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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 |
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Gowey Tincture Topical Gel
HSV causes viral infections affecting millions of patients globally, with vesicular lesions that tend to manifest on mucosal membranes and can be very painful and last for weeks to months before they resolve. Sarracenia is an herb, commonly known as the pitcher plant, with anti-viral properties. Preliminary case reports by Brandie Gowey, NMD, revealed that topical use of Sarrancenia compounded in VersaBase® gel gave patients immediate relief from pain caused by HSV I/II, and within 2-7 days, lesions were resolved or significantly improved. Also, Gowey Tincture Topical Gel has been used topically for conditions such viral infections (HPV and HSV I/II), squamous cell carcinoma, MRSA and warts.
Dr. Gowey has developed the Gowey Protocol® for cervical dysplasia, which utilizes a gel containing Sarracenia extract that has become known as Gowey Tincture. Dr. Gowey used Gowey Protocol® Gel as an alternative therapy for cervical dysplasia under the supervision of the Naturopaths International IRB for a study done from 2010-2011. The data has been compiled and published in her book Your Cervix (Just) Has a Cold.
By prescription, our pharmacist can compound Gowey Tincture as a 20% or 30% Topical Gel, which is ONLY to be used TOPICALLY (not for oral consumption). Gowey Tincture Topical Gel can be dispensed in the most appropriate container, such as a lip balm or vaginal applicator. Therapy works best when Gowey Tincture Topical Gel is applied directly to a new lesion, or viral or bacterial infection at least three to four times daily. For cervical dysplasia, physicians are to apply the Gowey Protocol® Gel directly to the cervix in monthly visits with the patient, with the patient using 4-8 grams vaginally each night.
Gowey Tincture Topical Gel is very drying once applied to the skin. The 20% concentration is usually well tolerated. For some women, stronger concentrations of the gel may cause stinging or burning.
References: Gowey, Brandie. Gowey Research Group, PLLC. Sarracenia purpurea vs HSV I and II: Limiting Deleterious Viral Effects.
Gowey, Brandie. Your Cervix (Just) Has a Cold. 2012 and 2014. Morgan James Publishing, New York.
PLoS ONE. 2012. 7(3): e32610.
Hort Science. 2011. 36(2):384. |
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Doxepin Oral Rinse to Relieve the Pain of Mucositis
A significant percentage of head and neck cancer patients treated with radiation will develop oral mucositis. These painful mouth sores can be debilitating and can affect eating and drinking. According to results of a phase 3 study presented at the 54th Annual Meeting of the American Society for Radiation Oncology, Abstract LBA2 N09C6, an oral rinse containing the antidepressant doxepin significantly reduced pain in patients with acute oral mucositis caused by radiation therapy, with or without chemotherapy. This makes doxepin a "new standard of care" for oral mucositis, according to lead study author Robert Miller, MD, of the Mayo Clinic in Rochester, Minnesota, who said The Mayo Clinic now treats all cancer patients with oral mucositis with doxepin, according to Medscape. Benjamin Movsas, MD, of the Henry Ford Hospital in Detroit, Michigan, said this is an "exciting development" because "there is nothing out there for head and neck patients [with oral mucositis].
In this study, patients who reported a pain score of 4 or more on a 10-point scale participated in a 2-day protocol. On the first day, 155 patients received a single blinded dose of doxepin rinse (25 mg/5 mL) or placebo; on the second day, patients crossed over to the opposite group. Patients filled out a pain questionnaire and recorded pain levels at baseline and 6 other time intervals. Compared with placebo, doxepin significantly decreased pain, which was measured by the area under the curve (AUC) on the pain scale over a 4-hour period after the administration of the rinse. The pain reduction peaked at 30 minutes when using doxepin oral rinse. After the study was completed, 64% of patients elected to continue doxepin.
Although doxepin was generally well tolerated, some patients reported increased stinging/burning, unpleasant taste, and drowsiness.
http://www.medscape.com/viewarticle/773567
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The Economics of Treating Clostridium difficile Infections
Clostridium difficile infection (CDI) is responsible for an estimated 14,000 deaths annually in the USA according to the Centers for Disease Control and Prevention, and annual costs attributable to CDI are in excess of $1 billion. Mergenhagen et al. of the Veterans Affairs Western New York Healthcare System summarized appropriate utilization of prevention and treatment methods for CDI that have the potential to reduce the economic and humanistic costs of the disease. Some cost-effective strategies to prevent CDI include screening and isolation of hospital admissions with C. difficile to reduce transmission in the inpatient setting, and probiotics, which are potentially efficacious in preventing CDI in the appropriate patient population. The most extensively studied agents for treatment of CDI are metronidazole, vancomycin, and fidaxomicin. Most economic comparisons between metronidazole and vancomycin favor vancomycin. With the emergence of metronidazole-resistant C. difficile strains, metronidazole can only be recommended for mild disease. The review concluded that moderate to severe CDI should be treated with vancomycin, preferably the compounded oral solution, which provides the most cost-effective therapeutic option. Fidaxomicin offers a clinically effective and potentially cost-effective alternative for treating moderate CDI in patients who do not have the NAP1/BI/027 strain of C. difficile. Probiotics and fecal microbiota transplant have variable efficacy and the US FDA does not currently regulate the content; the potential economic advantages of these treatment modalities are currently unknown.
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Case Report: Vancomycin Solution and Probiotics for Antibiotic-Associated Diarrhea in a Patient with MRSA
A geriatric patient status post intra-abdominal surgery presented with persistent diarrhea and heavy intestinal methicillin-resistant Staphylococcus aureus (MRSA) growth after multiple courses of antibiotic therapy. Additionally, swab cultures of the anterior nares tested positive for MRSA. In order to impede infection and prevent future complications, the patient received a 10-day course of vancomycin oral solution 250 mg every 6 hours, a 15-day course of Saccharomyces boulardii (probiotic) orally twice daily and a 5-day course of topical mupirocin 2% twice daily intranasally. Diarrhea ceased during therapy and repeat cultures 11 days after initiating therapy demonstrated negative MRSA growth from the stool and nares. Further repeat cultures 5 months later revealed negative MRSA growth in the stools and minimal MRSA growth in the nares. Overall, enteral vancomycin and probiotics successfully eradicated MRSA infection without intestinal recurrence. |
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Stability of Vancomycin in SyrSpend SF
The need for other dosage form options for patients who cannot take vancomycin capsules has led compounding pharmacies to seek other alternatives, specifically oral solutions and suspensions. Additionally, some patients are unable to use suspending agents containing alcohol or sorbitol. A study was done to determine the stability of vancomycin in SyrSpend SF, a suspending agent containing neither sorbitol nor alcohol. The studied sample was compounded into a 50-mg/mL suspension and stored in a low-actinic plastic bottle at temperatures between 2 degrees C and 8 degrees C. Six samples were assayed at each time point out to 90 days by a stability-indicating high-performance liquid chromatography method. The method was validated for its specificity through forced-degradation studies. The sample remained within 90% to 110% of the initial concentration throughout the course of the study. Based on data collected, the shelf life of this product is at least 90 days when refrigerated and protected from light. Based on the final potency data at day 90, the beyond-use date may be longer, but 90 days was the limit of this study. |
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