BEVA, BSAVA and AVA work together to resolve isoflurane supply problem

17 December 2018

The British Equine Veterinary Association (BEVA), The British Small Animal Veterinary Association (BSAVA) and The Association of Veterinary Anaesthetists (AVA) have successfully engaged with the Veterinary Medicines Directorate (VMD) to facilitate a practical solution to the isoflurane supply problems.

Isoflurane is the most widely used veterinary anaesthetic agent in animals, allowing both routine and emergency surgeries to be performed. It was announced last week that the third-party manufacturer of isoflurane had to cease production with immediate effect due to a mechanical problem on the production line. This resulted in a shortfall of the anaesthetic. Stocks of alternative products are believed to be limited, with the potential for supply to be restricted. It is therefore highly likely that routine operations for dogs, cats and horses would have to be postponed. Some clinics had concerns that they would not be able to safely perform emergency surgery over the Christmas period.

Having investigated alternative sources of isoflurane, and alternative products, BEVA, BSAVA and AVA proposed ways that the VMD might mitigate the risks to animal welfare including consenting to the use of unlicensed (“special”) isoflurane formulations. The VMD responded rapidly and positively.  It is understood that one specials manufacturer is now intending to produce isoflurane to fill or partially fill the gap in supply. This should be available in three to four weeks.

David Rendle, a member of BEVA’s Health and Medicines Committee commented: “BEVA has a close relationship with the veterinary pharmaceutical industry and will always work swiftly and collaboratively to help develop practical solutions to supply problems for our members.”

BSAVA President Philip Lhermette praised the VMD for such prompt action. He said: “The VMD listened to our concerns and acted immediately.  By doing so they have addressed and helped to prevent any potential welfare risks associated with a lack of isoflurane.”

Carl Bradbrook, AVA Junior Vice President, reminded clinicians to “seek advice when considering the use of unfamiliar anaesthetic protocols”

All the associations noted that the situation doesn’t give vets free rein to ignore the medicines legislation; the cascade must still be followed, and client informed consent obtained, if an unregulated anaesthetic is used.

Extemporaneous products are the last tier of the cascade. Vets are expected to use either an authorised human medicine or an EU authorised veterinary medicine before an extemporaneous preparation. If, after diligent attempts to source a product higher up the cascade, the vet has not been successful they could consider using an extemporaneous preparation for the immediate need. However, should an authorised product or a human product become available vets are obliged to use it over an extemporaneous preparation.

BEVA, the BSAVA and the AVA have each produced general advice on the use of specials or anaesthesia options.

Download Injectable Anaesthetics Chapter

To support all veterinary professionals working with small animals during the isoflurane shortage, the BSAVA is providing free access to the chapter on ‘Injectable anaesthetics’ from the BSAVA Manual of Canine and Feline Anaesthesia and Analgesia, 3rd edition.

Members and non-members can download the chapter from the BSAVA Library.