Bravecto

[Guest donatella]

Ok so their vet followed up with me and she was so damn nice! They are sending me 2 replacements as I didn't see who vomited. I am pretty confident it was Bonnie and domt think I want to try her again on this (she said it's completely up to me) but I am very happy to continue Lucy on it. Great follow up

[denali]

If anything their marketing is brilliant!

The clinic i work at received a package from them yesterday, usually its a box with some brochures, wall posters etc. maybe a trial tablet or two, they have sent a little cardboard card that has a screen! Like those singing cards it starts when you open it and plays through a little introductory video. Its very cool.

I was impressed So futuristic!

I am interested to know if it does in fact last the full 3 months.

[RuralPug]

There is a post doing the rounds on FB ATM re two dogs reacting badly to Bravecto, one dying rapidly and the other only just hanging on when last posted. Some posters are chiming in with some hearsay that their brother's mate mother-in-law's neighbour's nephew's dog has also had a swift and fatal reaction to this product. (FB being FB)

The picture of the dog that died looks to be a Smithfield or Beardie cross, and although there is no ivermectin in this product, there has been some speculation that Collies and collie crosses might be fatally sensitive to the active ingredient.

Because it is a relatively new active ingredient, there really isn't much of a history yet, good or bad.

It would be interesting to hear from those who have used this product successfully whether or not they have any collie in their dog's ancestry.

[Boronia]

A friend of mine emailed me this link from Snopes http://m.snopes.com/...d-tick-warning/

Here is the Snopes article:

BRAVECTO Flea and Tick Warning

FACT CHECK: Does BRAVECTO chewable flea and tick remedy kill dogs?

Claim: Bravecto brand Flea and tick remedy is dangerous to dogs.

UNPROVEN Example: [Collected via Facebook, June 2015]

Pet Helpers is incredibly saddened to learn of the recent death of one of our adopted dogs. This post is in loving memory of Duncan who was taken to his heavenly home last Thursday. This is from his family……… It has been too painful for us to post on his passing. We are still grieving deeply and miss him terribly. He was only 4 years old and died after a visit to the vet. He was put on a new flea chewable that took his life less than 24 hours after taking it. Our other dog who went to the vet at the same time and was prescribed the same flea chewable almost died on Friday from the same medicine. At this time we are not sure he will still make it as there is no antidote for it and our research has shown that several dogs have died within 30 days due to liver and kidney failure after taking this medication. Wish we had known this beforehand! Would have never allowed this to be prescribed, let alone given it to our dogs. Never again will we use a chewable flea & tick med! Please Keep Patti Winter and Todd Michael in your prayers. I fostered Duncan 3 yrs ago and he was such a joy.

Please avoid this drug called Bravecto. I know many vets are pushing it and it just isn't safe and there isn't enough info out there yet.

Origins: On 11 June 2015, the Facebook page Pet Helpers published the status update above, warning dog owners about the purported dangers of BRAVECTO chewable flea and tick remedy.

According to that update, the family of the depicted dog asserted that one of their pets had died within a day of being given BRAVECTO chewables, and that another of their dogs had nearly died after being given the same treatment at the same time. The update also asserted that BRAVECTO chewables were responsible for the dog's death and that several other dogs had died of liver and kidney failure shortly after taking the same medication. (No information was provided showing or explaining a causal link between the dead dog and BRAVECTO chewables, other than a post hoc ergo propter hoc assumption.)

Bravecto (fluralaner) is a systemic antiparasitic drug introduced to the veterinary market by Merck in 2014. A 7 March 2014 study published in the journal Parasites & Vectors (based upon a study of 32 beagles treated with fluralaner) observed no serious adverse side effects attributed to the medication:

Oral administration of fluralaner, formulated as a chewable tablet, to healthy dogs at dose rates of up to 281.3 mg/kg on three occasions at 8-week intervals did not lead to any treatment-related findings that could be detected through careful clinical observation, clinical pathological evaluation or on gross or microscopic post mortem examination. Oral administration of fluralaner at the highest recommended treatment dose (56 mg/kg) is well tolerated by dogs and has a safety margin of more than five in healthy dogs eight weeks of age or older and weighing at least 2 kg.

