Compounding Guide V1.5 by Pure Integrative Pharmacy

I N T E G R AT I V E

PHARMACY

Compounding Reference Guide 2013

PurePharmacy.com

Table of Content

Welcome Letter 4 Professional Compounding Centres of America (PCCA)

Pain Management 6 Dermatology 7 Hormone Replacement Therapy 8 Pediatric Medications 9 Travel Needs 10 Podiatry 11 Sports Medicine 12 Commonly Requested HCG Compounds 14 Over-the-Counter Compounds 15 Discontinued Product Compounding 16 How to Write a Prescription for Compounded Medication

Version 1.5 Updated January 24, 2013 Pure Integrative Pharmacy Compounding Reference Guide 2013

Welcome Letter Dear Physician, Thank you for taking the time to use this handy compounding reference guide. Some of you may be experienced and comfortable treating your patients with customized compounding. For others, the idea of individualized tailored medications may be new. Giving individual attention to patients needs represents the latest trend in pharmacological service, yet it isn’t new phenomenon. At one time, all pharmacies compounded medications to meet each prescriber’s unique prescriptions. But mass production by large drug companies made compounding a dying art. Today, we believe the art should be brought back. Here at Pure Integrative Pharmacy, we are at the forefront of that movement. The art and science of compounding is the process of mixing drugs to fit the unique needs of an individual. Pure Integrative Pharmacy focuses on compounded medications in the areas of bio-identical hormone therapy, pediatrics, pain relief, and dermatological preparations. How can compounding benefit you and your patients? • • • • •

Customized dosing – patient specific and individualized to meet any dosing problems Dye free, preservative free, lactose free dosage forms Customized flavouring Provide for unavailable, unformulated, or discontinued items Customized dosage forms (topical creams/ointments/gels, capsules, troches lozenges, lip balms, flavoured suspensions, suppositories, sprays, and many more!)

If you visit our pharmacies, you will see a facility that looks more like a laboratory than a traditional pharmacy. You will see the preparation of medicines from unformulated chemicals. Although this method requires extra time to research, measure, and mix, we believe it offers the best possible product - a high quality medication that is designed for your individual patient. New technology, devices, and compounding machines have made it possible for our highly trained pharmacists to prepare almost any prescription. We have both the ingredients and expertise to meet your patients’ needs. So call or visit Pure Integrative Pharmacy for all your special compounding drug needs. Kind regards, Doug Ma, Regional Pharmacy Manager, Vancouver Pure Integrative Pharmacy

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Professional Compounding Centres of America

The Professional Compounding Centres of America (PCCA) is our primary resource for compounding. From the highest quality USP grade chemicals, latest equipment, extensive database of formulations, and experienced consultants, PCCA empowers more than 3,500 independent community pharmacies in Canada, United States, Australia, and Europe. PCCAâ&#x20AC;&#x2122;s Quality Control department is exhaustively devoted to assuring the quality of the chemicals received, repackaged, and sold to our members. Steps include obtaining a Certificate of Analysis for all chemicals received, verifying the identity of every bulk chemical received both before repackaging and completing a second identity test after repackaging, conducting regular tests of all chemicals in inventory, and verifying all unique identifier numbers prior to shipping. As a repackager of unformulated chemicals for pharmacy compounding, PCCA is registered and inspected by the FDA and DEA. As a prescriber, you can be confident that working with Pure Integrative Pharmacy, a PCCA-certified pharmacy, will result in the highest quality compounds to treat your patients.

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Many chronic pain problems such as arthritis, fibromyalgia, migraine, nerve and muscle pain can be managed with topical compounded ain creams or gels. Every individual is unique, and the types of pain experienced can be equally diverse. We at Pure Integrative Pharmacy anagement work with physicians to find solution tailored specifically for the patients needs. Many commonly prescribed pain relief medications can cause stomach irritation and other unwanted side effects.

