Novartis, the company that makes these products has stopped shipping them to veterinarians.  Vets were not warned of the shortage, and many are only finding out about it when they go to re-order the products.

Why is there a shortage?

Novartis claims that there is no problem with either of the products.  There is, however, a potential problem with the plant that manufactures them.  The plant, located in Lincoln, Nebraska manufactures medications made for animals as well as several human medications.  According to the Novartis website, this plant also makes the human products Excedrine, NoDoz Alertness Aid and Gas-X.  Here is a statement from the website:

NCH is taking this action as a precautionary measure, because the products may contain stray tablets, capsules, or caplets from other products, or contain broken or chipped tablets.

As a result, the plant which makes these products (including the veterinary products) is closed and is currently being inspected.  According to Pharmalot.com, in November this year, three other Novartis plants received a warning from the FDA for “significant violations”.  It is unclear what these violations are.  There are no know claims of toxicity or illnesses resulting from problems at any Novartis plants.

When will Sentinel and Interceptor be available again?

Novartis is hoping to get the plant up and running again sometime in January although they have not given an exact date.  There are apparently stores of Interceptor and Sentinel already made and waiting to be shipped so hopefully, once the plant is open, it will not take long for the drugs to reach veterinarians.

Should I be concerned?

If your pet is on Interceptor or Sentinel then there is no need to worry.  There is no problem with the quality of these medications.  There is no fear of contamination or other problems.

Alternatives?

If Interceptor and Sentinel remain off the market for longer than expected, there are many alternatives.  Ideally it is best to speak to your veterinarian to find out what heartworm and flea preventatives are recommended in your area.  Many vets who normally prescribe interceptor will be prescribing a product called Heartgard instead.  In regards to flea medications you can consider Revolution, Advantage Multi, Comfortis (just fleas, not heartworm)  and Trifexis.

Have you been affected?

If you have been affected by this shortage, please leave a comment below!  The more information we share, the better!

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There is no official recall from the FDA at this point but there have been several news reports announcing the voluntary recall.

This food is manufactured in Louisiana and is only distributed in Louisiana and Texas.  So far, no dogs have been reported as sick, but if you have concerns you can contact this number: 800-256-2769.

Photo courtesy of Chris Willis.

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Cargill has posted an explanation for their recall on their website.  Their explanation is interesting!  They state that they test the corn that comes into their plant for presence of aflatoxin.  However, they recently discovered that their aflatoxin tests were not working as well as they should and were underestimating aflatoxin levels.  They received a batch of corn that actually did contain aflatoxin but did not detect this until the dog food had already been shipped.  As a precaution they are recalling a number of food lots.  To see if your dog’s bad of food is on the list, you can check the list here.

It is important to note that there have been no reported cases of illness.  Aflatoxin can cause liver problems and can present as lethargy, vomiting, diarrhea, jaundice and possibly seizures.  If you feel that your dog is sick because of eating one of these foods then please call your vet immediately.  They will file a report with the FDA and will initiate the proper treatment.

Has your dog been affected?

If you feel that your dog has been affected by this recall please leave a comment below.  By leaving comments, you can help other pet owners who are looking for information.

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Affected lots:

According to the official press release,  the food being recalled is Iams ProActive Health Smart Puppy Dry Dog Food.  The affected bags are either 7 lbs, 8 lbs, or 17.5 lbs and have a use by or expiration date of  February 5 or 6, 2013.  Look for the following code dates:

12784177I6

12794177D2

12794177D3

12794177K1

12794177K2

Or, the following UPC codes:

1901410208

1901402305

1901401848

What is aflatoxin?

Aflatoxin is usually caused by fungal (mold) contamination of dog food by either peanut products or corn.  The symptoms are a little vague but can include:

• vomiting
• bloody diarrhea
• lethargy
• loss of appetite
• jaundice (yellowing of the eyes, gums, ear or other skin pigment)
• seizures

How serious is this recall?

It is important to note that this is a precautionary recall.  In the 2006 recall of Diamond pet foods there was a large amount of aflatoxin detected in the food.  In this recall by Iams the levels of aflatoxin were reported to be just slightly higher than the acceptable amount.

For most pet food companies, corn shipments into the pet food plant are screened for aflatoxin before being used.  However, it is possible for there to be little pockets of affected corn that avoid detection.  This is why a reputable company will continually be doing testing on their food to be sure there are no problems.  I believe that Iams was doing routine testing of their food when they realized that there was aflatoxin in this batch of food.

Related: Is Iams a bad dog food? Does Iams torture animals?

Has your dog been affected?

