compounding HOTLINE

Mr. Erickson is director of professional affairs at Gallipot Inc.

I know most sources of testosterone come fromsoy. A patient at our pharmacy had an allergic reactionto a testosterone in petrolatum compound. Thephysician believes it is due to the soy protein, but from what Ihave read, the testosterone micronized USP is so purified thatpatients with a soy allergy should not have a problem with it.Are there other sources of testosterone?

Occasionally, dermatitis from petrolatum is diagnosedas an allergic reaction to congeners and otherbyproducts in the active ingredient. Has the physiciantried a blinded application of petrolatum under the same conditionsthe patient experienced when using the compoundedprescription? The testosterone can be derived from soy or,more often, from wild yam. Your supplier should be able toascertain the source and provide written verification. If thesource is soy, and no dermatitis reaction was observed in thetrial, switching the patient to the wild yam source testosteronemay alleviate the condition.

I would like to compound a tasty itraconazole suspensionfor a cat.

OItraconazole is not available in a commercially prepareddrug product for administration to animals. Theoral capsules contain sugar spheres with gelatin and acellulosic component. The powder also is available. Severalstudies indicate, however, that administration of an extemporaneouslycompounded oral suspension does not provide therapeuticblood levels.

The liquid drug product for human use contains itraconazole10 mg/mL with hydroxypropyl-β-cyclodextrin and otherexcipients. The hydroxypropyl-β-cyclodextrin is complexedwith the itraconazole for improved bioavailability (in humans,compared with capsules, bioavailability is about 25% lowerwhen the solution is administered). Data indicate the commerciallymanufactured solution is preferred for therapeutic compliance.Reportedly, this solution is not well accepted byfelines. Addition of a bitterness-masking agent and liver or fishflavoring may provide a preparation more acceptable to thecat.

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