A "Freedom of Information Summary" [PDF] dated 15 May 2014 available on the Food and Drug Administration's (FDA) web site reiterates the results of that study:

There were no clinically-relevant, treatment-related effects on physical examinations, body weights, food consumption, clinical pathology (hematology, clinical chemistries, coagulation profiles and urinalysis), gross pathology, histopathology, or organ weights. Diarrhea, mucoid and bloody feces were the most common observations in this study, occurring at a similar incidence in the treated and control groups. Five of the twelve treated dogs that experienced one or more of these signs did so within 6 hours of the first dosing. One dog in the 3X group was observed to be dull, inappetent, with evidence of bloody diarrhea, vomiting and weight loss beginning five days following the first dose. One dog in the 1X group vomited food four hours following the first dose.

As the BRAVECTO social media warning spread among dog owners, the Wilson Street Veterinary Facebook page published a status update addressing rumors about the drug's safety. In that update, Dr. Michael Mogavero stated that the drug had been extensively tested prior to its release and had proved safe for dogs:

We have been hearing some alarming statements made about the flea and tick medication, Bravecto.

Dr. Michael Mogavero states the following:

"After having read some of the posts on facebook regarding the safety of Bravecto, I felt it reasonable to make those of you who are concerned, aware of some information that you should know about this product.

Let me first say that veterinary pharmaceutical companies take the reporting of adverse reactions very seriously and are obligated by law to document all. Should you feel that your pet has had one please report it to your veterinarian as soon as possible.

Bravecto has been available worldwide for almost 18 months, in the United States for 1 year and here in Canada for about 8 months. To date, virtually all adverse reactions that have been seen or reported pertain to the gastrointestinal system, ie vomiting, decreased appetite, diarrhea, lethargy, excessive drinking and gas.

The active ingredient fluralaner, works by inhibiting the nervous system of insects. It does not have any effect on the nervous system of animals.

Fluralaner will in fact pass through both the liver and kidneys but is not metabolized by either and is excreted in feces, in the same form as it was ingested unaltered.

The literature and clinical use supports that Bravecto is safe, and consider for a moment all the animals that will not be infected by and succumb to the growing number of tick borne disease that we are seeing worldwide.

As a practicing veterinarian I have prescribed this product within confidence in both its safety and efficacy. I am 100% confident that should there be any real concern with respect to this product the manufacturer will advise us without hesitation. Your pets health remain both mine and the health care team at Merck Animal Healths primary concern."

Michael Mogavero DVM

BRAVECTO's FAQ (which includes information about the product's safety) can be found here.

Last updated: 12 June 2015

[RuralPug]

Wow! Snopes has an entry up within 24 hours of the facebook post! That is fast! thank you Boronia!

I still would like to hear if any collie owners have successfully used this product. Pretty please.

[Mrs Rusty Bucket]

Now I'm wondering how sentenial chewables work... I didn't think the spot ons had any repellent effect after the first 24 hours of stinky dog, either.

At least my dog will still get bit by mozzies when she's dosed with a spot on. Found fleas once when she was on frontline - but they were very groggy and easy to catch and destroy. Haven't found ticks but mostly avoid tick areas.

[Brandiandwe]

I'm watching this with interest. Advantix really is the only thing that seems to work for fleas and ticks here, but all of the topical ones seem to upset Paige's skin. Anything that avoided that would be worth considering.

[ruby6689]

Just wondering if anyone has purchased a large tablet and cut it in half to dose smaller weight dog? I have two that weigh 26 kilo each and the largest Bravecto tablet doses a 56 kilo dog so I am tempted to buy one and divide it? I have done this with Frontline spot on for years for my cats and with Comfortis for the dogs.

Has anyone tried this with positive results?

[DeltaCharlie]

Just wondering if anyone has purchased a large tablet and cut it in half to dose smaller weight dog? I have two that weigh 26 kilo each and the largest Bravecto tablet doses a 56 kilo dog so I am tempted to buy one and divide it? I have done this with Frontline spot on for years for my cats and with Comfortis for the dogs.

Has anyone tried this with positive results?

We have just done this with our border collies. Ours are all 10-15kg so we bought the 20-40kg ones and cut them in half.

Because there is no way of knowing if the active drug is spread evenly throughout the chew nobody in any official capacity will ever advise doing it (to cover themselves if your dog ended up with inadequate protection as you could go back at them if they did advise it). I spoke to many people who have done it themselves for a while now so decided it was worth the risk with our dogs.

