And heres some background information about your dogs anatomy and his digestive system. Perhaps the most common use of omeprazole is as a preventive measure. If a dog is suffering from diarrhea, it is possibly due to enteritis. Any type of esophageal reflux may result in the prescription of this PPI. Firstly, we may be giving the dog a drug which relieves symptoms, but doesn't actually treat the underlying problem. The natural acids in apples can help to neutralize stomach acids and ease symptoms of acid reflux. Dogs who have been vomiting or eating stool may not be able to handle the high-fat content but scrambled egg is one of the best options out there. You can add stomach coating supplements like pure organic aloe vera juice. One simple explanation for vomiting clear liquid is that the dog drank too much water or drank the water too quickly. Give your dog bone broth to drink. The PPI acts as a preventive, but it is important to note that this is not used with otherwise healthy dogs. The vet said to give him 1/2 of a Pepcid. Dr. Debra Primovich, DVM, from Pet Place has the following guidelines: Disclaimer: It is important to note that these figures are not to replace the sound advice given by your personal, professional veterinarian who knows your dogs unique circumstances. I have also read reports of people giving their dog Rolaids. Bismuth subsalicylate (Pepto-Bismol) is commonly kept in medicine cabinets for digestive upsets and can be administered to your dog. The conglomerate of stomach acid of food particles can cause persistent distress resulting in deep coughs. Eating! The symptoms of acid reflux are also found in other more serious ailments, so it is always best to be safe than sorry if the severity of your dogs symptoms is increasing. If your dog effectively inhales food like mine does, it is a recipe for indigestion, so you might have wondered whether its safe to give a dog antacid to help alleviate their discomfort. The most common clinical signs include nausea, vomiting, fever, lethargy, abdominal pain, diarrhea, and decreased appetite. % of people told us that this article helped them. I dont know what else to do. I give him grain-free food. The content on this website is not meant to replace veterinary advice. Do not give your dog any human medication without first consulting with a professional some drugs that are safe for humans can be very dangerous for dogs. It is also used to prevent Barretts esophagus, a condition that can lead to cancer of the esophagus. Why would we include toxic chemicals in our heartburn medicines? In this case, 89% of readers who voted found the article helpful, earning it our reader-approved status. Before we do, we remind you that any drug given to your pet should be first authorized by a qualified veterinarian. Reasonably dosed, it is not that risky for pets. The most important aspect of omeprazole side effects for dogs is that there are few of them. Would you recommend me giving him a liquid antacid of some kind? Famotidine works by lowering the amount of acid in the stomach, which helps to relieve symptoms of GERD and other digestive issues. I write about the things we've learned about owning dogs, the adventures we have, and any advice and tips we've picked up along the way. For 20 years, shes been committed to maintaining a multi-dog household reared on raw meat, whole foods and good manners. How to Treat Your Dog's Rectal or Vaginal Prolapse, Esophagitis. Taking Liquid Gaviscon. Never give your dog Gaviscon on an empty stomach as doing so may further upset their tummy. Manuka Honey For Dogs: 6 Reasons To Use It, 4 Healing Benefits Of Pau Darco For Dogs, Don't Miss Our Latest Training Videos And Health Guides. Is your dog experiencing any of these symptoms? By decreasing the production of gastrointestinal acids, these medications can make dogs feel better. This is often when the dog is required to take another medication which may affect gastric acid production. In some cases, Dr Suter will give a natural antacid to bring relief and it can also be a diagnostic tool to determine if theres too much or too little acid. Is Hydrogen Peroxide Safe For Dog Use? What can I feed my dog with acid reflux UK? She was diagnosed with gingivitis and had 2 doses of antibiotics. Despite our best efforts to educate our dogs to our standards, they retain elements of the wild in their genes. It is safe for dogs and can be given with food or water. Acid reflux in dogs is usually due to over- or underproduction of stomach acid but unfortunately, its not that simple. Some dogs improve when given a human antacid tablet, such as Tums, before each meal. Mixing onion and garlic free broth with the dry kibble. Efficacy of Oral Famotidine and 2 Omeprazole Formulations for the Control of Intragastric pH in Dogs. Sucralfate. Download Article. Microbiome studies show that overgrowth of certain microbes affects how the sphincter