Polypharmacy in Zoological Medicine

Abstract

Polypharmacy is a term that describes the inappropriate, concurrent use of multiple drugs in an individual patient. Zoological medicine practitioners must take approved agents (veterinary or human) and extrapolate their use to non-approved species often with little species-specific pharmacological evidence to support their decisions. When considering polypharmacy, even less information exists concerning multi-drug pharmacokinetics, pharmacodynamics, or potential drug-drug interactions in non-domestic species. Unfortunately, captive, zoological species are susceptible, just like their domestic counterparts, to chronic diseases and co-morbidities that may lead to the usage of multiple drugs. Polypharmacy is a recognized and important issue in human medicine, as well as an emerging issue for veterinarians; thus, this paper will discuss the novel, potential risks of polypharmacy in zoological medicine. Hopefully, this discussion will help bring the attention of veterinarians to this issue and serve as an interesting discussion topic for pharmacologists in general.

New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014–2016

“…The issue of polypharmacy is of increasing importance to human medicine, particularly in association with an ageing population ( Urfer et al, 2016 ); the same is likely to be true of veterinary medicine ( Hunter and Isaza, 2017 ). Whilst prescription of multiple PAs might be wholly appropriate to combat complex clinical situations, drug-drug interactions have been identified as a major cause of adverse drug reactions ( Cavallo et al, 2013 ; Sutherland et al, 2015 ).…”

Zoo elephant research: contributions to conservation of captive and free‐ranging species

“…The current treatment regimen recommended for infected elephants includes isoniazid and rifampin, as well as pyrazinamide and ethambutol, but these guidelines stipulate that ‘pharmacokinetic studies in elephants have not evaluated necessary blood concentrations needed for cure, only the amounts of drugs that need to be administered to achieve blood concentrations’ (Backues & Wiedner, : page 23). Additionally, multi‐drug therapy regimens require careful consideration of drug interactions and individual variables related to age and potential damage to renal, hepatic and gastrointestinal organs (Hunter & Isaza, ). Additional pharmacodynamics and therapeutic drug trials for the treatment of TB in elephants are still needed.…”

The Value of N-of-1 Data in Zoological Medicine: A Methodological Review

“…32 In such situations and others where there is uncertainty of treatment effect, N-of-1 trials offer clinicians a way to better inform their treatment decisions as well as avoid polypharmacy by discontinuing ineffective therapies. 14 As in human medicine, these trials could be used across a range of chronic diseases, including, but not limited to, osteoarthritis, epilepsy, cardiac disease, hypertension, diabetes, and inflammatory, autoimmune, and allergic diseases. In addition, N-of-1 trials may be useful in understanding which drugs or environmental modifications can reduce a particular patient's display of abnormal behaviors and stereotypies, such as feather-picking.…”