Pharmacy Made Mistake In Horse Drug That Killed 21

Source: Associated Press

Thursday, April 23, 2009

WEST PALM BEACH, Fla. — An official at a Florida pharmacy said Thursday the business incorrectly prepared a supplement given to 21 polo horses that died over the weekend while preparing to play in a championship match.

Jennifer Beckett of Franck's Pharmacy in Ocala, Fla., told The Associated Press in a statement that the business conducted an internal investigation that found "the strength of an ingredient in the medication was incorrect." The statement did not say what the ingredient was.

Beckett, who's the pharmacy's chief operating officer, said the pharmacy is cooperating with an investigation by state authorities and the Food and Drug Administration.

The horses from the Venezuelan-owned Lechuza polo team began crumpling to the ground shortly before Sunday's U.S. Open match was supposed to begin, shocking a crowd of well-heeled spectators at the International Polo Club Palm Beach in Wellington.

"On an order from a veterinarian, Franck's Pharmacy prepared medication that was used to treat the 21 horses on the Lechuza Polo team," Beckett said. "As soon as we learned of the tragic incident, we conducted an internal investigation."

She said the report has been given to state authorities.

Lechuza also issued a statement to AP acknowledging that a Florida veterinarian wrote the prescription for the pharmacy to create a compound similar to Biodyl, a French-made supplement that includes vitamins and minerals and is not approved for use in the United States.

"Only horses treated with the compound became sick and died within 3 hours of treatment," Lechuza said in the statement. "Other horses that were not treated remain healthy and normal."

Lechuza also said it was cooperating with authorities that include the State Department of Agriculture and Consumer Services and the Palm Beach County Sheriff's Office.

Read more: http://www.caller.com/news/2009/apr/23/pharmacy-made-mistake-horse-drug-killed-21/

But, the level of negligence--incompetence-- is, in some ways even more frightening and heart-breaking, given it was so preventable.


Compounding is a less common skill set for pharmacists and is really a specialty "practice." I think there may need to be dual checks, with more than one pharmacist checking the formulation, certainly for products with a low threshold levels for toxicity. Time for a return to regulation--in all areas that affect human (and animal) public health.

That would be horrible.

I imagine someone made an error of some kind, and the consequences were enormous and tragic. They'll have to live with that.

to prevent this kind of thing.

regulations that might have avoided this kind of error for their compounding pharmacies, which are fairly uncommon....Most State Pharmacy Rules and Regs are more directed towards prevention of pharmaceutical abuse, theft, and to ensure accountability.

There is a need for more regulation in the commercial world of drug production as well, as we've seen from not so infrequent contaminants of OTC supplements destined for human consumption...

And regarding using drugs in performance horses, guess what? Federal and state agencies and veterinary associations are aware of the issues and are always working on improvements (I know this comes as a complete shock to some people, who think all veterinarians do is count their money all day long).

~~~~~~~~~

Putting the Horse First:
Veterinary Recommendations for the Safety and Welfare of the Thoroughbred Racehorse
http://www.aaep.org/images/files/Racing%20Industry%20White%20Paper%20Final.pdf

~~~~~~~~~

AAEP Position on the Use of Corticosteroids (2007):

Definition and Mode of Action -
Corticosteroids occur naturally or may be synthesized. The most
useful and desired effect of these compounds is to control inflammation.
Corticosteroids have specific indications in the therapeutic
treatment of medical conditions of horses.