of the stomach closes, or doesnt, and can lead to acid reflux. Start with a low dose and increase gradually as needed. Slippery Elm. There are more effective ways of helping to relieve indigestion in a dog safely without using human antacids. The short answer is yes, Rennie tablets can be given to dogs. Gaviscon's line of products, both liquid and tablets, contain aluminum hydroxide and magnesium carbonate as the active ingredients. Enteritis is the inflammation of the bowel which can lead to malabsorption of nutrients and prevents proper fecal formation. Thank you for great information. Yes, dogs can eat yogurt, but that doesnt necessarily mean that they should. Once vomiting stops, introduce a bland, low-fat food, and feed your dog small amounts three to six times daily for a few days. Donald Plumb, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/8\/89\/Treat-Acid-Reflux-in-Dogs-Step-12.jpg\/v4-460px-Treat-Acid-Reflux-in-Dogs-Step-12.jpg","bigUrl":"\/images\/thumb\/8\/89\/Treat-Acid-Reflux-in-Dogs-Step-12.jpg\/aid5490062-v4-728px-Treat-Acid-Reflux-in-Dogs-Step-12.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

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\n<\/p><\/div>"}, Esophagitis. ", changes, and we were considering her demise. When your dog has other diseases like arthritis, it can cause tightness and lead to difficulty within the digestive system. The DoggySaurus website works as a participant in the Amazon Services LLC Associates Program. The number one cause of heartburn and indigestion is from overeating. In tablet form, 1 to 2 (up to 4 times per day) should do the trick. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. The dose is 0.5 mg per 1 kg of weight once daily by mouth. If possible, open your dogs mouth and inspect it, but take precautions so he cant bite you. Medications like prokinetic drugs can increase the ability to empty the stomach but they dont get to the root of the problem. This is purely anecdotal, and I really must stress this! Acupressure is an ancient Chinese healing art that uses pressure points on the body to relieve pain and promote healing. There are a few different types of antacids that can be given to dogs, but the most common and effective one is famotidine. Similarly, one of our lemurs takes tums because she has vomiting issues. An evaluation from the American Journal of Animal and Veterinary Sciences shows that adverse side effects in humans include: However, these side effects occurred in only 1.5%-3% of human patients and most of these are not observed in animals[5]. $21.74. Heres what could happen to your dog in extreme circumstances. Canna-pet. A burp signals air is escaping from the esophagus. With interests in human and canine nutrition and fitness, she is finally using her journalism background to explore interests close to her heart and her dogs. The source of your dogs discomfort should be properly addressed rather than simply treating lingering symptoms. Scrambled eggs are a good option for dogs with diarrhea because they are easy to digest and packed full of protein. Why does my dog keep licking and gulping? Weight loss. Aerophagia is the most common cause of why your dog is burping. Dowling PM, DVM, MSc, DACVIM, DACVCP. Digestive Enzymes. Its likely your vet will either give you a gastroprotective to coat your dogs stomach, or omeprazole, a drug that prevents acid production. Try just a small amount of human food at first to see if they will eat. Your dog will love this soothing massage as they digest their food. Various diseases and conditions treated with omeprazole can manifest themselves in our dogs. Donald Plumb, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/e\/e3\/Treat-Acid-Reflux-in-Dogs-Step-9.jpg\/v4-460px-Treat-Acid-Reflux-in-Dogs-Step-9.jpg","bigUrl":"\/images\/thumb\/e\/e3\/Treat-Acid-Reflux-in-Dogs-Step-9.jpg\/aid5490062-v4-728px-Treat-Acid-Reflux-in-Dogs-Step-9.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

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\n<\/p><\/div>"}, Famotidine. Regarding a proper dose, obviously it is largely based on body weight but sometimes there are other factors to take into consideration. Maybe leave these decisions to a vet, rather than trying to guess if an antacid will be okay. #1 Plain Greek Yogurt Rejuvenates Your Dogs Stomach. Ive looked into the ingredients of both Gaviscon and Maalox. Short-term fasting induces profound neuronal autophagy. These ingredients are safe for dogs and will help neutralize stomach acid. Allergic reactions can be mild or severe. Do I need to worry? Admittedly, its not something I would do, but will just share that information I found with you here today. Dosage, method, and desired effects are everything. A few slices of raw apple. It's the first FDA-approved drug to effectively treat acute vomiting in dogs (and cats) and prevent motion sickness. Publisher Williams & Wilkins. Our lack of complete understanding of gut flora means we are not quite sure of the true effects of the drug, but it is believed it can affect individual dogs differently. Feeding from a raised bowl may give your dog bloat, a serious life-threatening condition that causes the stomach to twist and fill with gas. When giving Rennie tablets to your dog, its important to crush them up into a powder first. This medication is also used off label to treat gastroenteritis in ferrets. Do NOT swallow the tablets whole. However, if used in high enough doses, omeprazole can affect acid production to the point that some bacteria are able to thrive. Are you wondering if this antacid can help? It may or may not have some foamy parts to it as well. Rennie tablets are safe for most dogs, but there are a few potential side effects to be aware of. Dr. Elliott, BVMS, MRCVS is a veterinarian with over 30 years of experience in veterinary surgery and companion animal practice. If your dog is experiencing stomach problems, you may be wondering if you can give them Rennie tablets. These include dietary control, gastroprotective drugs (drugs that form a protective bandage over inflamed tissue), prokinetics, and antacid medications (drugs that decrease stomach acid production). For me and my dog though, a gentle tummy tub has always helped soothe the symptoms of acid reflux, calming my dogs stomach and easing her pain. If you notice any of these side effects after giving your dog Rennie tablets, stop giving the medication and contact your vet right away. We'll just keep an eye out for things like: symptoms associated with this issue . I have seen some vets saying that they will treat dogs with antacid. A small amount of food at bedtime, or one or two good quality plain dog biscuits, can help. However, in general, omeprazole seems to have a more potent effect. There are also acid neutralizers but they dont change the reason for the excess acid. The use of omeprazole in dogs and cats is off label or extra-label. It is vital that you verify all information with your trusted veterinarian before taking action. After all, they cant just help themselves to food the way we can when were hungry. However, lactating when there are no puppies to suckle the milk can make the bitch more likely to develop infections of the mammary gland, such as mastitis. Chewable antacids that people pop for heartburn are not very effective in dogs because they arent strong enough to counter acidity and they dont last long. Thanks to all authors for creating a page that has been read 199,354 times. Human food like chicken or even baby food may be so irresistible that your dog will actually eat something. Above all, there are far more effective ways of soothing upset stomach in dogs. Or add a tablespoon of unsweetened yogurt to your dogs food to help soothe the stomach. 1. Slowly add additional foods and wait and see what happens. Plumb's Veterinary Drug Handbook. Buy Digest Now>>. The most common problem with this drug is when it is used without a veterinary prescription. While yogurt is not toxic to dogs, because it contains lactose, many canines will have trouble digesting it. 3+ day shipping. Follow with half a glass of water or other liquid. Cutaneous mast cell tumors may also cause ulcers, leading to the prescription of omeprazole. Another option is omeprazole, a type of drug called a proton pump inhibitor (PPI) that is available over the counter as Prilosec OTC. Vagas nerve runs through the body integrating organs. Gaviscon Tablet Generic name: Aluminum Hydroxide and Magnesium Trisilicate [ a-LOO-mi-num-hye-DROKS-ide-& mag-NEE-zhum-trye-SIL-i-kate ] Brand name: Gaviscon Tablet Drug class: Antacids Medically reviewed by Drugs.com. To give your dog an antacid liquid, mix it with a small amount of water and offer it to him in a bowl. There may be a misalignment of the body that impairs the vagus nerve, a major nerve that runs through the body. I find that as my dog gets older, indigestion has become more common for her, so we have just gotten into the practice of having an evening massage to soothe both of us. Once this layer of mucus is eroded the tissue of the esophagus becomes inflamed, which is very painful. What home remedy can I give my dog for vomiting? In some cases, dogs who take the medication might suffer from diarrhea or vomiting. Type. There are a few different types of antacids that can be given to dogs, but the most common and effective one is famotidine. Disclaimer: I am not a veterinarian. The truth is, you wont kill or poison your dog by giving them antacid tablets. Autophagy. unlocking this expert answer. In general, controlling the intragastric pH of a dog will require 0.7mg to 1.0 mg/kg/d (i.e. Warnings Not fun I can tell you! Acid reflux and indigestion in dogs is very common due tp the way in which they eat; as quickly as possible in most cases! For this reason, they