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Compounded Medications for Podiatrists

 

Pharmacy compounding is the art and science of preparing customized medications for patients. We specialize in customizing medications to meet unique patient and unique physicians needs. We work closely with physicians helping them formulate unique combinations both in strength and dosage form.

¨ Unique medication strengths: A medicine may be available only in one or two strengths. However, your doctor may find that the best dose is not one of those. We can prepare a dosage form that will contain whatever amount your doctor orders. You don’t have to take too much medicine which could cause adverse effects or too little which may not work for you.

¨ Unique dosage forms: Medicines often are available only in tablets or capsules. We are able to compound a medication in may different forms including a oral liquid, suppository, topical creams, gels, solutions, lozenges, troches, mini troches, rapid dissolve tablet, and more.

¨ Unavailable medications: Pharmaceutical companies may stop making products for which there is a limited demand. If we can obtain the medicine in its chemical form, we can compound it for you.

¨ Bad tasting medicine: Some individuals will not take a medicine because of bad taste. This is a special problem when a medicine must be taken for several months or years to control a chronic health problem. We can prepare dosage forms in flavors that people like. We have over 40 different flavors (ex: banana cream, butterscotch, pina colada, cheesecake, grape, english toffee, etc)

¨ Allergies: Commercial medicines may contain preservatives, dyes, flavors, and fillers. If a patient is allergic to any one of these ingredients using that medicine could result in unpleasant or life-threatening reactions. We can prepare medicines that are free of materials to which a patient is known to be allergic.

Onchomycosis treatment: Onychomycosis accounts for one third of fungal skin infections; because only about one half of nail dystrophies are caused by fungus. Dimethylsulfoxide (DMSO) base: Penetrates to nail and skin and has efficient delivery of drug to the site of action. There are a number of topical antifungals available like flucanozole, itraconazole, ketoconazole, undecleynic acid, tea tree oil etc. Ibuprofen has a synergistic action with “azole” antifungals. Bulk chemical source of antifungal agent allows for addition to cream, ointment, gel, and liquid preparations. They can also be combined with other agents such as steroid, anti-pyretic, anti-viral or additional anti-fungal for additive coverage The patient applies Urea cream 40% on the affected nail, to softens the nail, which allows for easier penetration of medication. Then apply the topical fungal compound for 3 to 6 months. The topical fungal compound can have 3 to 5 antifungal antibiotics such as miconazole, ketoconazole, itraconazole, sporanox and also ibuprofen. This eliminates the load on liver and kidneys.

D11A

Urea 40%

 

App HS

D11

Ketoconazole 2% + Ibuprofen 2% + Miconazole 2% + Lamisil 1% in DMSO/ Benzoyl alcohol solution

15ml

App BID for 14 wks

D12

Ketoconazole 2% + Ibuprofen 2% + Miconazole 2% in DMSO/ Benzoyl alcohol solution

15ml

App BID for 14 wks

D12A

Ketoconazole 2% + Ibuprofen 2% + Miconazole 2% + Sporanox 1% in DMSO/ Benzoyl alcohol solution

15ml

App BID for 14 wks

Pre-treatment for Onchomycosis: Urea 40% ointment –apply to nail at bedtime and occlude. Nail will soften and thin for optimal absorption of medication. Nail may come off in a week or two.

Warts: The Human Papilloma Virus causes this. Classic treatments include the use of caustic keartolytic agents of wart tissue. Agents most commonly used are 2-Deoxy-D-Glucose, Cimetidine, Cantharidin, Trichloroacetic acid, 5-FU, podophyllin, Salicylic Acid up to 80%, Squaric Acid,

D4

Canthardin Solution 70mg/10ml

   

D4A

Cantharidin + Podophyllin + TCA + 2-Deoxy-D-Glucose

   

D4C

Cantharidin + Podophyllin + TCA + Salicylic acid

   

D4D

2-Deoxy-D-Glucose 0.19%

gel

 

Hard to find or discontinued Injectables such as Hyaluronidase injection, Betamethasone sodium Phosphate injections, Dexamethasone sodium Phosphate injections, etc.

Foot Odor:

· Drying agents

· Adsorbent base-talc, Starch, Microcrystalline cellulose, Alcohol

· Antibacterial agents

In powder, cream, spray, solution, or roll-on dosage form.

