PROZINC INSULIN

I'd welcome some advice please. I have an appointment made with my Vet for tomorrow to discuss a replacement for Prozinc which is currently unavailable for purchase in the UK. Benny has been very well for the past 12 months having taken 8 months to get regulated. I'm concerned about changing to an alternative, as I work and am looking after Benny by myself which makes monitoring harder. Would anyone know if it's possible to obtain Prozinc via other sources?

 

We have members from the UK here @Elizabeth and Bertie is one. @Bron and Sheba is in Australia... I'm sure there are more. Hang on for more replies.

 

I am fairly certain that Lantus is available worldwide. It's a human insulin and along with Prozinc, one of the insulins that is recommended by the American Animal Hospital Association for the treatment of feline diabetes in their guidelines. I linked a copy of the guidelines should you need it for your vet.

 

Hi, waving from Surrey!

I haven't personally heard of anyone who has managed to get Prozinc from outside the UK (if that's what you're asking?). But it 'may' be possible to do so online from a pharmacy in Europe while we are still in the EU (well, we're still in the transition period where I 'think' the same rules apply...). Certainly, other EU countries should currently accept UK doctor's prescriptions, so I'm presuming it's probably the same with vet prescriptions... A couple of challenges that immediately come to mind though are, firstly, finding a pharmacy in Europe that can and will dispense the Prozinc; and secondly, how practical that might be to send insulin during the hot weather... I know that some UK pharmacies have written on their websites that they won't send insulin in hot weather. (And of course it would take longer for insulin to get here from Europe).
If you can't obtain it that way, then you'll be looking at an alternative insulin. For many UK vets the default alternative is going to be Caninsulin because this is the other veterinary insulin. It 'typically' has a shorter duration than Prozinc, and tends to drop the blood glucose faster than Prozinc. Your cat might do OK on it, or it might not.

The international guidelines recommend the use of longer lasting insulins for kitties. Prozinc is considered a longer-lasting insulin. You could put the case to your vet that, since your cat is doing well on this, you'd like to try another longer lasting insulin. This would mean switching to a human insulin such as Lantus or Levemir, under the 'cascade system' of prescribing. There are quite a few UK kitties on these insulins now. You can get a prescription from your vet (typical cost of prescription is around £15), and then buy the insulin from a human pharmacy.
Vets vary enormously in their willingness to prescribe human insulins. Some actively promote their use, some refuse to prescribe them, some are fairly neutral about it but can be open to persuasion.
Whether switching to Caninsulin or to a human insulin there are some little differences that you'd need to be aware of, but switching insulins is usually straightforward.

Eliz

 

I would strongly discourage using Caninsulin. It is very sort acting and is no longer recommended for use with cats.

 

Thank you to you all for the advice, I'll discuss these options with the vet tomorrow.

 

Stay away from caninsulin if you can. It was made for canines hence the name and doesn’t work as well in cats who have a higher metabolism. Lantus is the best option. It’s a great insulin for cats. Good luck!!

 

Good luck with the vet visit.
I know it's not an easy thing to do, and the idea of changing insulin can be a bit unnerving. But, whatever insulin you get (including Caninsulin), there are ways of working with it to get the best out of it.
It may even be that the insulin that you switch to works better for your kitty than the one you're using now.
Do let us know how you get on.

 

Unfortunately, at the moment, the choice for UK kitties is greatly reduced, and many kitties will be switched to Caninsulin while Prozinc is unavailable. There is no obligation for UK vets to prescribe a human insulin instead. A lot depends on the vet, and their knowledge and experience of diabetes (and whichever insulins they have or haven't had prior experience of). The international guidelines do recommend longer lasting insulins, but these are just 'guidelines'.

 

Interesting and I’m sorry to hear the UK is going through this shortage of prozync. I wonder if saying something like I’ve researched the options and this is the insulin I want to switch to would help...? Being the owner, you should have some say on what medications you want your cat on. Like a human would be able to tell a doctor what it wants and what it doesn’t want. I had to do that a few times with vets and even had to push a little and say no, I don’t want Cerenia it doesn’t work for her I want to try ondansetron since I heard it has great results. The other thing is that there are a lot of human medications still used successfully in cats, like ondansetron for example, so Lantus is not the only human medication to be used for cats. Just a thought

 

Lantus/Levemir isn't licensed for use for felines in the UK like it is in the US, so circumstances are a little different. There is always the 2018 AAHA Diabetes Management Guidelines that could be brought up but I'm not sure how much leverage it would give, since it's an American guideline.