If you have fed your dog one of the affected lots and you feel that he or she is sick because of it then immediately contact your veterinarian.  The vet will run blood tests to determine if your dog’s liver has been damaged.  Your vet will also likely file a report with the FDA.

I would also greatly appreciate any comments from people who feel their pets have been affected by this.

Related: Chicken Jerky treats making dogs extremely sick!

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What is Tolfedine?

Tolfedine (also known as Tolfenamic acid) is a Non Steroidal Anti Inflammatory (NSAID) drug.  It is meant for use in cats to reduce a fever or to reduce pain in cats with upper respiratory tract infections.  Many vets will prescribe this drug to cats as a pain reliever after a surgery such as a cat spay.

The drug is not available in the USA.

Many Canadian vets use Tolfedine as a replacement for Metacam.

Adverse Reactions?

I was not aware of any problems with Tolfedine until I received this letter in my office.  (You can click on the image to enlarge it):

The letter is to inform veterinarians that over the past few years there have been an increased number of adverse reactions reported in kittens who have been given 3-5 days of tolfedine tablets.  The letter implies that some of the problem is due to veterinarians performing spays and neuters at a younger age than we normally would in the past.  The drug was tested on adult cats and is not approved for use in kittens.

Although the letter does not state exactly what type of adverse reactions have been reported, most likely there have been cats who have suffered kidney damage after being given tolfedine.

Tolfedine, like any other NSAID, is processed through a cat’s kidneys.  A normal, healthy cat should have no problem processing tolfedine.  However, if a cat had a pre-existing kidney problem, or if their blood pressure dropped while under anesthetic (causing reduced blood flow to the kidneys), then it is possible for kidneys to be damaged.  This damage has the potential to be very serious.

My theory:

Is Tolfedine a dangerous drug?  Is there something wrong with it? In my opinion there is not.  So, why are we seeing more serious reactions now?  My theory is that many Canadian vets have switched from using another NSAID called Metacam, and started to use more Tolfedine.  The reason for the switch is that there has recently been a number of cats who have had serious kidney problems because of Metacam use.  (The drug is considered very safe, but there have been a few cases that have veterinarians concerned.  For more information, see my article on Metacam.)  So, now that more veterinarians are using Tolfedine, we are bound to see more adverse reactions.

What should we do?

The problem here is that there is no NSAID that is perfectly safe to use in cats.  We are very limited in what pain medications we can give to a cat after surgery.  In some cases we can use drugs like Tramadol or Buprenorphine.  But, these drugs don’t always give the type of pain relief that we need after a surgery like a spay.

In my practice, for pain relief after a surgery like a cat spay, here is what I do to minimize risk and to provide analgesia (pain relief):

• Highly recommend pre-anesthetic blood testing to make sure there is no pre-existing kidney problem.
• Intravenous fluids during surgery – This helps to keep the blood pressure up and flush the kidneys during surgery.
• Blood pressure monitoring during surgery - If we notice a drop in blood pressure then we act quickly to increase the pressure.
• We currently use Metacam for immediate post operative pain relief.  In the US, the recommended dose for a Metacam injection is 0.3 mg/kg.  In Canada it is 0.2 mg/kg.  We currently give a dose of 0.1 mg/kg.  We feel that this is providing adequate pain relief and this low dose makes me feel comfortable about safety.
• If we feel that take home pain medications are required, we will sometimes prescribe Tramadol, or we will do a 2 day course of oral Metacam at the dose that is labelled in Canada for oral use.

Is your cat affected?

Do you have an experience with a Tolfedine reaction in a cat?  If so, please share with us.  The goal here is not to instill fear about the use of this drug.  I have used it for years in cats and have never had a problem.  But, if there is an emerging problem, then reporting it will help us determine whether or not we should cut down on Tolfedine use as veterinarians.

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The study looked at 211 dogs and cats over a period of eight years.  Each of these animals had idiopathic epilepsy (which means they have seizures, but the cause is unknown).  The date of each seizure was documented.  Then, they looked at whether the seizure happened during a full moon, new moon, or any other particular lunar phase.

Conclusion:

The study concluded that there was no correlation at all between the phase of the moon and the number of seizures that an animal had.  So, it looks like this is just urban legend!

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Vetsulin vs. Caninsulin

I have never understood why Vetsulin would be discontinued in the US and Caninsulin would still be allowed to be sold in Canada.  They are the same product.  When Vetsulin was discontinued it was because the insulin was not believed to be stable.  As a result, pets who were on Vetsulin ran the risk of their diabetes not being well controlled.