Topical Anesthetics: Main ingredients contain - Benzocaine + Lidocaine + Tetracaine. We call it “Fort BLT”. Many dermatologists use this for laser hair removal and minor in office procedures to provide a local anesthetic effect. We can compound as solution, spray or gel for local anesthesia. Any combination of anesthetics in many choices of bases is available to be compounded.

P9

BLT Gel – Benzocaine 20% + Lidocaine 8% + Tetracaine 4%

Gel

30g

App 20 minutes prior to procedure

Wound care is critical because without it, loss of morbidity or death from overwhelming systemic infection can occur, especially in immunocompromised patients or those with lymphedema or peripheral vascular disease. Even newer antibiotics require a special vehicle to reach the site of injury. It has been found that if an effective base is used, only topical preparations are necessary to heal wounds unless the patient has underlying health problems. Some of the formulations that have given excellent results are:

· Misoprostol 0.0024 %(a gastric antisecretory and antiulcer agent that exerts a protective effect on the

gastro-duodenal mucosa), Metronidazole 2 %( for odor control), and lidocaine 2% (for pain relief) in a

gel base.

· Nifedipine gel encourages vasodilation, epidermolysis and possible microvascular neogenisis in the

area surrounding the ulcer.

· Phenytoin 5 % (for wound healing), misoprostol 0.0024% (a gastric antisecretory and antiulcer agent

that exerts a protective effect on the gastro-duodenal mucosa).

D19A

Gabapentin 1% + Lidocaine 1% + Ketoprofen 2% + Phenytoin 2% + Misoprostol 0.0024% Burn cream

   

D19C

Misoprostol/Phemnytoin/Tobramycin cream

   

D19D

Misoprostol 0.0024% + Metronidazole 2% + Lidocaine 2%

   

D19E

Misoprostol 0.0024% + Phenytoin 5%

   

Diabetic Neuropathy: Neuropathic agents applied transdermally to treat pain avoid systemic side effects, efficiently deliver the drug to the site of application and may also be able to administer multiple drugs in one dosage form. Agents used to increase the circulation are:

· Nifedipine transdermal

· Pentoxifylline transdermal

· Alpha lipoic acid: Modulates the nitric oxide within the cell, stimulates the glucose uptake from free radicals and also helps prevent diabetic neuropathy by decreasing lipid peroxidation of nerve tissue.

P6P

Lidocaine 10% + Ketoprofen 10 % + Ketamine 10% + Gabapent 10%

Gel

60g

App 2 to 3 times a day

P6P1

Lidocaine 10% + Ketoprofen 10 % + Ketamine 10% +

Gabapent 10% + Nifedipine + Pentoxyfylline + Alpha lipoic acid

Gel

60g

App 2 to 3 times a day

P7

Lidocaine 5% + Ketoprofen 20% + Ketamine 2% + Carbamezapin 5% + 0.2% 2-Deoxy-D-Glucose + 3% Acyclovir

Gel

60g

App 2 to 3 times a day

Pain and Inflammation: Compounding with transdermal bases enables the delivery of drug to the site of action while avoiding systemic side effects as with NSAIDS, narcotics, Pentoxyfylline, Neuropathic pain agents. They may be combined with muscle relaxants such as Cyclobenzaprine, Baclofen etc as needed. The major advantage is that it avoids drowsiness and gastric upsets.

P1

Ketoprofen 10 %

Gel

60g

App 2 to 3 times a day

P2

Ketoprofen 10% + Cyclobenzaprine 1% + Lidocaine 4%

Gel

60g

App 2 to 3 times a day

P3

Diclofenac 5% + Lidocaine 4% + Prilocaine 2% + Gabapentin 3% + Baclofen 1%

Gel

60g

App 2 to 3 times a day

P5

Lidocaine 5% + Ketoprofen 20% + Ketamine 2% + Carbam 5%

Gel

60g

App 2 to 3 times a day

 

 

 

Hyperhidrosis:

· Local anesthetics:

· Lidocaine 5% + Prilocaine 5%

· Other agents: Methenamine 5%, Formaldehyde 5-20%, Glutaraldehyde10%, Atropine or Scopolamine 0.25%

· Iontophoresis with tap water

· Deodorant additives—tea tree oil, triclosan chlorhexadine etc.

Feel free to call myself, or one of our compounding pharmacists, if you have any questions or interests. We do mail directly to patients or physicians offices. Our commitment to our patients and physicians is always our priority. We hope to help you to help your patients!



Tel: (562) 866-8363

Fax: (562) 925-6208