Examples of Pain Management Compounds: Rheumatoid Arthritis / Joint Pain • Ketoprofen 10% or 20% Topical Lipoderm Soft Tissue Inflammation • Diclofenac 5% or 10% in Lipoderm Transdermal Gel • Ibuprofen 20% in Lipoderm Transdermal Gel General Pain • Magnesium Chloride 15% Gel • Ketoprofen 10%/ Cyclobenzaprine 2% Topical Lipoderm • Ibuprofen 20%/Piroxacam 1% / Cyclobenzaprine 2% Topical Lipoderm Neuropathic Pain • Amitriptyline 2%/Baclofen 2% Topical Lipoderm • Ketamine 5%/ Gabapentin 10%/ Baclofen 2% Topical Lipoderm • Amitriptyline 2%/Baclofen 5%/Ketamine 5%/Ketoprofen 10% Topical Lipoderm Inflammatory Pain from Injury • Diclofenac 5% or 10% in Lipoderm Transdermal Gel • Ketoprofen 10% or 20% Topical Lipoderm Gel • Piroxicam 5% in Lipoderm Transdermal Gel Plantar Fasciitis • Piroxicam 2% to 5% in Lipoderm Transdermal Gel Migraines • Pain Away Capsules (Ibuprofen, Riboflavin, Caffeine) Hemorrhoids and Anal Fissures • Nifedipine 2% rectal ointment • Diltiazem 2% rectal ointment • Nitroglycerin 0.2% rectal ointment

**All formulations are customized per prescription to meet the unique needs of each patient. Please call us to discuss the dosage form, medication, and strength which are most appropriate for your patient.**

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Dermatology At Pure Integrative Pharmacy, we can formulate individualized products for a many of dermatologic conditions. All topical formulations are customized to meet the unique needs of each patient. Please call us to discuss the treatment options, dosage form, and the strength that is most appropriate for your patient

Examples of Dermatological Compounds

Acne

Psoriasis

Rosacea

•

Azelaic Acid 10%/ Niacinamide 4% Topical Cream Clindamycin 2%/ Hydrocortisone 1% Topical Cream

•

Fungal Nail infections • •

Terbinafine 6% in DMSO Nail Polish Itraconazole 1%/Ibuprofen 2% DMSO Nail Polish

Zinc Pyrithione 0.2%/Clobetasol Proprionate 0.05% topical spray

Azelaic Acid 20%/Kojic Acid 4%/ Niacinamide 4% in emollient cream

“Magic” Nipple Cream •

Mupirocin 2%/ nystatin 1%/ clotrimazole 1%/ hydrocortisone 1% cream

Eczema •

Bob’s Nonsteroidal Vitamin B12 cream

Anti-Aging/ Wrinkles •

Hair Loss •

Bob’s Wrinkle Vitamin ACE Cream: contains ingredients that helps fight cellular aging. It also builds up collagen in the skin to help reduce those wrinkles.

Minoxidil 5% scalp spray solution

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Hormone Replacement Therapy The standard for replacing hormones in women is often patented, and manufactured hormones. These hormones are not identical to the ones in our body. The objective with the Bio-Identical Hormone Replacement (BHRT) is to replace hormones with the exact ones that we are deficient in. These hormones are often derived from soy or yam and match the ones in us. Using these bio-identical hormones, we can titrate doses until the desired level and result is reached. Hormones include estrogens, progesterones, testosterones, and dehydropiandosterone (DHEA), thyroid, Liothyronine that can be compounded into capsules, topical creams, suppositories, and sublingual troches lozenges.

