (Amber)	1.35 Gm

PCCA Fixed Oil Suspension Vehicle

Our Fixed Oil Suspension Vehicle is a great choice as a base for veterinary compounding, especially for cats, dogs and ferrets. These animals generally like the taste of oils, and the almond oil used in the base is neutral tasting, so it is palatable for many species. This product is a premade form of the highly used and frequently recommended fixed oil oral suspension formula, so it eliminates the need to make the base yourself. You can just add your active ingredient, sweetener and flavor (the flavor must be oil-soluble or miscible in oil).

For drugs that are known to be unstable in water, or if the aqueous stability is unknown, it is common to prepare an oral suspending vehicle that is oil-based (anhydrous), when appropriate for the patient. Oil bases also can help coat drug particles in suspension, thus making bad-tasting drugs more palatable. The current USP Chapter <795> also allows for a 180-day beyond-use date for non-aqueous liquids such as our Fixed Oil Suspension Vehicle. Therefore, unless there is stability data that states otherwise, this base allows pharmacists to use beyond-use dating that is great for them and their veterinary patients.

PCCA members with Clinical Services access can view our fixed oil oral suspension general formula as a guide for how to use this base with active ingredients.

PCCA SuspendIt^®

SuspendIt is another versatile option for veterinary compounding. It is an all-in-one oral suspension base that has patented anti-sedimentation technology. It uses a natural suspending agent and has a synergistic polymer complex that provides for a unique thixotropic flow — meaning that it thins as it is shaken and thickens upon standing. This allows for rapid redispersion of active ingredients with agitation and minimizes sedimentation.

SuspendIt is also the only compounding suspension base made with an all-natural sweetener derived from monk fruit. You can use oil- or water-soluble flavors in it, but if you use an oil-soluble flavor, you’ll need to add polysorbate 20 to emulsify the flavor into SuspendIt. Use a 1:1 ratio of polysorbate and the flavor in the formulation.

Please note, however, that SuspendIt contains sodium benzoate, a potential toxin for felines when chronically ingested, so use in cats should be limited to two weeks.

If veterinary compounding is an area that your pharmacy is starting to work in or is already part of your daily routine, PCCA is here to help you to succeed with your furry patients. Veterinary medicine is an area that PCCA has been dedicated to for more than 35 years, and we are always improving and adding new ways to help owners medicate their pets. We have a long list of formulas that we’ve tested in the lab. In addition, we have the new digital PCCA Flavor Guide, which lists the most recent findings in how to flavor a compounded medicine. PCCA members with Clinical Services access can view our formulas and the new flavoring guide on our website. They can also call us at any time for patient- and formulation-specific questions at 800.331.2498.

Fabiana Banov, RPh, MS, PCCA Senior Formulation Pharmacist and flavors expert, earned her pharmacy degree from the College of Pharmaceutical Science of the University of Mogi das Cruzes in Brazil. She also obtained specialization in cosmetic science from São Paulo State University and completed post-graduate work in the technology of cosmetic products from Osvaldo Cruz College. Prior to joining the PCCA team, Fabiana was the owner of Fórmula Médica Compounding Pharmacy in São Paulo, where she was instrumental in the development of unique cosmetic products. She is also the author of Pharmaceutical Veterinary Formulary.

This article originally appeared in two parts in PCCA’s members-only magazine, the Apothagram.

New Episodes Added to The Mortar & Pestle: A PCCA Podcast — June 2019

Wed, 26 Jun 2019 13:26:38 GMT

by PCCA

The Mortar & Pestle is a podcast for the pharmacy compounding world. Whether you are a pharmacy owner, staff pharmacist, technician, marketer or patient using personalized medicine, this is a home for you. Co-hosts Mike De Lisio and Sebastian Denison, RPh, along with a guest list of the industry’s most influential leaders, explore a cross-section of topics impacting today’s compounders.

This is your front-row seat to conversations with pharmacists at the forefront of science and medicine; experts in the fields business, marketing and entrepreneurship; and visionary leaders who share the belief that custom medicine is the future.

