In the prescribing cascade, step 2 asks: which question?

• A. Is there a licensed medication in Northern Ireland?
• B. Is there a licensed medication for the same condition but in a different species?
• C. Is there a licensed medication for human use for the same condition?
• D. Is there an unlicensed alternative?

Answer: (A)

In the prescribing cascade, the priority is to use medicines that are licensed for animals in the clinician’s jurisdiction. The next check is to ask whether there is a licensed medication available in Northern Ireland for the same condition. If such a locally licensed option exists, it should be used rather than moving to unlicensed products or medicines licensed elsewhere. Only if there is no NI-licensed option would you consider other routes, such as medicines licensed for a different species, human medicines, or unlicensed alternatives, with appropriate safeguards. The other questions don’t fit the immediate step because they either refer to licensing outside Northern Ireland or to unlicensed options, which come after confirming a locally licensed product.