Ask the Vet: What to Know Before Buying From an Online Pharmacy

By Lee Pickett
Lee Pickett
Lee Pickett
Lee Pickett, VMD, practices companion animal medicine in North Carolina. Contact her at Copyright 2021 Lee Pickett, VMD. Distributed by
September 21, 2021 Updated: September 21, 2021

Q: Our six dogs and cats are on preventives throughout the year to protect them from heartworms, intestinal parasites, fleas, and ticks. We want to continue buying them from our veterinarian, but he can’t match the prices we found online.

A friend learned the hard way, though, that some online pharmacies sell counterfeit medications. How can we be sure we’re getting the real thing?

A: Buying drugs from an online pharmacy does present risks. Most manufacturers guarantee medications dispensed by your veterinarian, but not those shipped from an online pharmacy. One reason is that freezing winter temperatures and summer heat and humidity can affect the potency and stability of drugs and vaccines.

In addition, many online pharmacies sell counterfeit or adulterated medications made by companies that ignore federal and state drug laws. One hint that a pharmacy isn’t legitimate is that it doesn’t require you to provide a prescription for a prescription-only medication such as heartworm prevention.

The National Association of Boards of Pharmacy, or NABP, investigated more than 25,000 online sources of prescription medications and found that only 5 percent comply with U.S. laws and industry standards. Many of the others are rogue pharmacies that distribute drugs that are useless or even harmful.

To address these problems, the NABP established the “.pharmacy” web address available only to legitimate pharmacies. The NABP thoroughly evaluates each internet pharmacy, probing the entire supply chain, from the manufacturer through the distributor to the pharmacy dispensing the medication to the consumer.

You can feel confident buying from a “.pharmacy” website. To find these reputable pharmacies in the United States, Canada, and elsewhere, visit Safe Pharmacy’s website. Or purchase directly from your veterinarian.

Q: My 2-year-old cat has had recurrent episodes of urinating outside the litter box, straining to urinate, and producing bloody urine. His veterinarian, who ruled out bladder stones, infection, and other diseases, diagnosed Pandora syndrome and recommended environmental enrichment. Amazingly, it’s working. Please educate me.

A: Pandora syndrome, sometimes called feline idiopathic cystitis, is a group of physical manifestations of an abnormal stress response system. Pandora syndrome can’t be cured, but it can be successfully managed.

In addition to recurrent urinary problems, these cats usually have another medical or behavioral condition, such as obesity, vomiting, diarrhea, or excessive grooming, that waxes and wanes.

Cats diagnosed with Pandora syndrome often have a history of early abandonment or other trauma. They tend to be nervous, exhibiting heightened vigilance and slower return to normal behavior after a stressful event.

These cats differ from normal cats in physical ways, too. The region of their spinal cord that receives sensory nerve signals is larger, and they are more sensitive to pain.

At rest and during stressful events, a Pandora cat’s nervous system produces higher levels of some neurotransmitters, particularly those related to stress. As a result, their response to external stressors, such as sudden noise, is more pronounced.

Their adrenal glands are smaller and function less well in response to stress. Moreover, the structure of the Pandora cat’s bladder wall is abnormal.

While dietary modification and increased water intake have proven helpful, the most effective treatment is environmental enrichment.

The first step in lessening resource-related stress is to offer at least one more of each important resource than the number of cats you have. So, if you have two cats, you should provide at least three sleeping areas, food and water bowls, litter boxes, and scratching posts.

Lee Pickett
Lee Pickett, VMD, practices companion animal medicine in North Carolina. Contact her at Copyright 2021 Lee Pickett, VMD. Distributed by