BET Pharmacy Frequently Asked Equine Questions

Frequently Asked Questions

BET Pharm is here to help answer all your questions. If you cannot find an answer here, please give us a call!

Compounding

How does BET PHARM ensure quality?

BET PHARM strictly follows State Board of Pharmacy and Federal Guidelines as well as Standards of U.S. Pharmacopeia 795 & 797 (Pharmaceutical Compounding Non-Sterile Preparations & Sterile Preparations). Our prescriptions are prepared in a class 100 /ISO 5 cleanroom at our State Licensed Pharmacy. Facility & equipment monitoring, Pharmacists continued education & training, and third party testing of formulations for pyrogens, endotoxins, purity, concentrations as well as stability assure the quality of BET PHARM compounded formulations.

How are BET PHARM compounded formulations unique?

BET PHARM specializes in equine reproductive formulations that use controlled release delivery. Our staff is unique in that it includes world renowned experts in equine reproduction and controlled release drug delivery with decades of expertise. We also collaborate with experts around the world to assure that our formulations perform at the highest level. These efforts include extensive research & development, in vivo and in vitro testing as well as clinical trials including dozens of blinded controlled studies.

Educational

My Histrelin arrived warm after shipping. Is that okay?

Be assured that your Histrelin formulation left BET Pharm with a frozen ice pack which goes on to melt over a period of 12-24 hours. This is normal and your formulation is in good condition. We have performed stability studies that demonstrate that Histrelin is stable for at least 7 days at 40 C (greater than 100 F).

What is the low dose (50 µg/mL) Histrelin used for?

The low dose Histrelin is used by most veterinarians to stimulate follicular development in mares that have 15 to 25 mm follicles that appear to be static and not growing as expected.

 

It is also used in mares that are anovulatory due to PPID. Even after 90 days of appropriate Pergolide/Cabergoline treatment ovarian follicles may only attain a diameter of 20 to 30 mm and then regress.

 

Histrelin at 50ug IM BID will often recruit these follicles to grow and ovulate. The Histrelinis continued until ovulation occurs. This formulation should not be used in stallions as it may cause down regulation followed by significant declines in both estrogen and testosterone serum concentrations.

How is BioRelease Histrelin LA different than Histrelin in Saline?

BioRelease Histrelin LA is formulated to stimulate maximal LH release and is released over approximately a 24-hour period whereas Histrelin in saline is released over a much shorter period (3 to 5 minutes). Research trials over the last decade strongly suggest the slower release (LA) formulations are more effective at ovulating smaller follicles (28 to 35mm) and all follicles during early spring (February thru April.) We offer both formulations in our pharmacy but BioReleaseHistrelin is preferred by > 99% of our clients even though it costs nearly four times more. Multiple research studies have shown that doses as low as 0.25 or 0.5 mL are clinically effective (>90% Ovulation in 48 hours) from mid May thru September.

What can be used to improve uterine tone post foaling?

Field studies have suggested that IM administration of 50 to 100 mg of Estradiol-17 β given between days 5 and 7 post partum may improve uterine tone. Acupuncture may also be of benefit.

Is there a formulation that can be used to improve uterine tonicity and/or reduce uterine fluid retention?

Poor uterine tone and fluid retention is often associated with PPID (Cushing’s Disease) and these cases respond well to Pergolide and/or Cyproheptadine. If PPID is not present, acupuncture and exercise in the form of using a pony to force the mare to exercise are very helpful. As an adjunct to this, high doses of Estradiol-17 β given IM when the mare is anovulatory have been reported to be effective. Usually a single dose of 10 – 20 mg Estradiol-17 β followed by a single dose of BioRelease Estradiol-Cypionate 30- 50 mg is the protocol followed.

Which formulation can be used to eliminate stud-like behavior in a gelding?

The most commonly used drug is Altrenogest. Doses of 44 mg per day orally have been used or more recently veterinarians have been using compounded Altrenogest in BioRelease vehicle at a dose of 225 mg IM once per week to reduce studdish behavior. Other options (not presently available) include long acting GnRH antagonist/agonist to down-regulate intact stallions so they are temporarily biochemically castrated.