[sandgrubber]

Just wondering if anyone has purchased a large tablet and cut it in half to dose smaller weight dog? I have two that weigh 26 kilo each and the largest Bravecto tablet doses a 56 kilo dog so I am tempted to buy one and divide it? I have done this with Frontline spot on for years for my cats and with Comfortis for the dogs.

Has anyone tried this with positive results?

We have just done this with our border collies. Ours are all 10-15kg so we bought the 20-40kg ones and cut them in half.

Because there is no way of knowing if the active drug is spread evenly throughout the chew nobody in any official capacity will ever advise doing it (to cover themselves if your dog ended up with inadequate protection as you could go back at them if they did advise it). I spoke to many people who have done it themselves for a while now so decided it was worth the risk with our dogs.

if uneven distribution of the drug through the tablet is the problem, you could resolve that by grinding the table and dividing the resulting stuff into parcels. The 'tablet' in this case is huge . . . as big as an $AU 0.20 coin, so there should be enough stuff to make it easy to split accurately.

We have AWFUL flea problems here and fleas have developed a resistance to many meds. My three are on day 87 with Bravecto . . . so far no fleas and one dead tick. Very impressed with the product.

[sheena]

I just cant get my head around why these products would not be evenly distributed thoughout the tablet. It is not as if each tablet is individually made & then the active stuff squirted into them. It would be all mixed up in a vat or something & then poured into moulds. So if there is a risk that it is not evenly distributed in the tablet then that means that some tablets may have missed out all together, & that definately would not be the case. I always split my tablets or viles....have done for twenty years & never had a problem & everyone else I know that has more than one dog does the same.

[DeltaCharlie]

The chances of them not being evenly split would be so slim that as far as I am concerned it isn't exactly a risky thing to do. I have never split vials as I am not talented enough to do that, but things like interceptor and bravecto are easy to cut in half. I had considered splitting the really big ones 3 ways but thought that was probably pushing my skills a little too far LOL The companies can't advise it though as not only will it cost them money if people start splitting them instead of buying 2 smaller, but they would also be liable if for whatever reason it wasn't evenly split.

[denali]

Most of these products have been tested at very high "overdoses" also with no ill effects. So you don't have to worry too much about splitting exactly.

I split all my dogs and cats tablets, the comfortis for the dogs and revolution large dog split with a syringe for the cats :)

[Fides]

This is my first post though I have been a member of DOL for a few years and dog owner for most of my life. I guess it is my concern about Bravecto which has prompted me to finally post.

Please do a lot of reading independently of what the drug companies say in regard to this drug. I have researched through Merck's submissions to FDA and EMA in Europe regarding the tests they have done. The reproductive study (on 10 breeding pairs of beagles only, where 2/9 litters produced deformities) left me reeling - the FDA's own conclusion is that there can be effects on pups related to treatment with Bravecto.

"The repeated oral administration of fluralaner at a dose of up to 168 mg/kg was well tolerated in reproducing dogs. In adult dogs, potential treatment-related effects include seizures, diarrhea and salivation after dosing. In puppies, potential treatment–related effects include limb deformity, enlarged heart and spleen, and cleft palate."

In the US, Bravecto requires a prescription from the vet, so it is not over the counter like here. And one of the reasons for this apart from FDA wanting better reporting of adverse events, is it requires professional expertise to consider the suitability of Bravecto for breeding dogs i.e. weighing the risks v benefits. The product information leaflet in the US also states the findings of the reproductive studies but not the conclusions (pups born with cleft palate, limb deformities etc)…

Also, with the margin of safety tests (i.e. overdose studies) were conducted on 32 Beagles, beginning when they were aged 8-9 weeks. The test lasted 24 weeks, then pups were euthanised. Nothing is known about the long term or cumulative effects. Young dogs may well metabolise it differently to older dogs, dogs with intercurrent medical problems or on medications.

The literature about fluralaner (i.e. Bravecto) is that it is rapidly absorbed, then stored in fat, muscle, liver and kidney for 12 weeks, 90% is excreted unchanged in the faeces. Who knows really what happens as the pups tested above did not have their urine or faeces, or organs studied for any accumulation.

Regarding splitting or crushing - please don't do this! See the FDA's handling procedures just to reinforce that it should be handled as a poison...