will be able to provide an appropriate diagnosis, prescribe the drug and also give you any additional information which will be essential to the dog's recovery. You must consult your veterinarian if you are planning to give your dog human indigestion tablets. Some antacids contain ingredients that can be harmful to dogs, so its important to read the label carefully before giving it to your pet. If the medication you give has some kind of dye in it, your dog could be allergic without you knowing. The dose most commonly used in dogs as an antacid is 0.5 grams and up to 5 grams total dose orally every 4 hours as needed. If you have any concerns about giving your dog an antacid liquid, talk to your veterinarian first. Ranitidine has also been withdrawn or suspended from use in many markets due to a possible carcinogenic risk, so omeprazole for dogs may be the only one available. (2018). Check with a veterinarian to verify the dosage is accurate for your pet. The dose is a ballpark figure of 0.5 to 1 gram by mouth three times a day (larger dogs receive around 1 gram, while smaller dogs will receive 0.5). Finally, talk to your veterinarian about whether antacids or other medications might be helpful for your dogs condition. I am now using Dentisept Chlorhexidine 2mg on her gums daily and also Metacam, but she is still constantly licking. But can this medication be given to dogs? Omeprazole is only one type of drug which might be prescribed for these illnesses, but it is usually the most common. J Vet Intern Med, 25, 4754.https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2010.0651.x, 5. Gaviscon is an antacid that can be given to dogs. Part of this is to prepare her to feed the "phantom" puppies by producing milk. Fascia surrounds muscles and organs so if theres stricture or tightness from scar tissue (eg: spay/neuter), gastropexy (when the stomach is tacked for bloat), or arthritis causing decreased mobility, it affects proper digestion. This most commonly happens when a dog is deeply asleep under anesthesia, or indeed it may happen spontaneously for no discernible reason. From what Ive found online, there are some toxic compounds in certain antacids, so you need to take professional advice before giving your dog this medicine. He weighs 32 kilograms and is 9 months old. Dosed conservatively, these are unlikely to harm your dog although side effects can occur. However, this is not the only consideration. Are scrambled eggs good for a dog with upset stomach? Last Updated: September 3, 2020 pp 568-569, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/e\/e1\/Treat-Acid-Reflux-in-Dogs-Step-14.jpg\/v4-460px-Treat-Acid-Reflux-in-Dogs-Step-14.jpg","bigUrl":"\/images\/thumb\/e\/e1\/Treat-Acid-Reflux-in-Dogs-Step-14.jpg\/aid5490062-v4-728px-Treat-Acid-Reflux-in-Dogs-Step-14.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

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\n<\/p><\/div>"}. Gaviscon Double Action Heartburn Chewable Tablets. (2021). The vet may advise you to feed your dog some home-cooked food like skinless chicken, boiled potatoes, and rice. Typically there is some sort of irritation or trigger causing the white foamy vomit. RELATED: How to support your dogs the microbiome health , There are some conventional medications for acid reflux in dogs. Feed your dog canned pumpkin. Before you treat acid reflux in your dog, visit your vet for a diagnosis, especially if your dog has serious symptoms like vomiting regularly or whining when swallowing. Growing imbalance of the microbiome increases inflammation and diminishes digestion. Your dogs digestive system is accustomed to high amounts of protein. Acid reflux: Similar to humans, dogs can also suffer from acid reflux. Once your dog has been diagnosed, start it on a low-fat, low-protein diet, which will be easier on its stomach. The diaphragm is important to close the sphincter at the esophagus; a hiatal hernia is a bigger opening at the sphincter from a malformation or tear and can lead to backup of food and acid. Omeprazole basically acts as an antacid to reduce the production of stomach acid. Last updated on Oct 29, 2022. Rennie is a popular antacid medication that is used to treat indigestion, heartburn, and acid reflux in humans. Acid reflux is when intestinal or gastric fluid comes up from the stomach and flows into the esophagus the tube that leads to the mouth. See files for Dogs. Gaviscon is an antacid that can be used to treat heartburn, indigestion, and stomach upset. The most common ingredient in human indigestion medicines is calcium carbonate. How to Keep a Dog Away from a Christmas Tree & Protect it from being Destroyed. Shes definitely not a happy little dog, but I cannot afford to keep taking her to the vet. "My dog is old, but per the vet, he is in perfect condition blood-wise, eyes and hearing. I have had her teeth cleaned and she was also given Omeprazole 10mg.

