Case by Case: Prescribing with Confidence with the Plumb’s Drug Interaction Checker

February 23, 2024
5 min

Between our full appointment schedules and ever-growing list of callbacks, drop-off appointments, and walk-in emergencies, we’re busier than ever in veterinary practice. And we’re not just seeing more patients. As our patients age and our treatment arsenal grows, so too does the number of patients we see on multiple medications. When we’re as busy as we are, how can we find the time to rule out drug interactions every time we prescribe?

The answer? Relying on a veterinary-specific drug interaction checker. Here’s a closer look at how to use the Plumb’s™ drug interaction checker to help discover potential interactions, while staying on schedule.

Spicy’s Dilemma: A Moderate Interaction in a Proposed Treatment Plan

Your first patient of the day is Spicy, a 4-kg, 8-year-old spayed female Chihuahua. Spicy’s owner accidentally stepped on her left front paw earlier today, and she has not put any weight on it since.

Spicy was healthy prior to the accident. She has a history of atopic dermatitis and is managed on oral cyclosporine daily. 

On physical exam, you find pain, swelling, and crepitus associated with Spicy’s left metacarpal region. Her exam is otherwise unremarkable. Radiographs reveal a nondisplaced fracture of the fourth and fifth metacarpals of the left paw.

You plan to administer analgesia prior to discussing management options with Spicy’s owner. 

You consider using methadone to provide pain relief for Spicy, but before you do, you want to ensure it won’t interact with the cyclosporine she’s already on. So you grab your nearest device, open the Plumb’s app, and turn to the interaction checker.

The interaction checker reveals a moderate potential interaction between these two drugs.

The results indicate that cyclosporine modestly increases methadone concentrations in humans, and both cyclosporine and methadone are CYP3A substrates in dogs, so sedation levels need to be monitored. 

You consider your other options and enter hydromorphone into the interaction checker instead.

No known interaction—perfect. You proceed with administering hydromorphone and discuss surgical versus medical options with Spicy’s owner. She elects to proceed with a surgical referral, so you send a very comfortable Spicy on her way and move on to your next patient.

Muffin’s Emergency: Prompt Drug Interaction Assessment in a Pinch

Next up is Muffin, a 4-kg, 11-year-old female spayed Maltese mix. Muffin helped herself to a grape that was dropped on the ground, and when her owner called the clinic for advice, you recommended she bring Muffin in right away.

Six months ago, Muffin was diagnosed with congestive heart failure secondary to myxomatous mitral valve disease. She is currently being treated with furosemide, pimobendan, and benazepril, and her heart disease appears stable.

You plan to induce vomiting as soon as Muffin arrives, so while waiting, you bring up Plumb’s to check that ropinirole doesn’t interact with any of the drugs that Muffin is already on.

You see that ropinirole can impact blood pressure, so you plan to monitor Muffin’s blood pressure throughout treatment and be prepared to manage any hypotension that occurs.

Next, you consider whether you should treat Muffin with activated charcoal after inducing vomiting. 

Before proceeding, you decide to check current treatment recommendations to see if using activated charcoal after grape ingestion is necessary. 

You click on Dx & Tx on Plumb’s and read the monograph on grape and raisin toxicosis. You find that activated charcoal administration doesn’t appear to make a difference in prognosis and is only indicated if more than 1 lb of grapes or raisins is ingested and if grapes or raisins aren’t completely recovered by emesis.

Given this information, you plan to hold off on activated charcoal, particularly if emesis is successful.

And you get lucky! When Muffin arrives in the clinic, you induce vomiting with ropinirole and are rewarded with an intact grape. On to your next case!

Pumpkin’s Case: Mitigating Risk with a Veterinary-Specific Drug Interaction Checker

Your next patient is Pumpkin, a 6.4-kg, 12-year-old male neutered Himalayan who requires treatment for osteoarthritis. His owner has noticed that Pumpkin is more reluctant to jump up on his cat tree lately, and he is playing less and sleeping more.

Pumpkin is otherwise doing quite well. He has a history of chronic megacolon but is doing well on long-term cisapride and a canned, low-residue diet.

On physical exam, you find that Pumpkin is moderately overweight and has decreased hip extension bilaterally. Radiographs confirm your suspicion of osteoarthritis in his hips. His complete blood count, chemistry panel, and urinalysis are unremarkable.

You plan to start Pumpkin on an NSAID and initially consider treating him with meloxicam, as you’ve had success with using it for similar cases in the past. 

But before you print your prescription label, you open the interaction checker to ensure there’s no concern with using meloxicam in combination with the cisapride Pumpkin is already on. 

The interaction checker reveals a minor potential interaction involving protein binding. 

Based on that, meloxicam is a reasonable option. On the other hand, the idea of putting an older kitty on a long-term NSAID makes you a little nervous, so you start searching for an alternative. 

You consider gabapentin and enter it into the interaction checker. You find there is no known interaction between gabapentin and cisapride, so you elect to try it and see if it helps make Pumpkin more comfortable. If it doesn’t make enough of a difference, you’ll consider adding meloxicam in the future. You’ll follow up in a few days to see how Pumpkin is doing.

Ensuring Patient Safety with a Veterinary Drug Interaction Checker

We face the potential for drug interactions every single time we prescribe more than one medication, and it’s impossible to remember every potential interaction between the drugs we prescribe.

That’s why relying on a drug interaction checker for support is so invaluable. Unlike human-specific drug interaction tools, which don’t typically list veterinary drugs or use species-specific data, you can rely on the interaction checker in Plumb’s for veterinary-specific guidance.

It’s continually updated by our team of experts and is available in seconds from any internet-connected device, so you can quickly—and confidently—prescribe.

When you use the Plumb’s™ drug interaction checker, you’ll know you’re doing all you can to help protect your patients against drug interactions.  

Already subscribed to Plumb’s? Try the interaction checker.

Think you could use the Plumb’s interaction checker in your practice? Choose your Plumb’s™ plan today.