Example of delivery formulations:

•

Examples of Hormone Replacement compounds:

• • • • • • • •

• • • • •

Oral capsules (regular release or Sustained release) Troche Lozenges Topical Creams Vaginal Creams Suppositories Suspensions

Bi-estrogen (Estriol/Estradiol) Tri-estrogen (Estriol, Estradiol, Estrone) Progesterone Testosterone Estriol DHEA Desiccated Thyroid Hormone Liothyronine

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Children often cannot take medicines made for adults! At Pure Integrative Pharmacy, we know that treating children can sometimes be a real challenge. We can help by compounding: • • •

Liquid suspension dosage forms from commercially prepared tablets or capsules Kid friendly flavors (Cherry, Strawberry, Apple, Grape, Tutti Frutti, Marshmallow, etc.) Medications without certain dyes, preservatives or other allergens

We can make medications into more infant and baby friendly dosage forms such as liquids, lollipops, and when a child cannot take medicine after surgery, suppositories. Examples include: Acne - Parents are often looking for alternatives for acne for their teenagers. Here are a few non-antibiotic treatment options: • Niacinamide 4% Acne Gel

Diaper Rash • Zinc 20%/hydrocortisone1%/ Clotrimazole 2% in Petrolatum Chicken Pox • Oatmeal/Calamine/ Pramoxine Hydrochloride Lotion • Diphenhydramine HCl 1%/Calamine 8% Topical Cream • Diphenhydramine HCl 2%/Hydrocortisone 0.5% Topical Cream trimazole 2% in Petrolatum

Suspensions for Reflux or G-tubes • Omeprazole Oral Suspension • Lansoprazole Oral ediatric Suspension • Domperidone Oral edications Suspension Flavours for compounded Suspensions • Cherry • Strawberry • Apple • Grape • Tutti Frutti • Marshmallow

P M

Psoriasis/Eczema • Vitamin B12 Cyanocobalamin 0.07% Topical Cream

Travel Needs To help make any trip a wonderful and rewarding experience, preparation is key. The following formulations, here are examples of a variety of compounding formulations we can create for travel needs. Motion Sickness • Meclizine HCl 25mg (Bonamine)

•

Ketoprofen 10% Topical Lipoderm

Airplane Airborne Germs • Bob’s Travel Balm: Tranilast 1%/ Deoxy-D-Glucose (2) 0.19% in Shea Butter (Applied inside the nostrils)

Anti-Viral Lip Balms • Acyclovir 2%/Deoxy-D-Glucose (2) 0.2% Lip Balm • Deoxy-D-Glucose (2) 2%/Lidocaine 1%/PABA 0.75% Lip Balm

Jet Lag • Melatonin 1mg/ml Oral Solution

Leg Cramps • Magnesium Chloride 20% Gel Cream

Snoring • Dimethyl Sulfone 20% Uvula Spray

Romance and Libido • Sildenafil Citrate 1% Topical Cream

Circulation • Nifedipine 4% Topical Lipoderm

Sunburn Pain • Ketoprofen 5%/Lidocaine 0.5% Topical Gel • Aloe Vera/Lidocaine Lotion

Hangover Relief • Cysteine (L) 200mg/Ascorbic Acid 600mg Oral Effervescent Aches and Pains • Diclofenac Sodium 10% Transdermal Gel

Bug Bite Relief • Ketoprofen 5%/ Lidocaine 0.5% Topical Gel

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Podiatry Pure Integrative Pharmacy works closely with physicians and podiatrists to compound medications to treat many foot-related conditions. Here are some of commonly requested podiatry compounds that may benefit your patients. Nail Fungus • Terbinafine 6% in DMSO Nail Polish • Itraconazole 1%/Ibuprofen2% in DMSO Nail Polish Circulation Problems • Nifedipine 4% Topical Lipoderm Diabetic Neuropathy • Ketamine 10%/Gabapentin 6%/ Nifedipine 2% Topical Lipoderm • Amitriptyline HCl 2%/Baclofen 2% Topical Lipoderm • Amitriptyline HCl 2%/Baclofen 5%/ Ketamine HCl 5%/Ketoprofen 10% Topical Lipoderm Raynaud’s Phenomenon • Nifedipine 4% Topical Lipoderm Rough/Dry Feet Urea 25% Topical Foam

