words, if you are treating a horse and prescribe a compounded medication and something goes wrong, your insurance company may not have to defend you from or indemnify you for any liability.
The safest course of action is to avoid the use of compounded medication altogether whenever possible and find a reputable compounder to use in those instances where it is the only alternative.
Abbreviations
See Appendix 1 for a complete list.
Internet Resources
1 American Association of Veterinary Medicine, Veterinary Compounding, undated. Available at https://www.avma.org/resources‐tools/avma‐policies/veterinary‐compounding (accessed February 8, 2021).
2 Thomas K. Polo ponies were given incorrect medication. The New York Times, April 23, 2009. Available at: https://www.nytimes.com/2009/04/24/sports/othersports/24polo.html (accessed February 5, 2021).
3 United States Food and Drug Administration. Compounded Unapproved Animal Drugs from Rapid Equine Solutions Linked to Three Horse Deaths, July 23, 2019. Available at: https://www.fda.gov/animal‐veterinary/cvm‐updates/compounded‐unapproved‐animal‐drugs‐rapid‐equine‐solutions‐linked‐three‐horse‐deaths (accessed February 5, 2021).
4 United States Food and Drug Administration. FDA Alerts Horse Owners and Veterinarians About Adverse Events Associated with Certain Unapproved Compounded Drugs in Horses, May 15, 2014. Available at: https://wayback.archive‐it.org/7993/20170406075905/https:/www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm397345.htm (accessed February 5, 2021).
Suggested Reading
1 Thompson J, Mirza M, Barker S, et al. Clenbuterol toxicosis in three quarter horse racehorses after administration of a compounded product. J Am Vet Med Assoc 2011; 239:842–849.
2 Barlas S. Deaths from contaminated methylprednisolone highlight failures of compounding pharmacies: Less hospital access to outside vendors and more visits from state pharmacy boards. P T. 2013; 38(1):27–57.
Author: Dionne Benson, DVM, JD
Consulting Editor: Dionne Benson, DVM, JD
section II
Specific Toxins and Toxicants
Drugs: Illicit and Recreational
Insecticides, Herbicides and Farm Chemicals
Ionophores and Growth Promotants
Chapter 6 Cobalt
Cobalt is a trace element that is a necessary part of the equine diet.
There are no reported cobalt deficiencies in horses.
Cobalt is present in feed, supplements, and injectables that are marketed for equine use.
Cobalt is also purchased from compounding pharmacies.
Cobalt is used in the equine hindgut to make vitamin B12.
In humans, cobalt has been used to mimic hypoxia, stimulating RBC production.
In horses, no RBC production has been observed with IV administration of varying doses.
Intentional administration of excessive amounts of cobalt have led to toxicosis.
Controlled substance under ARCI rules.
Mechanism of Action
Unknown – in humans cobalt stabilizes HIF factors, causing increased erythropoiesis. Although studied, the same effects have not been observed in horses.
Toxicokinetics
Onset is rapid with effects occurring within minutes of IV administration.
Duration of action is minutes to hours for a single exposure. Repeated exposure effects have not been studied.
Absorption through the GI tract – in studies in sheep bioavailability varied by preparation. In horses, they are most often administered IV.
Hepatic metabolism: horses administered cobalt often