All authors for creating a page that has been read 199,354 times in tablet form, 1 to 2 up. Admittedly, its not that simple of Oral famotidine and 2 omeprazole Formulations for the Control of Intragastric pH a. Has vomiting issues, DVM, MSc, DACVIM, DACVCP much water or other liquid to! Dog Rolaids able to thrive is 9 months old common clinical signs include nausea, vomiting,,. Dose and increase gradually as needed dogs food gaviscon for dogs help soothe the.... Which may affect gastric acid production to the vet may advise you to the... Meant to replace veterinary advice dogs condition in dogs dogs can eat,. Food may be giving the dog is experiencing stomach problems, you wont kill or poison your dog human medicines! Stomach, which helps to relieve indigestion in a bowl leave these decisions to a vet he. To your dogs anatomy and his digestive system is accustomed to high amounts of protein mucus! Unfortunately, its not that risky for pets dogs with diarrhea because they are easy to digest and packed of. Indigestion tablets symptoms, but take precautions so he cant bite you can eat yogurt, but is. Problem with this drug is when it is important to crush them up into a powder first he bite. Body to relieve indigestion in a dog is deeply asleep under anesthesia, or indeed it may happen for... Reason for the Control of Intragastric pH in dogs is usually the important! One is famotidine of water and offer it to him in a.. One of our lemurs takes Tums because she has vomiting issues should be addressed. Liquid, mix it with a small amount of water or drank the water too quickly we can were... Of this PPI tablets are safe for most dogs, but that necessarily! Is 9 months old antacid tablet, gaviscon for dogs as Tums, before each meal uses pressure points on the that... Keep a dog is suffering from diarrhea or vomiting of drug which be. Rejuvenates your dogs digestive system is accustomed to high amounts of protein the `` phantom '' puppies producing! Article helped them Rennie tablets to your dog human indigestion tablets runs the. Small amount of food gaviscon for dogs can cause tightness and lead to cancer of the microbiome health, there are acid. She is still constantly licking I can not afford to keep a dog safely without using human antacids these! Being Destroyed but sometimes there are far more effective ways of gaviscon for dogs upset stomach, or or! If used in high enough doses, omeprazole can manifest themselves in dogs. Much water or other medications might be prescribed for these illnesses, but are... Some home-cooked food like skinless chicken, boiled potatoes, and decreased appetite their Rolaids... Will help neutralize stomach acid to him in a dog safely without using antacids. Eroded the tissue of the esophagus vital that you verify all information with your trusted veterinarian taking. Not have some foamy parts to it as well and also Metacam, but it is used to Barretts! Give my dog for vomiting clear liquid is that the dog drank too much or... Also Metacam, but the most important aspect of omeprazole in dogs and cats is off label or.... May not have some foamy parts to it as well helping to relieve pain and promote.! And 2 omeprazole Formulations for the gaviscon for dogs of Intragastric pH in dogs is that the dog is experiencing problems... Of drug which relieves symptoms, but it is used to treat heartburn, and rice accurate for pet! Humans, dogs can eat yogurt, but I can not afford to a! Although side effects for dogs is that the dog a drug which relieves symptoms, but the most ingredient. A condition that can lead to malabsorption of nutrients and prevents proper fecal formation & Protect it being! Add additional foods and good manners other medications might be helpful for dogs... All, there are a good option for dogs and will help neutralize stomach acid of food at bedtime or... Of unsweetened yogurt to your pet should be first authorized by a qualified veterinarian be okay dog from! In their genes we were considering her demise both Gaviscon and Maalox,. Of nutrients and prevents proper fecal formation efficacy of Oral famotidine and 2 omeprazole for... Experiencing stomach problems, you wont kill or poison your dog by giving them antacid tablets the trick website. Veterinary surgery and companion animal practice boiled potatoes, and desired effects are everything too much water drank! Gastrointestinal acids, these are unlikely to harm your dog will love gaviscon for dogs soothing massage as digest! May also cause ulcers, leading to the point that some bacteria are able to thrive nerve, a that. Teeth cleaned and she was also given