|
|
|
Thank you for entrusting in the compounding services at MD Custom Rx to help meet the unique medication needs of your patients. We are excited to share with you our monthly newsletter and look forward to continuing to be your medication problem solvers. Please don't ever hesitate to let us know how we can be of further assistance to you and your practice.
Sincerely,
John, Dan and Monica |
How Topical Compounding Has Worked For My Patients
by Allen Jacobs DPM FACFAS
"[The] science of topical pharmaceutical compounding has advanced significantly over recent years... given the low systemic levels of the medications when administered topically, drug interactions are far less likely to occur. Topical compounded medications expand the ability... to effectively treat a variety of problems commonly encountered in daily practice. Many podiatric physicians are reluctant to utilize systemic medications for fear of adverse sequella or drug interactions, as a result denying some patients optimal efforts at pain relief or the reduction of inflammation. In addition, topically compounded medications are frequently accepted by the 'I am already taking too many medications' patient and the 'needle phobic' patient. A particular aspect of topical compounded medications is the fact that they are medication(s), allowing me to combine multiple agents with multiple mechanisms of action. As a result, my ability to provide a patient with pain relief is substantially greater... [An] example is that of symptomatic diabetic neuropathy. Here again, many podiatric physicians are reluctant to utilize antidepressants, anti-seizure medications or opioid analgesics. However, one may apply these same medications, such as gabapentin (Neurontin, Pfizer), clonidine (Catapres, Boehringer Ingelheim) or ketamine in combination topically, not infrequently reducing patient symptoms while averting adverse side effects. Many patients presenting to our offices are under care for problems such as hypertension, reflux, congestive heart failure and renal disorders, and are on anti-coagulant therapy. Although we may desire to utilize NSAID therapy for such patients, their concurrent medical conditions or drug therapy typically preclude the use of these agents systemically. The topical application of NSAIDs, however, provides a safe and very effective alternative for the treatment of common problems...
"Wound healing represents another area of significant potential for use of topical compounded medications. It is my belief that we as a profession have become 'product bound.' In other words, we debride and offload wounds, and then try to determine what product' we should apply. Rather, we should be 'process bound', asking what the wound requires. From a histologic and physiologic standpoint, there is overlapping within each wound of the so-called stages of wound healing. Utilizing compounding for wound management, I can determine what ingredients are necessary to enhance wound healing and have them all incorporated as individual prescriptions for each patient to meet his or her individual needs. As an example, one can mix a debriding agent (e.g. collagenase, (Santyl, Healthpoint) with an agent to increase vascular perfusion (e.g. nifedipine, pentoxifylline (Trental, Sanofi Aventis) with an antibiotic or antiseptic (e.g. mupirocin, metronidazole (Flagyl, Pfizer) with something to stimulate cell growth (e.g. phenytoin, Dilantin, Pfizer), and so forth. Furthermore, I can utilize such agents to enhance the effectiveness of various grafting techniques, e.g. Dermagraft (Shire Regenerative Medicine), Apligaf (Organogenesis), Primatrix (TEI Biosciences), etc.
"Finally, topical compounded medications are helpful for the management of nail and skin disorders. Rather than being restricted to the preset components of available dermatologic preparations, I can determine what each patient requires and incorporate that into my compounded medication. For example, for heel keratosis, I can utilize a keratolytic (e.g. salicylic acid or urea); an antifungal e.g. itraconazole (Sporanox, Janssen), terbinafine (Lamisil, Novartis) or fluconazole (Diflucan, Pfizer); [and] tea tree oil, [with agents that] synergistically improved antifungal azoles (e.g. ibuprofen) and so on.
"I would suggest that you look into this opportunity to better treat many of your patients with reduced likelihood of adverse reaction and increased efficacy of treatment."
We believe that the information that Dr. Jacobs shared is valuable for many specialties, not only podiatry. You can read Dr. Jacobs' entire blog at:
|
Propranolol Suspension
Propranolol hydrochloride is a beta blocker used to treat high blood pressure, abnormal heart rhythms, heart disease, pheochromocytoma, and certain types of tremors. Propranolol is a drug of choice for many diseases such as infantile hemangioma occurring in neonates and infants, an age group for which oral suspensions are required almost exclusively. Many adult and elderly patients for whom propranolol is prescribed are also unable to swallow solid dosage forms, leading practitioners to seek alternative dosing options; specifically oral suspensions in the strength that is most appropriate for the patient, using a vehicle that will mask the bitter taste of propranolol powder, while remaining alcohol, sorbitol and sugar-free when required.
A recent study determined the stability of propranolol hydrochloride compounded into a 1-mg/mL suspension using SyrSpend SF and subsequently stored in a low-actinic plastic prescription bottle at room temperature conditions. Six samples were assayed at each specific time point extending to 90 days by a stability-indicating high-performance liquid chromatography method. Based on the data collected, when protected from light at room temperature, the beyond-use date of propranolol hydrochloride in SyrSpend SF was shown to be at least 90 days.1
To evaluate the stability of more concentrated propranolol suspensions in a sugar-free, commercially available vehicle after storage at room temperature and under refrigeration for up to 120 days, suspensions of propranolol (2 and 5 mg/mL) were prepared in the sugar-free vehicle (Ora-Blend SF), placed in 100-mL amber plastic prescription bottles, and stored at 25°C and 4°C. Physical compatibility was evaluated in terms of color, taste, precipitation, and pH. Propranolol suspensions 2 mg/mL and 5 mg/mL stored at 25°C maintained at least 94.7% of their initial concentration for 120 days, and suspensions stored at 4°C maintained at least 93.9% of their initial concentration for 120 days. There were no notable changes in pH, and all samples remained physically unchanged except for a slight change in color, around day 70, of suspensions stored at room temperature.2
|
Nasal Sprays
Aminocaproic acid and tranexamic acid are antifibrinolytic agents with differing potencies.
The Indiana Hemophilia and Thrombosis Center recommends the use of compounded aminocaproic acid nasal spray 250 mg/ml, 1 spray to the affected nostril every 4 hours while awake for 7 days following a nosebleed.
For relief of severe epistaxis, tranexamic acid injection has been applied topically to the nasal mucosa, as a spray or by packing the nasal cavity with a gauze strip that has been soaked in the solution. The NIH is conducting a clinical trial known as North American Study of Epistaxis in HHT (NOSE) and is currently recruiting participants to carefully examine the efficacy and safety of 3 nasal sprays (bevacizumab, estriol, and tranexamic acid), compared to placebo, for the treatment of HHT (Hereditary Hemorrhagic Telangiectasia) related nosebleeds. As per this study, tranexamic acid can be compounded as a 10% nasal spray, used as 0.1 ml spray in each nostril twice daily for 12 weeks (total dose of tranexamic acid is 40 mg/day).
When patients suffer from recurrent nosebleeds, our compounding pharmacy can work with physicians to customize a nasal spray to meet each patient's specific needs.
|
So, Who Exactly Needs Bio-Identical Hormones? Find out at our FREE SEMINAR!
 | |
Dr. Debra Muth, ND, WHNP, APNP, BAAHP
Board Certified with the American Academy of Anti-Aging Medicine
|
Wednesday
June 5th, 2013
6:30pm - 8:30pm
Presented by Dr. Debra Muth, ND, WHNP, APNP, BAAH
Dr. Muth will discuss the need for BHRT:
- After a Hysterectomy
- With Uterine Fibroids
- With Breast Cysts & Fibrocystic Breast Tissue
- For Bone Health
Call 262-373-1050 to register.
Space is limited!
|
|
|
|
|
