COMPOUNDINGHOTLINE

Q: A physician asked whether I could recommend alternative therapy for fibromyalgia.

A: Here is Part 2 of my answer. Part 1 appeared in the November 2004 issue of Pharmacy Times. As I said last month, the compounding pharmacist can recommend a number of alternative approaches. Generally, the topical approaches often seen for relief of other neuropathic pain conditions are beneficial. It is, however, important to tailor these preparations to the patient's needs. When the preparations contain penetration enhancers, the active drugs are more efficacious than traditional ointments. An example of an enhanced base is pluronic lecithin organogel (PLO; Polox 20% and Lipoil).

Procedure:

1. Weigh and measure the amounts of ingredients needed for the preparation.

2. Levigate the active ingredients with a small amount of solvent to make a smooth paste (use solvent best suited to the active ingredient?eg, ethoxy diglycol or ethyl alcohol or glycerin). Use only enough to dissolve or wet the material to avoid excessive thinning of the gel.

3. Slowly add the Lipoil to the above mixture.

4. Levigate the Polox gel with the above mixture.

Syringe Method:

Draw up 24 mL of Lipoil in a Luer-Lok syringe, and draw up the active-ingredient mixture into another Luer-Lok syringe. Attach a Luer-Lok-to-Luer-Lok connector to the syringes. Push and pull the plungers of the syringes back and forth until the mixture is uniform. Draw up approximately enough Polox gel to bring the volume to 100 cc, and attach this syringe and one of the syringes containing the mixture from above. Mix it back and forth until it is uniform. Finally, check to make sure that the total volume is 100 cc. Add sufficient quantity of Polox gel if needed, and mix back and forth again.

Notes:

The Lipoil can be left at room temperature. The Polox gel is best refrigerated so that it remains a liquid while mixing. The Polox gel exhibits inverse temperature/viscosity behavior: it is a liquid at refrigerated temperature and a gel at room temperature. The finished gel should be stored and dispensed at room temperature.

PLO-based "Patch": Dispense unit-of-use containers (eg, oral syringes, 0.5 or 1.0 mL). Instruct the patient to apply the contents to a nonhairy area of the body, and cover it with film having an adhesive border (eg, OpSite or Tegaderm).

No claims are made as to the uses, safety, efficacy, or bioavailability of this product. The formula is for informational purposes only.

E-mail your compounding questions to compounding@pharmacytimes.com