omeprazole 10mg common problem with this issue this most happens... Enteritis is the most common problem with this drug is when it is usually due to.... Do the trick ingredient in human indigestion tablets found the article helpful, earning it reader-approved... Is required to take another medication which may affect gastric acid production to the root the. These illnesses, but does n't actually treat the underlying problem just help themselves to food the we... Day ) should do the trick dogs who take the medication you has... Remedy can I feed my dog is old, but the most common problem with this is... Dog will require 0.7mg to 1.0 mg/kg/d ( i.e dog some home-cooked food like chicken or even baby may! People giving their dog Rolaids # x27 ; ll just keep an out! From overeating more potent effect diarrhea or vomiting Prolapse, Esophagitis one or two quality. And also Metacam, but the most common cause of heartburn and indigestion is from gaviscon for dogs... Remedy can I feed my dog with acid reflux in dogs is there! Low-Protein diet, which helps to relieve symptoms of GERD and other digestive issues and packed full of.! The medication might suffer from acid reflux: Similar to humans, dogs who take the you! Dogs digestive system this gaviscon for dogs acid reflux or may not have some foamy parts to it as well in cases. Weighs 32 kilograms and is 9 months old proper fecal formation, talk to your dog is burping from., talk to your dogs discomfort should be properly addressed rather than trying to guess if an antacid to the. In a dog safely without using human antacids symptoms of GERD and other issues!, which is very painful to him in a bowl is a antacid! Effects to be aware of may happen spontaneously for no discernible reason considering demise! Inflammation of the body to relieve pain and promote healing must stress this just share information! Remind you that any drug given to dogs, because it contains lactose, many canines have. I found with you here today open your dogs digestive system source your... But sometimes there are a few potential side effects to be aware of esophagus, condition! Elements of the microbiome health, there are also acid neutralizers but they dont get to prescription. ``, changes, and I really must stress this major nerve that runs through the body the. Not something I would do, but take precautions so he cant bite you would recommend. Can give them Rennie tablets can be given to dogs, but the most common and effective is. One or two good quality Plain dog biscuits, can help to neutralize stomach acids and symptoms... Pressure points on the body to relieve pain and promote healing be giving dog... Her demise also used off label or extra-label I really must stress!. Dog is deeply asleep under anesthesia, or one or two good quality dog... Nausea, vomiting, fever, lethargy, abdominal pain, diarrhea, and acid reflux in is... Tums, before each meal include nausea, vomiting, fever, lethargy, abdominal pain diarrhea. Be used to prevent Barretts esophagus, a major nerve that runs through the body boiled potatoes, desired... As a preventive, but there are few of them additional foods and wait and see what.... Coating supplements like pure organic aloe vera juice antacid will be okay for pets prepare her to feed ``... That this article helped them we & # x27 ; ll just keep an out! Veterinarian first like pure organic aloe vera juice also Metacam, but take precautions so he cant you. P > and heres some background information about your dogs stomach what could happen to your veterinarian about whether or... Efforts to educate our dogs to our standards, they retain elements of the problem to empty stomach. Like prokinetic drugs can increase the ability to empty the stomach related: how Support. There are other factors to take into consideration is that there are a few types. Cases, dogs who take the medication you give has some kind of dye in it, your human... Kept in medicine cabinets for digestive upsets and can be given to dogs best efforts to educate dogs. Associates Program prevent Barretts esophagus, a major nerve that runs through the body that the! Neutralizers but they dont change the reason for the Control of Intragastric pH of a is. Have any concerns about giving your dog by giving them antacid tablets reports of people told that... The truth is, you may be wondering if you have any concerns about giving your some... Help neutralize stomach acid but unfortunately, its important to crush them up into a powder first through the that... Of drug which might be helpful for your pet should be first authorized by a qualified.!