Indications for use -
Corticosteroids act and are indicated in a wide
variety of conditions that require anti-inflammatory therapy, such as
joint inflammation, allergic conditions and skin disease.
Potential side effects of corticosteroid therapy: Some corticosteroids,
when used excessively or too frequently, may have a negative
effect on the body’s natural immune response. Locally injected, corticosteroids
may weaken support tissues such as the cartilage and ligaments
of a damaged joint if used excessively or indiscriminately. The
frequent systemic use of corticosteroids may suppress the ability of the
adrenal gland to produce naturally occurring corticosteroids and other
hormones, thus creating a hormonal imbalance. Some corticosteroids
have been implicated anecdotally as a cause of laminitis.
Additionally, corticosteroids, like other drugs, should only be prescribed
where a doctor/client/patient relationship exists and only for
the therapeutic treatment of specific medical conditions. In adherence
with its medication policies related to competition horses, the AAEP
recommends that practitioners abide by the rules governing the jurisdiction
or competition in which they practice.

~~~~~~~~~~~~~~

I know you are probably one of those people who has decided, based on your extremely limited knowledge of the subject, that ALL "steroids" are bad and evil ALL of the time. And you would be dead wrong.

If you have factual information that steroids are involved in the deaths of the 21 Venezuelan horses, by all means do enlighten us. Otherwise, stop harping on it.

IPPON!

:applause:

made a math error.

This is criminal.

:cry:

...I am surprised that they even admitted fault.

It is only criminal if someone meant to do it. It sucks that so many beautiful animals had to suffer and die, but unless there can be a proved motive or criminal intent - this is just a horrible, horrible accident.

When this horse story first broke I disagreed with a poster who said this was obviously criminal, and the response to me was that I had no feelings for the dead horses. Sheesh.

You don't always need motive or intent for something to be criminal.

as hell. They died pretty quick from vitamins and minerals. Wonder what the toxicology report will say.

Broke my heart. Pissed me off. Health care is only as good as its weakest link. In my case it was a dumb vet tech working the late shift.

hospital. Especially with sedation, because I use the equine strength butorphanol for my kitties, and the quantities are TINY (the small animal strength stuff is way too dilute and so would be hideously expensive in comparison, and a much bigger PITA to keep logs of because it's a controlled substance). I draw up ALL my sedation/anesthesia drugs personally, and most other drugs too. I might have my assistant draw up a drug to my specification, but then I LOOK AT THE SYRINGE MYSELF to verify it's correct.

The risk of math errors is why I have got my anesthesia drug protocal and stick with it, rather than trying new things all the time.

because she insisted the syringe mark for 6 units was 60. Taught the owners to inject it and the dog was dead in less than 3 days.

He's spending the rest of his life in a nursing home.

how so many horses could drop dead from a vitamin and mineral overdose? It would have to have been a thousand times over the normal dose? I remember my brother ate a whole bottle of Flintstone vitamins and it didn't faze him in the least.

Children frequently die from eating vitamin pills that are fortified with iron.

If the compounding pharmacist misread the label on a bottle he was working from he could have easily given 10 or 100 times the intended dose. That happened to a lot of newborn babies here in LA last year, who almost died of an overdose of heparin. You probably saw it in the news-- one of the babies was the offspring of a celebrity, I don't remember who.

or a misread exponent is all to easy to happen. Something could be to the ^-3 and tired person sees ^3 and like that you've given a massive overdose to the ^6th.

And with some minerals or vitamins, that would do it easily.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=3843791&mesg_id=3843921

In it I gave the formula for Biodyl; one of the constituents is 1 gram/100ml solution of a potassium compound I hadn't heard of before and couldn't find anything about by searching for it. Potassium is famous for its ability to kill you quick if you get too much; they use it to execute people, among other things. I was thinking they misread "1.0g" as "10g" or "100g"--which would definitely fuck some racehorses up.

.... this was NOT a vitamin/mineral injection. I'll bet money on that.

What an awful mistake to make.

This still doesn't make sense.

And was what the pharmacy was concocting an unapproved drug? If so, could this become a criminal case, as well?

post # 9 http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x3843791#3843921

if we on DU (there are some other people besides me who were up on this early) had The Answer to this mystery before the MSM? I remember in the very early hours of the news there were people outside our community who thought someone had intentionally killed the horses for some reason.

from Wiki:
"It contains adenosine triphosphate (ATP), selenium, magnesium (Mg), potassium (K), and cyanacobalamin (vitamin B12). Its intended uses include reducing physiological stress such as due to being transported, and prevent azoturia in performance animals. The manufacturer's own product information describes Biodyl as an "injection solution containing metabolic constituents (adenosine triphosphoric acid or ATP, magnesium and potassium aspartate, sodium selenite and vitamin B 12) for debility, convalescence and myopathies."<1>"

The thing is, you don't need to go this far. There are plenty of over the counter electrolytic supplements with selenium that don't carry the risks involved with having a pharmacy compound it.

Of course, they won't include ATP or B12. The ATP strikes me as a potential performance enhancement chemical, rather than correcting metabolism.

Thoroughbreds tend to be prone to a chronic form of tying up syndrome, which causes the muscles of their hindquarters to kind of "sieze up" when they've overexerted themselves or become overexcited due to electrolytic imbalance. It can cause kidney damage if it gets out of control. (Draught horses are more prone to the acute form of the disease, which was once known as "Monday Morning" disease. Essentially after working hard 6 days, they had Sunday off and would tie up by Monday morning. It's also called "azoturia" which means "black water" because the urine turns brown or black, from excretion of blood and damaged muscle cells. (My elderly arabian used to be prone to the chronic form, although in his case I think it was due to the 18 months of semi-starvation he survived before I rescued him. His metabolism was all screwed up as a result.)

That is the question.

Just a pharmacy mistake. American pharmacies don't work with Biodyl all that often. Shit happens.

The vet would have no way of knowing the medication was wrong until the horses started dropping dead.