What to do during a shortage
Unfortunately, in the case of MNVP shortages, there are likely no alternatives to fill the void.
Sabino says it leaves veterinarians and physicians alike in the position of having to find alternative drug therapies, and
that is not always possible.
"We feel just as helpless (as the veterinarians)," Sabino says.
"They do their best to come up with an alternative, but it may not be as not as good as the drug originally prescribed," Alvarez
adds. "It might not work as effectively as the real drug, the original drug."
Hohenhaus says The Animal Medical Center develops protocols when drug shortages are anticipated, researching alternative drugs
and therapies that could be used. In the case of the doxarubicin shortage, she and her colleagues identified a cousin drug
that could work for treatment. Fortunately, the shortage never hit The Animal Medical Center, she says. But a remedy for dogs
suffering from allergies in their ears, Synotic, has been backordered for a long time, and Hohenhaus says she has gotten creative
in finding alternatives. She recently sent a client home with a similar formulation of eye drops, with instructions to place
the drops in the dog's ear for relief. Substituting similar drugs is often preferred over compounding medications, she adds.
Veterinarians may find themselves having to trade or borrow from colleagues, but oftentimes in a shortage, many people will
hold on to whatever supply they have, Alvarez says.
Jordan says for drugs where the raw ingredient can still be obtained, compounding pharmacies may help ease a shortage. But
in many cases, there are no alternative drugs but only inferior therapies, Jordan says.
In Immiticide's case, the American Heartworm Society unveiled an interim management plan that includes maintaining the health
of the heartworm-positive dog until it can be appropriately treated, pre-treatment of heartworm-positive dogs to prevent shock,
careful administration of a macrocyclic lactone heartworm preventive followed by clinical observation for at least eight hours,
continuous administration of a heartworm preventive on the regular dosing schedule, administration of doxycycline on a one-month-on/two-months-off
schedule, restricted activity and exercise and medical treatment of symptomatic heartworm infection to relieve signs of respiratory
The University of Florida College of Veterinary Medicine (UF) also is offering an alternative treatment in the absence of
Immiticide—surgical extraction of the heartworms. The treatment could benefit dogs with extensive disease, according to UF.
The process involves veterinary cardiologists surgically extracting the worms using specialized instruments inserted just
into the right side of the heart and pulmonary arteries through the jugular vein on the side of the neck.
"This minimally invasive technique is deemed most valuable as an option for dogs with considerable symptoms or high levels
of heartworms," says Herb Maisenbacher, VMD, a clinical assistant professor in cardiology at UF's College of Veterinary Medicine.
"In this way, the heartworms are physically removed from the dog...
"The procedure is not risk-free, because it involves heavy sedation or general anesthesia and is not inexpensive," he adds.
"But for dogs with extensive disease, it could be another option to consider at a time when there is no other available treatment."
Jordan says these less-than-ideal alternatives are challenging for practitioners.
"I have clinicians who have come and said, 'What am I going to do?' Then you have to just start looking for alternative drugs
that might not be as good for what you're treating and that's very frustrating for practitioners and pharmacists," she says.