I have been suspicious all along that the problem affected Caninsulin as well.  I have noticed over the last few years that many of my patients on Caninsulin were needing higher and higher amounts of insulin in order to remain stable.  Because of my suspicion, I’ve transitioned a lot of my patients to another type of insulin.  I don’t prescribe Caninsulin any more when I am starting a newly diagnosed diabetic dog or cat on insulin.  For most dogs I will use NPH insulin (see below) and for cats I am very impressed with Glargine (Lantus) insulin.  I have had a number of cats revert to being non-diabetic after several months of Glargine insulin.

Is Caninsulin coming back?

I’ve heard reports that Caninsulin is only on temporary backorder and will be back in mid November, but so far I can’t confirm anything.  When I look back at my post on the Vetsulin shortage I see that the manufacturer had promised it was coming back to the market, but it never did!

The Caninsulin Website doesn’t give us any further information.  There is no mention of the shortage.

Alternatives to Caninsulin

If your pet is on Caninsulin, my advice would be to talk to your vet about switching to a different type of insulin.  If you are going to switch insulin types it is extremely important to do this on the advice of your vet.  Do not attempt to do this without veterinary supervision.

There are several alternatives to Caninsulin:

• NPH Insulin:  My preference for insulin in dogs is NPH insulin.  This product is available from a human pharmacy.  In many cases, no prescription is needed.  However, I would advise getting a prescription from your vet just to be sure that you are getting the right dosage.  This is a human product and as such you will find that it is much cheaper than Caninsulin.
• NPH/Regular Insulin (Humulin):  This is a mixture of short and intermediate acting insulins and is actually quite similar to Caninsulin.  It is available without a prescription at a human pharmacy and is less expensive than Caninsulin.
• Detemir Insulin (Levemir, Novo Nordisk):  This is a newer type of insulin that is similar to Glargine (Lantus).  The difference is that Detemir works much better for dogs than it does for cats.  While it tends to work well in dogs it is more expensive than most insulins.

How to start on a new insulin:

I can’t stress enough how important it is to speak to your vet to learn how to transition to a new insulin.  What we generally tend to do is  start over as if this is the first time the pet is receiving insulin.  I will usually start the dog on a low dose that I know is extremely unlikely to be too much insulin.  (This means that there may be a period of time where your dog has a recurrence of the symptoms of drinking and urinating too much.)  Then, after a week or so I like to do a glucose curve.  I will usually give my clients the choice of doing the curve in the clinic or learning how to do it at home.  Once I see how the dog is responding to the new insulin, then I know how much to increase the dose of insulin.  Often there will need to be several glucose curves done before we are satisfied that we have the correct dose of insulin.

New information: November 19th, 2011:

I just received the following letter in my office. (See photo on left and click to enlarge.) The letter is from Merck, the makers of Caninsulin. It states that there was a period of time where Caninsulin was not being manufactured but that it is now available again. They also sent us some information on how to transition to another insulin if need be.

I find this interesting. Why would a company encourage vets to transition to a different product? My guess is that eventually they will stop making Caninsulin. They may be preparing us for this. But, time will tell!

Have you been affected?

Was your pet on Caninsulin?  Have you been affected by the shortage?  I’d love to hear how this has affected you and your pet.  Please leave a comment below.

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According to the FDA, one of the manufacturers of propfol, Teva Pharmaceuticals is no longer making the drug.  As a result, one of the other manufacturers, Hospira Inc is experiencing a shortage as they try to increase the amount produced in order to keep up with the increased demand.  Another manufacturer, APP which makes Diprivan, (pictured at right) is not reporting any shortage.

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The man has been banned from the market.  Selling dog or cat fur is against German protection laws.  There is no word yet though on whether the man has been charged.

What do you think of this?

Would you ever even consider wearing a cat fur coat?  It seems repulsive to me!

(Cat fur photo by Stefan David.)

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“We have not issued any recall for any of our Milk-Bone dog snacks. Because we believe in the quality of our products, we did initiate a voluntary withdrawal of two sizes of Milk-Bone Large Biscuits with a single lot code from distribution 12071K. We determined that the biscuits may not have been completely dried after the baking process and did not meet our quality standards, but rest assured there is no health or safety issue associated with this product!”

I’m not sure how “not completely drying” a treat will affect it.  Could it possibly cause mold to grow?  I have seen pet foods that have grown mold.  Some moldy foods can produce mycotoxins which are quite toxic.  Or, it’s possible that the not-well-dried treats were simply not as tasty as the regular ones.

Were you affected?

Did any of you have one of the “affected” batches?  I’d love to hear from you.  Post a comment below if you have any more information.

(Milkbone photo by Dougww)

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