| 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.
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D11A |
Urea 40% |
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App HS |
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D11 |
Ketoconazole 2% + Ibuprofen 2% + Miconazole 2% + Lamisil 1% in DMSO/
Benzoyl alcohol solution |
15ml |
App BID for 14 wks |
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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,
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D4 |
Canthardin Solution 70mg/10ml |
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D4A |
Cantharidin + Podophyllin + TCA + 2-Deoxy-D-Glucose |
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D4C |
Cantharidin + Podophyllin + TCA + Salicylic acid |
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D4D |
2-Deoxy-D-Glucose 0.19% |
gel |
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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 |
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D19C |
Misoprostol/Phemnytoin/Tobramycin cream |
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D19D |
Misoprostol 0.0024% + Metronidazole 2% + Lidocaine 2% |
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D19E |
Misoprostol 0.0024% + Phenytoin 5% |
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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
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