Podiatrists and other health care professionals encounter numerous problems that may be helped with compounded medications.
We commonly prepare unique formulations that prescribers develop to meet specific needs of their patient population, or “tried and true” formulas acquired during professional training. Penetrant enhancers can be added to improve the extent of absorption of topically applied medications. Numerous compatible medications can be combined into a single dosage form for ease of administration. Also, a synergistic effect can be achieved when certain medications are used concomitantly.
Various synergistic combinations are used for antifungal therapy. Research points to the practicality “of using ibuprofen, alone or in combination with azoles, in the treatment of candidosis, particularly when applied topically, taking advantage of the drug’s antifungal and anti-inflammatory properties.”
Neuropathy Foot Cream
Resistant warts and molluscum contagiosum have been treated successfully with compounded topical medications, avoiding discomfort associated with freezing, scraping, electrocautery and laser therapy.
Although surgical excision is the most popular method for removing nails, the use of concentrated urea plasters applied under occlusion may be superior. The use of urea plasters has inherent advantages – they are inexpensive, several nails can be treated in one session, and the procedure is essentially painless. Various synergistic combinations and topical medications with penetrant enhancers can be compounded for antifungal therapy. Topical medications usually have a lower adverse drug-reaction profile than systemic medications.
Management of onychomycosis, a fungal infection of the fingernails and toenails, usually consists of systemic antifungal medications, topical therapy (e.g., urea ointment, desiccating solutions, keratolytics, vital dyes), or surgical intervention (e.g., nail plate avulsion, laser therapy). Topical prescription antifungal preparations, containing the active ingredient of your choice, may be less likely to cause the serious systemic side effects that can occur with oral antifungal therapy and can provide a more economical alternative, as lower doses are needed when the medication is applied topically at the site. Penetrant enhancers can be included in the preparation to improve the effectiveness of topical antifungals.
Wounds and pressure sores may heal more quickly if treated with topical phenytoin. Medications which improve capillary blood flow can be added to a compounded medication to enhance circulation at the wound margins and promote healing of the injured area.
Topical Phenytoin for Wound Healing
The stimulatory effect of orally administered phenytoin on gingival tissue prompted its assessment in wound healing. Phenytoin may promote wound healing by a number of mechanisms, including stimulation of fibroblast proliferation, facilitation of collagen deposition, glucocorticoid antagonism, and antibacterial activity. Phenytoin has been used topically in the healing of pressure sores, venous stasis and diabetic ulcers, traumatic wounds, skin autograft donor sites, and burns.
Iontophoresis & Phonophoresis
Iontophoresis facilitates delivery of medications into the tissues beneath the skin by electronic transport of ionized drugs in solution. Acetic acid iontophoresis is effective in the treatment of heel pain. Iontophoresis of dexamethasone for plantar fasciitis should be considered when more immediate results are needed. Iontophoresis has also been used to successfully treat plantar hyperhidrosis.
Phonophoresis is a technique that combines topical drug therapy with ultrasound to achieve therapeutic drug concentrations in muscle and other tissues beneath the skin. Ultrasound gels can be formulated to contain medications such as anti-inflammatories and/or anesthetics.
Examples of compounded medications
The following list is just a few of the preparations that we can compound for podiatry. We work together with prescriber and patient to solve problems, and all formulations are customized per prescription to meet the unique needs of each patient. Therapeutic results depend not only on the selection of drug, but also the use of a proper base and preparation technique. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.
Clotrimazole in DMSO solution
Dexamethasone iontophoresis solution
Fluconazole/Ibuprofen topical gel
Ketamine/Gabapentin transdermal gel
Ketoprofen 10% topical gel
KOH solution – 5% and 10%
Urea 40% ointment