What is the most effective treatment to prolong estrus & delay ovulation?

Studies in Brazil have demonstrated that 10 mg Estradiol–Cypionate (single dose IM) given when follicles are 25 to 35 mm will delay ovulation by approximately 24 hours. The Estradiol-Cypionate treated mares will respond to Deslorelin LA if the need to delay ovulation changes. This treatment needs to be explored in foal heat where small delays in days to ovulation can greatly enhance pregnancy rates.

What is the best choice for stimulating studdish behavior in a gelded teaser?

Most often veterinarians are using Testosterone in oil or Estradiol-Cypionate in BioRelease vehicle to maintain gelded teasers. Generally a dose of 100 mg Testosterone IM two to three times each week are effective. Estradiol-Cypionate can usually be given at a dose of 10 mg per day or 50 mg twice per week. Doses will vary from animal to animal depending on their sensitivity to the steroid.

What is the most effective Estrogen to use for urine pooling?

Historically, Veterinarians have used the synthetic Estrogen Dinestrol to treat urine pooling. However, this Estrogen is no longer available. Therefore, vets are now using a compounded concentrated Estradiol-17 β (50mg/ml) to treat the condition. Usually doses of 100 mg IM q 48 hrs or 50 mg intravaginally q 24 hrs are used. This may be done in conjunction with acupuncture or forced exercise.

How does the Ivermection-Fenbendazole anthelmentic compare to other anthelmentic formulations?

The compounded double anthelmentic can be top dressed on feed and the two actives work synergistically to eliminate more parasites when given in a strategic deworming program for three consecutive months in the Spring and three months in the Fall. Some parasitologists hypothesize that this combination will decrease the likelihood of parasite resistance. The cost per dose is very competitive.

Can Meloxicam, an NSAID, be used in horses competing in shows monitored by FEI or USEF ?

No, since Meloxicam is not an approved drug in the USA, there is no official withdrawal time for this compound. Similarly, this NSAID should not be used in racing since there are no guidelines available.

How long does the BioRelease Meloxicam have efficacy following a single IM injection?

Preliminary pharmodynamic data generated by NC State University and lameness score data as experienced by field practitioners, indicate a 3 to 4 day window of release and efficacy of this primarily Cox-2 inhibitor.

How is Meloxicam, an NSAID, used clinically?

Meloxicam appears to be useful in most musculoskeletal lamenesses including suspensory and articular problems. The vehicle in which Meloxicam is formulated releases the active over a 3+ day period (data from North Carolina University). Field veterinarians report efficacy in improving lameness scores for 3 to 5 days, depending on severity, following a single IM injection.

 

The dose used also depends on the severity of the case and body weight of the patient. Doses used clinically in the field range from 750 to 1500 mg per 450 kg horse. Since Meloxicam is predominantly a selective Cox-2 inhibitor it may be safer than other Cox-1 + Cox-2 inhibitors such as Flunixin Meglumine and Phenylbutazone.

Can compounded Altrenogest be used to suppress estrus in FEI horses?

Yes, both the BioRelease Altrenogest LA (suppresses estrus for 12 days on average), and the BioRelease Altrenogest Microparticles LA (suppresses estrus for 30 days on average) can be used in FEI horses (MARES ONLY, cannot be used in geldings). Veterinarians prefer these two compounds because they can be administered before arriving at the show grounds and will be effective during the event.

What are most veterinarians using to synchronize estrous behavior and ovulation?

Many veterinarians continue to use P+ (Progesterone + Estradiol in Oil) for a ten day treatment with prostaglandin F2 on the tenth day. Historically, this has required daily injections.

 

More recently, veterinarians have been using one 10 mL injection of P+ LA with a PGF2 injection 10 days later. Results have been reported as similar to the daily protocol.

 

Another newer protocol has utilized a single injection IM of BioRelease Altrenogest LA 225mg dose concomitant with PGF2 given on the same day. Practitioners report that mares are typically in estrus on day 13 after the injection and the grouping of ovulations is as good or better than that obtained with P+.

What if my horse is sensitive to injections?