Foot Cramps • Magnesium Chloride 10% Topical Cream • Ketoprofen 10%/Cyclobenzaprine HCl 2% Topical Lipoderm Plantar Fasciitis • Baclofen 5%/Ketoprofen 10%/ Lidocaine 5%/ Gabapentin 5% Topical Lipoderm • Ketoprofen 10%/ Cyblobenzaprine HCl 2% Topical Lipoderm Corns/Callouses • Salicylic Acid 10%/ Podophyllum 10% Trichloroacetic Acid 10% (W/V) Topical Solution Warts • Fluorouracil 5%/ Salicylic Acid 15%/ Cimetidine 5%/ Deoxy-D-Glucose 0.2% Topical Lipoderm • Cimetidine 10%/ Deoxy-D-Glucose 0.29%/ Ibuprofen 2% Topical Lipoderm

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Sports Medicine

Platar Fasciitis • Ketoprofen 10%/Cyclobenzaprine 2% Topical Lipoderm • Baclofen 5%/Ketoprofen 10%/ Lidocaine 5%/ Carbamazepine 2% Topical Lipoderm Nail Fungus • Itraconazole 1%/Ibuprofen 2% in DMSO Nail Polish • Fluconazole 1%/DMSO Topical Solution Fungal Skin Infections • Clotrimazole 2%/Ibuprofen 2%/ Tea Tree Oil 1% Topical Cream • Ketoconazole/ Tea Tree Oil/DMSO Antifungal Solution Methicillin-Resistant Staphylococcus aureus (MRSA) • Clindamycin 3%/Doxycycline 1% Topical Ointment

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Excessive perspiration/ Foot Odor • Aluminum Chlorohydrate 5% and 10% Topical Antiperspirant Cream • Aluminum Chlorohydrate 5% Topical Powder Pain • Ketoprofen 10%/Cyclobenzaprine 2% Topical Lipoderm • Baclofen 5%/Ketoprofen 10%/ Lidocaine 5%/Gabapentin 5% Topical Lipoderm Nausa • Promethazine 25mg/mL Topical Lipoderm • Meclizine 25mg Capsules Muscle Spasms/Leg Creamp • Guaifenesin 2% and 10% in Lipoderm Base • Magnesium Chloride 10% Topical Lipoderm

Sunburn • Diclofenac Sodium Sunburn gel 1.3% • Ketoprofen 5%/ Lidocaine 0.5% Topical Gel • Aloe Vera/Lidocaine Lotion Warts • Salicylic Acid 40% Ointment • Salicylic Acid 27% Topical Solution

Iontophoresis Solutions • Dexamethasone 0.4% Iontophoresis Solution • Dexamethasone 0.4%/ Lidocaine 4% Iontophoresis Solution • Ketoprofen 10% Iontophoresis Solution (PF) Phonophoresis Gels (Ultrasound) • Hydroxyethyl Cellulose 3% Ultrasound Gel • Hydrocortisone 10% Ultrasound Gel

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Commonly Requested HCG Compounds

Sublingual Drops

Injectable Formulation

•

Chorionic Gonadatropin 125 U/0.1mL Sublingual Solution (preservative-free)

Troches •

Chorionic Gonadatropin 500 U Troches

Topical Formulations • •

Chorionic Gonadotropin 500 U/Gram Tropical Lipoderm Chorionic Gonadotropin 250 U/Gram / Methylcobalamin 2mg/Gram Tropical Lipoderm

Chorionic Gonadotropin 1000 U/mL Injection Solution

Flavored Stevia Drops for Food/Drink Recipes Used on the HCG Diet Help patients get some flavour variety in their diet! Stevia flavored drops can be used for flavoring coffee, tea, water, crushed ice, and soda. Some top flavour choices are lemon, orange, raspberry, chocolate, vanilla, grape, and toffee. •

Stevioside 200 mg/mL Concentrate (Flavored)

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Over-theCounter Compounds

At Pure Integrative Pharmacy, we have developed over-the-counter products that may benefit your patients. Please talk to one of our compounding pharmacists for more information about these customized compounds that have been used patients with great success.

