Changing Excipients for Special-needs Patients

Some patients cannot take various drug products (Rx and OTC) because they have allergies or are intolerant to various substances, including:

• Dyes
• Flavorings
• Sweeteners
• Preservatives
• Gelatins
• Milk products
• Gluten
• Corn
• Soy
• Nuts
• Alcohol
• Chocolate
• Animal-derived ingredients

Sometimes the specific allergy or intolerance is difficult to determine. Once known, the compounding pharmacist can work with the patient to circumvent the offending agent and resolve the problem.

Oftentimes, the offending agent is an excipient in a commercial drug product. The source that can be used for compounding of the active drug may be a raw material or possibly an injection or dosage form with minimal excipients and not containing the offending agent. Next, there are numerous excipients in each group that may be substituted for different patients with a little bit of research and asking questions on the Compounders' Network List (CNL), etc.

In some cases, the issue can be resolved by changing brands or even generic manufacturers, as many different generics of the same drug product contain different excipients. The package insert should list the excipients contained in their products. Manufacturers of generics are not required to have identical excipients in their products; this can sometimes be an issue.

Additional reading and resources on special-needs patients can be found at:

Nagel-Edwards KM, Ko JY. Excipient choices for special populations. IJPC 2008; 12(5): 426-430.

Cacace JL. Formulating for the gluten-sensitive individual. IJPC 2005; 9(5): 357-358.

Claycomb J. Pharmacists Must Guard Vulnerable Patients Against Inactive Ingredients in Medications. Pharmaceutical Industry Today June 11, 2015. Available at:
http://drugtopics.modernmedicine.com/drug-topics/news/pharmacists-must-guard-vulnerable-patients-against-inactive-ingredients-medications

www.Glutenfreedrugs.com

Coming in the Next Issue of IJPC

News

Alkalinized Lidocaine-heparin in Interstitial Cystitis Symptoms
A combination of alkalinized lidocaine with heparin provides significantly better relief of symptoms of interstitial cystitis when compared with alkalinized lidocaine alone, according to a new study published in the Canadian Journal of Urology. Compared with lidocaine alone, the heparin-alkalinized lidocaine combo provided better reduction of bladder pain (38% vs. 13%) and urgency (42% vs. 8%) and the patients reported better immediate and long-term improvement at 1 hour (77% vs. 50%) and 24 hours (57% vs. 23%) after the combination treatment.
http://www.renalandurologynews.com/overactive-bladder-oab/heparin-lidocaine-combo-relieves-interstitial-cystitis-symptoms/article/424358/

FDA Agrees to Delay Enforcement of Track and Trace Requirements
The FDA has announced that it will delay enforcement of Track and Trace requirements until November 1, 2015. Title II of the Drug Quality and Security Act (DQSA) requires that prescription drug data be tracked through the supply chain, from the manufacturer or end user, or dispenser.
http://www.ashp.org/menu/AboutUs/ForPress/PressReleases/
PressRelease.aspx?id=861

Metric Dosing Only Urged with Plastic Dosing Cups
A fatal event was reported recently in which a nurse confused two dosing scales that appear on a plastic oral liquid dosing cup and administered 1 dram instead of 1 mL of morphine sulfate 20-mg/mL oral solution; similarly, a nurse gave a patient 5 drams of a formerly available acetaminophen liquid concentrate, 100 mg/mL, instead of 5 mL, a total of 18.45 mL, or 1.845 g of acetaminophen! To prevent such mix-ups between variable measurement systems, multiple organizations have called for the adoption of the metric system (milliliter) as the standard for prescribing and measuring doses of liquid medications.
http://www.ismp.org/NAN/files/NAN-20150630.pdf

Dress Code for Doctors?
You've probably seen it before; a physician or other health practitioner, in loose blue or green scrubs, standing in line at the grocery store. You wonder if they are coming from or going to work. It appears that he or she belongs in an emergency room—not the dairy section. Questions arise, could the clothes carry some sort of dangerous microbe? What organisms will the outfit pick up on public transit or in line at the ATM that will track back to an operating room or patient? Have we taken casual attire too far? Clothing for healthcare practitioners is more than just a matter of personal style: It is an emblem of their specialty, training, and culture.
http://www.empr.com/features/should-there-be-a-dress-code-for-doctors/article/424332/

IJPC Now on Facebook and Youtube

Become a fan of the IJPC Facebook page and share ideas, photos, and keep up to date with the latest compounding information - http://www.facebook.com/IJPCompounding

Learn about the Journal's new multi-media features and view our growing collection of educational and training videos at www.ijpc.com/video or by subscribing to our Youtube channel at https://www.youtube.com/user/IJPCompounding.

Did You Know ...

�how interesting it is that some individual states are so far in debt that it will take decades to pay it down�but they keep on spending? That also sounds like our federal government and some foreign countries!

Tip of the Week

There comes a time when you have to "pay the piper"! A simple fact about economics is that "you cannot continue to spend more than you bring in"�if you do, someone will come in and take you over. All states and the federal government should be required to have a total balanced budget and pay down their debt.

Note: It's interesting to look at the different political definitions of a "balanced budget"!

Looking Back

The hero was brave,
And strong and willin'.
She felt his chin,
Then wed the villain!
     Burma Shave