Technique of injection may be the most important component in experiencing or preventing a reaction. Many experienced veterinarians use one needle to draw up the solution and then switch to a clean needle with no drug on the outside to deliver the compound IM in sensitive horses. If injecting 5 mL, for example, inject into at least two different sites, using a total of 3 needles (1 to draw up the solution and second for the first injection and a third for the final injection of the compound). Remember there is no substitute for proper technique.

 

Information on IM injection technique is available on the web. We recommend http://www.aces.edu/pubs/docs/A/ANR-1018/ for a good review of proper injection technique.

 

Occasionally liquid formulations of both Altrenogest and native Progesterone have been reported, by practitioners, to cause some reaction at the injection site that seems to be similar to hives, suggesting an immune reaction. The reported incidence appears to be at a rate of about 7%. Microparticles use lactide-glycodide polymers that are extremely biocompatible and widely used in human products. These formulations are rarely associated with injection site reactions.

Can BET PHARM make oral Altrenogest (Generic Regumate) for me?

No, Compounding pharmacies are prohibited from copying approved formulations. Pharmacy reproduction of any FDA approved drug is prohibited by law. However, we do have two formulations that contain the same active ingredient: Altrenogest.

 

Our Altrenogest 500 mg MicroParticle formulation is an intramuscular injection that is given once every 30 days and our Altrenogest 150 mg/mL compound is given once every 12 days.

Which progestin should I use for a show or race mare to block estrous behavior?

Most veterinarians prefer to use either of the compounded Altrenogest formulations. (BioRelease Altrenogest LA 150 mg/mL or BioRelease Altrenogest Microparticles LA 500 mg). Many veterinarians prescribe the microparticle formulation and report no reaction at the injection site. Recent published research (Burns, et al. 2009 a,b) and clinical reports from veterinary practitioners suggest that these progestin compounds will suppress estrus for an average of 10 or 30 days, respectively. The onset of action has also been reported to be from 6 to 24 hrs. Burns, et al. 2008 and McCue, et al. 2008 have reported that compounded medroxy progesterone acetate (DEPO) did not affect or block estrous behavior in mares.

Ordering

Can owners order directly from BET PHARM?

Once their veterinarian has faxed in a completed Prescription Form with refills, owners can call in with their refill information (prescription #, located on Rx bottle) directly to the pharmacy at our toll free number.

How can I pay for my order?

BET PHARM accepts Visa, MasterCard, Discover and American Express. Please submit your credit card information with your prescription order. Be sure to update any cards that may have expired or changed when you refill your orders so we can avoid delays in filling your prescription.

How can I order a compounded formulation from BET PHARM?

Licensed veterinarians can order by using our online Pharmacy.  Vets can also order by calling the pharmacy at 1-866-707-0998. Only veterinarians with a valid U.S. license can order prescription medications.

How quickly are orders processed by BET PHARM?

BET PHARM fills and ships most prescriptions within 1-3 business days following the receipt of a completed order. Non sterile preparations are shipped weekly during the breeding season (Feb 15- July 15th). If faxing in your order please be sure to include all information requested on the Prescription form so that your order can be processed quickly. This includes: patient name, owner name & address, shipping address, & updated credit card information.

How are prescription refills handled?

If you have a valid refill on a BET PHARM filled prescription you may call in your refill using your prescription #. Both the prescription number and toll free phone number can be found right on your prescription bottle.

How are orders shipped by BET PHARM?

We use FED EX ground and air for shipping.

Can BET PHARM drop ship orders directly to my client?

We can ship directly to your client/patient. Simply indicate the shipping information for your client on your Prescription Form.

What is your return policy?

Federal Regulations & State Law do not allow the return of compounded medications. Be sure to order correctly. Contact our Customer Care Specialist to help you determine exactly the formulation that you are looking for.

How do I set up an account with BET PHARM?

Veterinarians can open a new account on our website to start ordering online. Our staff will be in contact with the veterinarian to verify all details to ensure we have the correct information. If ordering via fax or phone, an account will be established when we receive your first completed Prescription Form.

Join over 8400 veterinarians using BET Pharm with BioRelease.  Check out our specially formulated long acting compounds.