 

Lantus and Levemir are NOT licensed (FDA approved) for cats or dogs in the USA. In the USA, like appears in the UK, Lantus and Levemir are prescribed off-label for cats and dogs.
In the UK the cascade prescribing system is used for a vet prescribing non-vet medicines for animals.
https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines

 

Thanks, I assumed they were licensed since they're on the AAHA Diabetes Guidelines! I believe it is still easier to acquire Lantus in the states than in the UK?

 

Yes it seems like US vets are more apt to prescribe Lantus than UK vets. Lantus seems to be readily available in the UK like in US.
https://www.diabetes.co.uk/diabetes-medication/diabetes-and-lantus.html

 

Lantus, like many medications, is used off-label in the US, just as Larry noted. There is no restriction to using a medication off label. If you are licensed to prescribe, you can prescribe any medication for whatever purpose regardless of what the FDA has approved the medication for.

 

Yes, it certainly can help if a caregiver can tell the vet that they've researched the options regarding the different insulins (and the vet can be reminded of the international ISFM guidelines which recommend the use of longer lasting insulin). It also helps hugely if the caregiver is regularly testing blood glucose at home and can show that they have a good understanding of their cat's diabetes.
But nobody in the UK has the 'right' to ask for - and expect to given - a certain insulin.

In the UK the standard requirement is that a vet prescribes a veterinary medicine for animals. If the medicine that the vet prescribes isn't sufficiently effective the vet can use something else that may be more effective. If there is another veterinary medicine available the vet would probably prescribe that. In terms of insulin though that would currently mean prescribing a human insulin, such as Lantus or Levemir. It is not difficult for vets to do this, though some will have never done this before. There are now quite a few UK cats on Lantus or Levemir.

As said earlier, the attitude of vets varies enormously when it comes to prescribing human insulins. Some vets actively promote their use (and a tiny minority will even prescribe human insulin as a first choice despite the UK requirement for prescribing a veterinary insulin first.) Some vets may not have used human insulins before but may be open to prescribing them. Some will steadfastly refuse. Some don't even know that they 'can' prescribe human insulins. ...If a vet refuses outright, then there is always the option of trying to find a vet who is willing to prescribe a human insulin. Some people have done this. Sometimes another vet in the same practice is more open to prescribing human insulin, sometimes it involves moving to another vet in another practice.
There is a big element of luck involved too. There are quite a few people who, despite their best efforts, can't get access to a vet who will prescribe a human insulin.

It's important to remember too that some cats have done just fine on Caninsulin. While it is not so much used in the US these days it has been widely used in the UK and much of Europe, and other parts of the world. And because we've had to use it we've learned ways to get the best out of it.

Whichever insulin a kitty is on this forum is always here for advice and support.

@Julie & steve j - Useful reference info here should you need it, the ISFM guidelines and some info from the RVC. And for general UK info see link in my signature.
https://journals.sagepub.com/doi/full/10.1177/1098612X15571880
https://www.rvc.ac.uk/Media/Default/small-animal/documents/feline-diabetes-guide.pdf

 

It's a very short and cheap flight to Denmark for example. I'm using prozinc and have no problem getting hands on it. France could also be an option? It's just a train ride
Maybe even the german pharmacy's may ship some?
Why can't you get prozinc?
Is it possible to ship insulin? I have two levemir pens I don't need, and 8 vials of caninsulin.

 

If it needs to be refrigerated, like Lantus, you need to use some type of insulated envelope inside the box and add some ice packs as well so it can stay cool. I’d also avoid shipping in the summer because of the temperature during the trip. I believe that it’s technically illegal to ship insulin so don’t declare it if you do. Maybe not in Europe though...?

 

Its totally illegal here to share prescription drugs, human of animal. However if it's the solution?

 

I agree but just don’t declare what’s in the package when shipping

 

I have purchased insulin from people in the past and and would do so a again. I doubt one would get prosecuted if you had a script for the insulin. I would not purchase or sell on schedule (controlled) drug like (in the USA) Buprenorphine or now gabapentin.