Bob’s Iron Formula • Bob’s specially formulated iron has been recommended by many physicians, midwives, naturopaths, physicians and clients to help bring up iron levels. It contains all of the ingredients needed to help absorb and process iron efficiently. Pain Away Capsules • Do you suffer from headaches or migraines? Try our special blend of ibuprofen and vitamins to stop the pain. Bob’s Eczema Cream • This non-steroidal Vitamin B12 cream reduces irritation, itchiness and inflammation seen with eczema and psoriasis. This specially formulated cream is also free of added drugs, fragrances, colors, or preservatives. Travel Balm • Do you seem to catch a cold when you travel? Try our compounded remedy before you go traveling. Bob’s Vitamin ACE Wrinkle Cream • This cream contains ingredients that helps fight cellular aging. It also builds up collagen in the skin to help reduce those wrinkles. Snore Spray • Do you or a loved one need a better sleep? Try our compounded snore spray along with our special blend of essential oils to help tame the lion! Nicotine Lollipops • Are you trying to stop smoking? Our Nicotine Stick allows you to apply the medication to your inner wrist to help alleviate the craving immediately. Our Nicotine Lollipop helps you kick the habit in a fun way! Boric Acid Vaginal Capsules Magnesium Glycinate Capsules

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Discontinued Product Compounding

The reason a manufacturer discontinues a product is usually due to financial reasons, not therapeutic ones. However, discontinuation of certain medications can pose serious problems for a patient and may result in chronic disabilities or a decreased quality of life. We realize the importance of therapies that physicians have come to know and trust in their practices. Thus, we are able to provide compounded versions of discontinued and/or back-ordered medications. Below are some of our most popular discontinued product compounds that we have compounded into capsules upon physician request. We compound discontinued prescription products and non-prescription products. This is by no means an exhaustive list, and we welcome new inquiries by both physicians and patients alike. Examples of Discontinued Prescription Product Compounds

Phenazopyridine (Pyridium)

Meclizine (Bonamine)

Disulfiram (Antabuse)

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How to Write a Prescription for Compounded Medication When writing a prescription for a compounded medication, we recommend beginning with the phrase â&#x20AC;&#x153;Compounded Medicationâ&#x20AC;?. This indicates that the prescription should be brought to a compounding pharmacy. List all ingredients along with the dose in mg or %. The dosage form should be specified such as capsule, topical cream, spray, nail lacquer, troche, suppository, suspension, etc. Lastly, be sure to include the appropriate directions and quantity. Keep in mind that all formulations are customized per prescription to meet the unique needs of each patient. We at Pure Integrative Pharmacy are here to help with your difficult to treat patients. So please call us to discuss the most appropriate dosage form, medication, and strength for your patient.

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9 Locations

to serve you on the Lower Mainland

Bentall

Chilliwack

Coal Harbour

400 - 1055 Dunsmuir St. Vancouver, BC V7X 1L4 Phone: (604) 682-7755 Fax: (604) 682-7744

110F - 6640 Vedder Rd. Chilliwack, BC V2R 0J2 Phone: (604) 847-3496 Fax: (604) 824-1811

B - 622 Bute St. Vancouver, BC V6E 3M1 Phone: (604) 336-3038 Fax: (604) 336-3044

Dunbar

Garrison Village

Kitsilano

#1 -45555 Market Way Chilliwack, BC, V2R 0M5 Phone: (604) 846-8782 Fax: (604) 846-8794

3533 West 4th Ave. Vancouver, BC V6R 1N9 Phone: (604) 733-7211 Fax: (604) 733-7215

Robson

West Broadway

White Rock/Surrey

238 Robson St. Vancouver, BC V6B 6A1 Phone: (604) 681-8190 Fax: (604) 681-8195

2685 West Broadway Vancouver, BC V6K 2G2 Phone: (604) 568-8844 Fax: (604) 568-8944

#111, 15388 – 24th Ave South Surrey, BC V4A 2J2 Phone: (604) 542-7780 Fax: (604) 542-3263

4198 Dunbar St. Vancouver, BC V6S 2E7 Phone: (604) 732-3010 Fax: (604) 732-3011