Authorising Gabapentin without examination

In what circumstances can I authorise Gabapentin for a new client before having examined the animal?

You may find yourself in a situation where you have been requested to perform a home euthanasia or examine an aggressive dog for a new client and you have no personal knowledge of the animal. The issue relates to you, the veterinarian, authorising a sedative, for example Gabapentin, in the absence of having performed a consultation and examining the animal.

There are a number of factors over and above the usual aspects of authorising veterinary medicines that the veterinarian should consider and if scrutinised they should be able to justify their actions.

Firstly the choice of drug. Gabapentin is a Prescription Medicine (PM) not a Restricted Veterinary Medicine (RVM) and its use would be considered off label. The veterinarian would therefore need to be comfortable that their decision to select this product (Gabapentin) instead of an RVM was justifiable under the Cascade system.

That said the use of Gabapentin in companion animals is widely documented and a brief search provided the following information:

Secondly in establishing a new vet-client relationship the veterinarian should, with the client’s consent, consider requesting the animal’s previous clinical records and also contacting the previous veterinarian in order to gather more information about the animal. They would also naturally be more able to rely on the information provided by the client, and they could consider conducting a teleconference in order to determine if it was appropriate to authorise the Gabapentin.

Thirdly the veterinarian should turn their mind to the risk of misuse of Gabapentin by the client. The veterinarian should consider these risks such as assessing the perceived risk with whatever knowledge they have about the client, the size and therefore dose required for the animal etc, and act accordingly.  

This risk however appears to be considered low and would presumably be manageable in the situations described. This document describes one review of the misuse, abuse, and diversion of Gabapentin: Gabapentin misuse, abuse, and diversion: A systematic review.

Lastly they should ensure they have the informed consent of the owner including covering risks and side effects etc before they complete their authorisation. It would be important to record this in the patient file and it may be wise if there appeared to be concerns for the veterinarian to document this formally with the owner by way of email correspondence or a signed consent.

In the absence of being able to satisfy the aspects above the veterinarian may decide to require an in-person consultation and conduct an examination (at a distance if necessary) of the animal before authorising the Gabapentin or they could work with the previous veterinarian and suggest that they authorise the Gabapentin in anticipation of the new client visit.