The cascade and equine practice

The prescribing cascade is a risk-based algorithm for the selection of medicines that should be used whenever using medicines outside of their marketing authorisation. It is a part of the current Veterinary Medicines Regulations (2013) and may see some minor changes in the next EU Veterinary Medicines Regulations; these changes are likely to be minor, although could include restrictions on how the cascade is applied to certain classes of antimicrobials. Medicine selection under the cascade is totally the responsibility of the prescribing vet. Advice from the Veterinary Medicines Directorate (VMD) is that ‘the use of a medicine under the cascade is legal provided the veterinary surgeon follows the cascade decision tree and is able to justify the choice of treatment based on animal welfare.’ ...