New Podcast Episodes for June 2019

Episode 20: Autoimmune Disorders and Compounding with Sara Hover
Sara Hover, RPh, FAARM, PCCA Clinical Compounding Pharmacist, joins Mike and Sebastian to discuss the world of autoimmune disorders and how Sara thinks compounding may be able to help patients with them. She also goes over a few conditions she’s heard about from pharmacies around the world and what she has done to help patients through compounding.

Listen to Episode 20

Episode 19: Compounding for the Veterinary World with Deborah Clark
Deborah Clark, BSPharm, RPh, PCCA Clinical Compounding Pharmacist, joins Mike and Sebastian to discuss customized medicine for veterinary needs. In addition to interesting compounding options, Deborah also shares marketing ideas she’s seen and used.

Listen to Episode 19

In Case You Missed It
Listen to our 18th episode with Gus Bassani, PharmD, Chief Scientific Officer of PCCA, where he tells the story of how he started his compounding career at a pharmacy in Alaska. Gus, Mike and Sebastian also discuss the value that the FormulaPlus™ database brings to PCCA members and how Gus leads his team with the goal of innovating everywhere. Listen here.

Lipoderm®: Still the Standard in Topical Pain Management Compounding

Mon, 18 Mar 2019 16:38:10 GMT

This article was updated October, 29, 2020

In 2018, we introduced the pharmacy compounding world to PermE8^® Anhydrous Gel, a new permeation-enhancing topical base that holds a lot of potential for compounding pharmacies and their patients. While PermE8 delivers active pharmaceutical ingredients very well, and provides prolonged beyond-use dates by default, the experts in our Clinical Services and Formulation Development departments still recommend Lipoderm as a first choice for customized permeation-enhancing medications. Here’s why.

Incomparable Support

Lipoderm has provided important options for many patients over the years as the premier base used in deep-penetrating topical compounds for local absorption or systemic absorption. It is scientifically proven to deliver active ingredients through the skin, even up to four at one time. It is also supported by a significant portfolio of peer-reviewed publications. In fact, it has been included in over 30 journal articles. Most recently, the United States Pharmacopeial Convention included Lipoderm in an official USP compounded preparation monograph, “Ondansetron Compounded Topical Gel (20 mg/mL).”

Don’t Forget the Pets

Many compounders are familiar with Lipoderm for human use, but some don’t know that it has also been third-party tested for feline use , and that it is safe for topical use in dogs, cats and horses as well as certain exotic species. This means it provides options that can be easier for a pet owner to apply to the patient than administering pills or liquids.

Numerous Formulas

We have developed over 150 formulas with Lipoderm, including many for veterinary use. We have studied over 20 of those in our FormulaPlus ^™ program, and they have extended beyond-use dates backed by stability-indicating methods. Four of those are bracketed studies, offering compounders extended beyond-use dates in a range of active pharmaceutical ingredient concentrations. These FormulaPlus beyond-use date studies can save compounders thousands of dollars in stability testing because we’ve already taken care of it. PCCA members with Clinical Services access can find all of our Lipoderm formulas , including those with extended beyond-use dates, in the PCCA formula database.

Meet the Family

The technology at the core of Lipoderm has been so powerful that we have used it to develop a line of bases to give compounding pharmacies even more options:

Lipoderm ActiveMax^® is appropriate when compounding with ingredients in salt form at high concentrations
Lipoderm HMW^™ can accommodate ingredients with high molecular weight
Anhydrous Lipoderm is useful when working with ingredients that are unstable in aqueous environments, similar to our newer base, PermE8 Anhydrous Gel

If PCCA members have questions about Lipoderm , they can contact us at 800.331.2498. Not a member? Learn more about all that comes with PCCA membership, including access to Lipoderm and other exclusive compounding bases.

Pictured in the banner: David, a patient who has benefited from compounded permeation-enhancing medication. Watch David’s story .

These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment.