Who is prescribing sildenafil for animals?

[flightdoc09]

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I have no pets, but keep getting ads on my feed from Chewy, Petsmart, and other pet related stuff. Happened to see a veterinary pharmacy formulation of sildenafil, and was curious what the indication is. Is it for pulmonary hypertension, or a little animal breeding purposes, or do people get animal prescriptions and use it for themselves? Or all of the above?

 

[JaynaAli]

It’s most commonly used in animals for pulmonary hypertension. It would be illegal for a veterinarian prescribe an unnecessary medication you know will be taken by humans and I would hope no veterinarian would risk their licensure for such silly uses. I’m not saying that doesn’t ever happen because I’m sure that’s untrue, but it should not be happening legally and ethically. The few times I’ve prescribed sildenafil for a dog, usually the owners are taken aback and you have to explain how it works and why fluffy needs it.

 

[pp9]

I've prescribed it many, many times for pulmonary hypertension, a few times for megaesophagus. Personally I've never had a client that seemed to recognize the word 'sildenafil' right off the bat. A small handful looked it up at some point later/connected the dots and called for an explanation. IMO most people don't know what they are taking all that well, let alone what their pet is taking. "He needs a refill of the little white pill!"

The thing between veterinary and human doses is that we use crazy different dosages for humans vs. animals. There are some drugs that we go wayyyy higher on than a human would receive (and if you are dealing with a nurse or MD/DO client, that's always a fun argument they'll start), some we go way lower, some are safe for pets but not for people/vice versa. I've definitely known a vet or two that would throw some amoxicillin at their sick kid in a pinch (and human doctors that would do the same for their pet, although the dosing is usually wrong...), but beyond that I don't think you'll find a vet that is willing to risk harm to a human/losing their license for that.

And for Chewy more specifically, they've questioned me when I scripted out a single bag of fluids for my own rabbit before (I couldn't get a single bag from a supplier and didn't want to buy a whole case). And that was just fluids. So while we vets don't love Chewy for a lot of reasons, they are not necessarily filling whatever script comes through without a second thought. They like it to come from a clinic and be able to reach out to said clinic, and that does make it harder to get vet drugs for human use.

 

[Trilt]

Agreed, mostly just lots and lots of pulmonary hypertension in lil dogs with chronic airway disease, and long term heartworm+ patients.

 

[battie]

or do people get animal prescriptions and use it for themselves?

I don't even know how you would do this. If a vet doesn't suspect pulmonary hypertension in their patient, their not going to prescribe it. So regardless of the owners "needs", their symptoms are a few steps away from that of a pet with PH. 😅

 

[flightdoc09]

I don't even know how you would do this. If a vet doesn't suspect pulmonary hypertension in their patient, their not going to prescribe it. So regardless of the owners "needs", their symptoms are a few steps away from that of a pet with PH. 😅

Maybe I want beef flavored compounded sildenafil instead of the boring blue pill?

But I think these days it's easy to find a pill mill pharmacy with a "provider" that'll write a prescription for whatever you want without seeing you, doing an adequate history or physical. And there are a surprsing amount of people that go to Tractor Supply to get antibiotics that they use on themselves. They even buy things like DMSO to crush up ibuprofen into and apply to shingles and stuff. I'm sure you recall from organic chemistry that DMSO can be pretty dangerous.

I just found it interesting, didn't realize so many small pets have pulmonary hypertension. Also, they could have chosen other meds, but they chose that one to put in an advertisement.

 

[battie]

Maybe I want beef flavored compounded sildenafil instead of the boring blue pill?

But I think these days it's easy to find a pill mill pharmacy with a "provider" that'll write a prescription for whatever you want without seeing you, doing an adequate history or physical. And there are a surprsing amount of people that go to Tractor Supply to get antibiotics that they use on themselves. They even buy things like DMSO to crush up ibuprofen into and apply to shingles and stuff. I'm sure you recall from organic chemistry that DMSO can be pretty dangerous.

I just found it interesting, didn't realize so many small pets have pulmonary hypertension. Also, they could have chosen other meds, but they chose that one to put in an advertisement.

Sure, there are plenty of pill mills with the advent of telemedicine in human med. But it's definitely less of a thing in vet med. At this point, all states require a VCPR (vet client patient relationship) and a physical exam in order to prescribe meds through a legit pharmacy (at least the last time I looked something like 4 or 6 months ago). And the USDA is working on getting more and more prescription drugs off the shelves of feed stores. 2017 was the start of the crack down and hopefully it will slowly continue.

Likewise, the average vet won't prescribe sildenafil without radiographs. So even if you did Dutch or another "telehealth" consulting company within vet med, those docs generally don't have prescribing powers through the platform. They'll tell you your coughing dog needs an X-ray and to schedule a GP appointment or go to an ER

Shady websites will be shady regardless of type of medicine, no vet needed to get Viagra at that point. Whether or not the med is real is a whole other discussion.

 

[pp9]

But I think these days it's easy to find a pill mill pharmacy with a "provider" that'll write a prescription for whatever you want without seeing you, doing an adequate history or physical. And there are a surprsing amount of people that go to Tractor Supply to get antibiotics that they use on themselves. They even buy things like DMSO to crush up ibuprofen into and apply to shingles and stuff. I'm sure you recall from organic chemistry that DMSO can be pretty dangerous.

This is probably very common in human med, extremely uncommon in vet med (and usually then, at most, it's telehealth in states where that is legal, and even those are stressful and sketch for us). People are generally really clueless about what is happening in their animal so physical exam is absolutely key. Whereas we can go to a doctor's office, they won't lay a single hand on us, and will write us a script based off of the symptoms we say we have. I mean I got a script for clonazapam no questions asked with a 3 minute telehealth visit. That would never, never happen in vet med.

Don't get us started on Tractor Supply. Lol.

Also ETA:

Also, they could have chosen other meds, but they chose that one to put in an advertisement.

I would consider your own algorithm tbh. Most ads these days are targeted to you by your search history on your phone, personal computer, work computer, etc because all that **** is tied together whether you know it or not. I've looked up random drugs a single time on my work computer and later gotten an ad for it on my FB feed on my phone. At this point we can say a word out loud and our tech picks up on it and adds it to our algorithm. If you had a conversation about sildenafil in a patient/read it off in a patient history during verbal charting and your phone was in your pocket, that's why you saw that ad. If you looked it up one time, that's why you saw that ad.

Also double ETA:
Getting started on Tractor Supply, lol.

Tractor supply is essentially a nemesis to vet med. People literally kill their pets and probably themselves, we definitely aren't surprised. Ivermectin is a big one that's far too easy to obtain. People think they are saving a buck and outsmarting the greedy vet and then end up with a bunch of dead pets. People treating their coughing dogs with random antibiotics they'd had in a closet (often from unfinished scripts from other pets/themselves) when the dog was actually in heart failure the whole time. And so on. As I'm sure you're well aware, you can't always fix stupid. If they're that hard pressed to treat themselves/their pet, they'll find a way.

 

[flightdoc09]

USDA is working on getting more and more prescription drugs off the shelves of feed stores

Good to hear.

I mean I got a script for clonazapam no questions asked with a 3 minute telehealth visit.

That's crazy. Human medicine is in a huge downward spiral right now. Corporate medicine and private equity are squeezing it for every last dollar, and trying to sideline physicians by hiring mid-levels due to lower cost and thus higher profit. And then physicians are getting tired of making less and less money, and an unfortunate number are doing shady things to pull in some more money on the side.
Not sure if you got the clonazepam from a mid-level or a physician, but the amount of polypharmacy crap I see people prescribed that traces back to midlevels scares me. Luckily you don't have midlevels in vet med, at least not as far as I'm aware.

People treating their coughing dogs with random antibiotics they'd had in a closet (often from unfinished scripts from other pets/themselves) when the dog was actually in heart failure the whole time.

And yeah, see this all the time in people too. A google search, Dunning - Kruger, and the expenses of medicine (human or animal) can make people do some really dumb, and dangerous, stuff.

 

[JaynaAli]

Luckily you don't have midlevels in vet med, at least not as far as I'm aware.

Not currently but very likely occurring soon in a few states, specifically Colorado. A group got it on a public ballot and got it voted in by laypeople. From what I’ve read, most vets are opposed and some are trying to fight it and legislate into near-pointlessness or as limited scope as possible.

 

[flightdoc09]

Not currently but very likely occurring soon in a few states, specifically Colorado. A group got it on a public ballot and got it voted in by laypeople. From what I’ve read, most vets are opposed and some are trying to fight it and legislate into near-pointlessness or as limited scope as possible.

There will be vets, just like there are physicians, that will try and argue for limited scope to help with the vet shortage. Just like they argued it'll be useful for the physician shortage. And it'll make sense. Till that scope starts creeping more and more. Some states allow for independent practice of nurse practitioners, and more states are following. Y'all need to fight it as much as you can. Don't believe anyone that says it'll be limited scope. Might start that way, but won't end that way. The vets that push for it are the ones that will make a lot of money and push the others out.

 

[battie]

I'm in Colorado and the VPA position is essentially toothless at this point. Lots of stipulations like there has to be a signed agreement between the VPA and all licensed medical staff; signed agreements cannot be a term of employment; must have direct supervision; etc.

There's been a lot of work to make it essentially a useless position from a corporate money standpoint. A lot of us in Denver will not link our licenses to these folks with 5 semesters of online schooling.

 

[pp9]

There will be vets, just like there are physicians, that will try and argue for limited scope to help with the vet shortage. Just like they argued it'll be useful for the physician shortage. And it'll make sense. Till that scope starts creeping more and more. Some states allow for independent practice of nurse practitioners, and more states are following. Y'all need to fight it as much as you can. Don't believe anyone that says it'll be limited scope. Might start that way, but won't end that way. The vets that push for it are the ones that will make a lot of money and push the others out.

Yeah most people in vet med vehemently oppose the idea of a VPA. If you find yourself bored one day, we get into it in in these threads:

Thread 'Current Vets and Vet students: WWYD?'

Feb 10, 2025

Hi everyone. Been having a lot weigh on my heart, brain, and conscious lately. Need to hear from current graduates, vet students, and those with years into the workforce. If you were applying now, what is your best advice to navigate all of the craziness surrounding the possible elimination of income driven repayment plans, grad plus loans, and the current state of the field. Saw an article saying for 2025 the hottest career is a veterinarian. Wondering how they came up with this 😭 it’s so hard for me to see past all the doom and gloom of what ifs and commit to any school (given currently...

• Cowsrcool
• Replies: 128
• Forum: Pre-Veterinary

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DISCUSS: News on Future veterinary schools (starting toward the bottom of page 4)

The only people that stand to benefit from a VPA are corporate-owned practices, and any DVM willing to take on the 'med spa' business model - opening multiple practices of which one DVM is the 'medical director' and staff them with VPAs (or in human med, PAs and nurse practitioners) that follow an algorithm for each patient. You are right that there absolutely will be the entrepreneurial-type DVMs that will be so down to do this, and will become quite wealthy from it. But the VPA has to take off first...we are quite a ways away from that happening, but there is the chance that it will slowly take off, state by state.

The general public will absolutely (and has, in CO) support a VPA because they assume it means cheaper vet care, less wait for appointments, etc. We know this hasn't been the case for human med and PAs/nurse-types. Personally I don't believe that the general public has a good grasp on doctor vs. PA vs. nurse practitioner vs. standard nurse, they just show up for their appointment and think all is fine. It would probably be the same for vet med.

Vet med, however, is currently setting up for DVM employment crisis which is probably a bigger issue (especially if VPAs do take off). We are opening so many new schools/expanding class sizes at current schools, and the demand for vets just isn't there outside of chronically underserved geographical areas/fields, which are chronically underserved for the same reasons that human med has chronically underserved areas/fields.

 

[battie]

Lol. Throwing sildenafil at a CHF 14 yr old dog right now that is failing CHF treatment 😅 Hail Mary throws. Wish her luck 🤞🏼