Compounding Confidence and Clarity: Practical Decision-Making for Equine Veterinary Compounds

Compounded medications are an important tool in equine practice, particularly when addressing dosing challenges, and patient-specific needs—but they also introduce significant considerations related to efficacy, safety, regulatory compliance, and drug testing risk. This session provides a practical approach to help equine veterinarians confidently prescribe, evaluate, and partner with compounding pharmacies while protecting both horse health and competition eligibility.

We will address the most common and challenging questions faced in equine medicine, including when compounded medications are appropriate compared to FDA-approved products, who is responsible for ensuring clinical effectiveness, and why pharmacists may fulfill prescriptions without additional clinical discussion. Special attention will be given to the implications of compounding under AMDUCA, FDA Guidance for Industry (GFI #256), and USP standards, and how these regulations influence medication availability and prescribing decisions in equine practice.

Because drug testing is a critical concern, the session will also explore how compounded medications can impact detection times, variability in drug concentrations, and the risk of inadvertent positive tests under racing and sport horse regulatory frameworks. Participants will learn how formulation differences, excipients, and quality variability may alter pharmacokinetics and withdrawal recommendations.

Finally, the session will provide a practical framework for selecting high-quality compounding pharmacy partners. Attendees will learn how to evaluate pharmacy accreditation (e.g., PCAB), distinguish between 503A and 503B facilities, and identify key quality indicators that directly impact equine patient outcomes and regulatory risk.

By the end of this session, equine veterinarians will be equipped with actionable strategies to reduce therapeutic failures, better manage drug testing risk, improve client communication, and make safer, evidence-based decisions when prescribing compounded medications.

1. Apply a clinical decision framework to determine when FDA-approved products should be prioritized over compounded medications in equine patients, including consideration of regulatory compliance and competition rules.

2. Evaluate and select a high-quality compounding pharmacy partner by assessing facility designation (503A vs. 503B), accreditation (e.g., PCAB), and key quality assurance indicators relevant to equine practice.

3. Assess the efficacy, safety, and drug testing implications of compounded medications, including understanding the veterinarian’s responsibility in prescribing, advising on withdrawal times, and mitigating the risk of positive tests in performance horses.

Dr. Lauren Forsythe is an Assistant Professor at the University of Findlay College of Pharmacy. She is also a diplomat of the International College of Veterinary Pharmacists. Dr. Forsythe graduated from the University of Findlay, College of Pharmacy in 2015 and completed her veterinary pharmacy residency at Purdue’s Veterinary Teaching Hospital. She earned her MBA in 2024 from the University of Illinois. Following completion of her residency, Dr. Forsythe spent three years at the UC Davis Veterinary Medical Teaching Hospital as a Clinical Pharmacist followed by four years at the University of Illinois College of Veterinary Medicine as a Clinical Assistant Professor of Pharmacy and the Pharmacy Service Head. In addition to her teaching position, Dr. Forsythe is a co-author of the book Drug Compounding for Veterinary Professionals and provides consulting services to veterinary practices through her company Foresight Pharma Solutions.