Compounded Medications for Podiatrists
B&B Pharmacy for podiatry.
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 an 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|
Hard to find or discontinued Injectables such as Hyaluronidase injection, Betamethasone sodium Phosphate injections, Dexamethasone sodium Phosphate injections, etc.
- 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
- 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|
|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|
- 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.