"The product labeling contains the following information regarding safety to humans handling, administering, or exposed to BRAVECTO:

Not for human use. Keep this and all drugs out of the reach of children. Keep the product in the original packaging until use, in order to prevent children from getting direct access to the product. Do not eat, drink or smoke while handling the product. Wash hands thoroughly with soap and water immediately after use of the product."

I'm part of a group on FB that is looking into its safety and raising awareness of side effects and the proper channels to report adverse events. If you want to learn more, please look it up : Does Bravecto Kill Dogs. It was started by a lady in the US whose 1.5 year old Cavalier died in August, just weeks after taking Bravecto (a necropsy was performed). Her beautiful dog suffered terribly. It is not a scare mongering group even though I admit the name of the group might make you think it only wants you to draw that conclusion. There are vets that belong to this group and there is a lot of information there such as the documents I've quoted above, and others like MSDS.

I haven't used it and don't know anyone who has, so I can't say how effectively it works and whether there are side effects that I know of personally. However, in the FB group, there are alarming similarities (of some very severe side effects in which some dogs have died) being reported independently from people around the world.

[denali]

I agree, its not something i am willing to try yet, as many cavaliers have actually died from its use..

But do know of many who are using happily and with great results :)

[Lucky-Dog]

Thank you Fides. :)

" She who must be obeyed " got all exited and ordered some online and they arrived and are on the shelf. I am hesitant to give them as fleas are not a problem in our home and we have been very lucky with ticks.

Will make sure she reads all of this before any administration is thought of.

Thank you Fides. :)

[Fides]

No problem Lucky-Dog :)

I just think it is too new and has not been studied well enough. It could be the majority of dogs tolerate it well and it works brilliantly, but there are others who've had ongoing severe side effects. And having said that, even if it's been taken without issue initially, I've read of cases where it the owner feels the dog is starting to experience side effects after the second or third dose. Bravecto was only released in Europe/US in April/May last year, so no dogs would have had that many doses yet if given every 12 weeks.

My dog started developing reactions to Advantix. She was fine for about a year, but then would become very lethargic several hours after I applied it - she would not want to lift her head and just seemed disinterested. She'd always be back to normal the next day, but the last time I ever gave it, she started staggering around for a few hours before she settled. At that point I decided never again. So I'm wary of something taken orally if there is no antidote or way to clear it from their system.

It would be wonderful to have something remove the worry of paralysis tick but Bravecto seems just as much a worry to me.

[sandgrubber]

This is my first post though I have been a member of DOL for a few years and dog owner for most of my life. I guess it is my concern about Bravecto which has prompted me to finally post.

Please do a lot of reading independently of what the drug companies say in regard to this drug. I have researched through Merck's submissions to FDA and EMA in Europe regarding the tests they have done. The reproductive study (on 10 breeding pairs of beagles only, where 2/9 litters produced deformities) left me reeling - the FDA's own conclusion is that there can be effects on pups related to treatment with Bravecto.

"The repeated oral administration of fluralaner at a dose of up to 168 mg/kg was well tolerated in reproducing dogs. In adult dogs, potential treatment-related effects include seizures, diarrhea and salivation after dosing. In puppies, potential treatment–related effects include limb deformity, enlarged heart and spleen, and cleft palate."

In the US, Bravecto requires a prescription from the vet, so it is not over the counter like here. And one of the reasons for this apart from FDA wanting better reporting of adverse events, is it requires professional expertise to consider the suitability of Bravecto for breeding dogs i.e. weighing the risks v benefits. The product information leaflet in the US also states the findings of the reproductive studies but not the conclusions (pups born with cleft palate, limb deformities etc)…

Also, with the margin of safety tests (i.e. overdose studies) were conducted on 32 Beagles, beginning when they were aged 8-9 weeks. The test lasted 24 weeks, then pups were euthanised. Nothing is known about the long term or cumulative effects. Young dogs may well metabolise it differently to older dogs, dogs with intercurrent medical problems or on medications.

The literature about fluralaner (i.e. Bravecto) is that it is rapidly absorbed, then stored in fat, muscle, liver and kidney for 12 weeks, 90% is excreted unchanged in the faeces. Who knows really what happens as the pups tested above did not have their urine or faeces, or organs studied for any accumulation.

Regarding splitting or crushing - please don't do this! See the FDA's handling procedures just to reinforce that it should be handled as a poison...

"The product labeling contains the following information regarding safety to humans handling, administering, or exposed to BRAVECTO:

Not for human use. Keep this and all drugs out of the reach of children. Keep the product in the original packaging until use, in order to prevent children from getting direct access to the product. Do not eat, drink or smoke while handling the product. Wash hands thoroughly with soap and water immediately after use of the product."

I'm part of a group on FB that is looking into its safety and raising awareness of side effects and the proper channels to report adverse events. If you want to learn more, please look it up : Does Bravecto Kill Dogs. It was started by a lady in the US whose 1.5 year old Cavalier died in August, just weeks after taking Bravecto (a necropsy was performed). Her beautiful dog suffered terribly. It is not a scare mongering group even though I admit the name of the group might make you think it only wants you to draw that conclusion. There are vets that belong to this group and there is a lot of information there such as the documents I've quoted above, and others like MSDS.

I haven't used it and don't know anyone who has, so I can't say how effectively it works and whether there are side effects that I know of personally. However, in the FB group, there are alarming similarities (of some very severe side effects in which some dogs have died) being reported independently from people around the world.

Sure, do your reading. But don't just read up on Bravecto, read reports on NextGard, Trifexis, Soresto, and the many and various synthetic pyretheroids. Flea and tick treatments are all poisons of one sort or another. All are suspect. All have reports of dogs getting severely ill, having seizures, and/or dying after being treated. Some of these reports no doubt come from individual dogs with high sensitivity. Some are probably dogs whose onset of illness happened to coincide with being treated. You need to weigh the potential problems of treatment with the potential problems from not treating; and you need to compare one treatment against another with regard to both effectiveness and potential side effects. This is extremely difficult to do because data are limited (they test on Beagles so does it apply to CKCS?). . . extremely subjective. If paralysis tick is a problem in your area, the equation is heavily weighed in favor of treatment. If you're worried about a flea or two, stop worrying. If your dog has flea allergies, the equation is weighted differently.

In my situation. Frontline no longer works. Fleas are awful here and the do seem to carry tapeworm but we don't have paralysis tick. My dogs share my bed and, in addition to felling bad cause my dogs itch, I get no sleep when the fleas get bad. One of my dogs gets seizures from pyretheroids -- had a horrid incident years back from a spot-on flea treatment based on pyretheroids, and the Soresto collaar provoked mild nervous system problems. Moreover, our local fleas seem to have become immune to the Soresto collar. Bravecto has worked wonderfully for my three dogs with no side effects. At least for three months. I'm ready to continue with it for another three months.

I would not use Bravecto or any other non-essential meds on a pregnant bitch . . . although the FOI report on Bravecto is not as clear as Fides reports. Twenty, not 10, pairs of dogs/bitches were used. Ten were treated, ten were used as controls. The sample selection didn't rule out inclusion of bitches with prior history of birth defects: "The dogs were healthy and had a breeding history of at least four pups weaned in at least two of the three previous litters with no congenital malformations in any pup." So some of the bitches probably had prior history of delivering pups with birth defects. Moreover two litters from the control (untreated) group had total litter loss, as opposed to one of the treated group. The lost litters may well have included high defect loads . . .and somehow the bitch absorbed the pups or otherwise failed to deliver because somehow her physiological systems detected that the pups weren't viable.

The accusatory Facebook page can be found at: https://www.facebook.com/groups/411371212394679/

The FOI report can be located by googling: BRAVECTO FOI Summary - Food and Drug Administration

Happy reading.

It's complicated!!!

Edited September 22, 2015 by sandgrubber

[Fides]

This is link to the FOI summary for the submission to FDA from May 2014 - hope the link works.

http://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/UCM399075.pdf

Sandgrubber - yes it definitely is complicated!

Thanks for pointing out the control group in the reproductive study - I do usually mention the two litter losses in the control group (when I've mentioned the reproductive study in other places) but was just stating how 2 out of the 9 litters born had deformities. But only 20 Beagles (10 male, 10 female) were ever treated with Bravecto for the reproductive study and to me, that sounds like such a small number. I don't know how commonly deformities or litter losses occur in the general dog population, or if some breeds are more prone to problems, so it was the FDA's own conclusion that there are potential treatment related effects on pups that made me start wondering about the safety of the drug and Merck's claim for its use on breeding dogs. Also, my understanding of the eligibility criteria was the 4 pups per litter as you mentioned, but my interpretation was that there had to have been no congenital defects in any pup (not just from those litters). I could be wrong about that.

Agree all these are pesticides which have side effects and the risk vs benefits must be weighed. People need to make their own decisions but be properly informed regarding this.

I live in a tick prone area and tick paralysis is one of my biggest fears. I have picked a tick off my dog already this season (which has only just started in some parts of Australia). My dog is sensitive to permethrins like your dog, and it does limit my choices - it means Advantix, Kiltix, Scalibor and tick rinses are all out, and that pretty much only leaves Preventic, which has its own set of nasty adverse reactions, or the new orals. But given my dog has reacted to Advantix, I am just particularly wary of a drug taken internally which she might react to, that cannot be eliminated for three months and has no antidote. Even Nexgard, only on the market 2 years, is too new for me (especially considering they are a new class of pesticide not previously used even as crop pesticides) if there are other options which do work and she hasn't reacted adversely to. It's the chemical load on the organs in the new drugs that are the unknown - Bravecto sits in the liver, kidney, fat and muscle and who knows whether that will lead to renal/hepatic impairment with ongoing use, or how it might affect a dog that already has some degree of impairment? The studies just haven't been done, and there are no specific warnings on which dogs to take extra care with (apart from dogs with history of seizures I think, though that might be for Nexgard).

Unlike US and Europe where it is prescription only, Bravecto is available over the counter here in Australia. Being a new and relatively unstudied drug, this really worries me - people can buy online win it at auction on eBay, or win in social media give-aways… and I think it can make people lose sight of the fact that it is a potent pesticide and there will be susceptible dogs out there.

I'm sure in the majority of cases it's been taken with no ill effect. But one difficulty that people in that FB group have encountered is vets dismissing symptoms which the dog may experience after taking Bravecto and telling owners they are unrelated. Merck do mention the side effects that occurred in their studies, and there are dogs presenting with those side effects but are being told outright that it can't be from Bravecto.

It's great your dogs have done well on Bravecto and I hope they continue to do so :)

[DeltaCharlie]

I think, like anything, it is up to the individual to do the research and weigh up the risks for them. Every product out there has its pros and cons and due to the large number of people using them worldwide, there are always going to be negative experiences associated with each of them. Thousands of puppies react negatively or even die from puppy shots, but I will always administer the puppy shots anyway (and then titre after that). There is a much greater chance that everything will be fine than there is of it ending badly. Views are skewed as the negative is always broadcast more than the positive.

I was against this product for a long time (and may even have comments to that effect earlier in this thread, I haven't looked). The whole 4-months thing didn't sit well with me- what happened if the dog had a negative reaction? 4months+ is a long time for it to remain in their system with no way to get it out. I have sat back, watched with interest all the dog people I know who were prepared to try it, kept an eye on the results and summed it up for myself.

I will never give Shock Bravecto due to her seizures. I know it is supposed to be safe for fitting dogs (unlike Nexgard which is a big no-no) but that is not a risk I am prepared to take. She copes fine with Scalibor collars so that is what she will continue to wear. We will not give Bravecto to our older boy with the bad heart. He is not in full health to begin with so we will not risk a new product on him. We will not give Bravecto to our older terrier mixes. They are both under 5kg and I believe it is more risky to test something out on such a small body, especially given their ages (14 and 16).

We weighed up the risk for the other dogs, all active border collies in perfect health and decided it was worth trying on them. They all swim regularly (unlike the 4 mentioned in the previous paragraph) and when we move next month will likely swim daily. Too many times we have forgotten to put their scalibor collars back on them lately (we used to be really good at it) and some have started to eat them off. We worked out that one of them went 2 months without a collar and we hadn't realised. We just kept meaning to get her a new one and kept forgetting. The risk for those dogs is higher with the collars than it is with Bravecto.

Most dog products are via prescription only in the US :) You can't just buy interceptor etc like we can over here, everything has to be prescribed by the vet. They have different regulations over there than what we have here, it has nothing to do with Bravecto itself. I give Shock Melatonin at night to help with her seizures, it is only available by prescription in Aus but can be bought online in the UK or US and sent here without issue. Different regulations for different products.