Well, it has happened again with two more anti-inflammatory drugs that are commonly used for systemic administration (celecoxib-Celebrex and naproxen-Aleve). As a follow-up to the editorial a couple of weeks ago, why do we expose the entire body to specific drugs when they work on specific receptors and in many cases are only needed at specific sites on the body? It’s almost like painting the entire outside of a house when we only wanted to paint the trim on the windows.

Can pharmacy compounding help? Definitely! In many cases, though obviously not all, topical and transdermal administration of these agents may be adequate and provide the needed relief desired by patients. Again, these are specific patients in need of specific preparations to relieve their pain. Documentation is emerging that clinical results are obtained without need of the high blood levels of systemically administered drugs when drugs are administered topically in transdermal dosage forms. This is another reason why compounding is important.

Think of all the patients that will now be changed from one drug to another for a few weeks of therapy that may or may not be satisfactory, may or may not be quite as expensive and may or may not cause apprehension because of the change in their health status. In many cases, a few days therapy with a topically applied transdermal preparation of anti-inflammatories is all that is needed to determine whether or not that drug in that concentration will work for that patient; a change in the formulation is relatively easy and quick. Also, a small quantity can be specifically prepared for the patient without needing to dispense a months supply, etc. to later find out that it is not doing the intended job.

Now is a good time to provide information on transdermal formulations containing ketoprofen, naproxen, ibuprofen (available as a gel in Europe), ketorolac tromethamine, piroxicam (available as a gel in Mexico), etodolac, fenoprofen calcium, flurbiprofen, indomethacin, mefenamic acid, meclofenamate sodium, meloxicam, nabumetone, oxaprozin, sulindac, tolmetin sodium, and diclofenac (potassium and sodium). Various transdermal vehicles, including PLO gels, can be used.

With all the new transdermal patches on the market and new ones being approved by the FDA, transdermal administration is becoming very, very commonplace and offers many advantages. Until the PHARMA companies catch up with today’s therapeutic options, pharmaceutical compounding has a very important and vital role in helping patients remain pain-free and able to enjoy a better quality-of-life.

Effective January 1, 2005, the price of USP Chapters <795> and <797> will go up to $150 each. Currently these chapters are only $25 each. Buy now and comply for $125 less than it’s going to cost in the next week. Contact customer service at USP at custsvc@usp.org

The discussions this week on IJPC’s Compounders Network Listserv include:
• A pet treatment for fibromyalgia.
• A dose and frequency of betahistine for menieres disease.
• A formula for orgasm cream for women.

The theme this week is general dermatology.

• Albert SF, Weis ZH. Management of onychomycosis with topicals. Clin Podiatr Med Surg 2004; 21(4): 605-615, vii.
• Bellew SG, Quartarolo N, Janniger CK. Childhood warts: an update. Cutis 2004; 73(6): 379-384.
• Boelsma E, van de Vijver LP, Goldbohm RA, Klopping-Ketelaars IA, Hendriks HF, Roza L. Human skin condition and its associations with nutrient concentrations in serum and diet. Am J Clin Nutr 2003; 77(2): 348-355.
• Boguniewicz M. Topical treatment of atopic dermatitis. Immunol Allergy Clin North Am 2004; 24(4): 631-644, vi-vii.
• Buckley DA, Rycroft RJ, White IR, McFadden JP. The frequency of fragrance allergy in patch-tested patients increases with their age. Br J Dermatol 2003; 149(5): 986-989.
• Burdick KH, Poulsen B, Place VA. Extemporaneous formulation of corticosteroids for topical usage. JAMA 1970; 211(3): 462-466.
• Cannon BC, Cannon JP. Management of pressure ulcers. Am J Health Syst Pharm 2004; 61(18): 1895-1905.
• Chilukuri S, Rosen T. Management of acyclovir-resistant herpes simplex virus. Dermatol Clin 2003; 21(2): 311-320.
• Clemons RJ, Clemons-Miller A, Johnson SM, Williamson SK, Horn TD. Comparing therapy costs for physician treatment of warts. J Drugs Dermatol 2003; 2(6): 649-654.
• Del Rosso JQ. New and emerging topical approaches for actinic keratoses. Cutis 2003; 72(4): 273-276, 279.
• Downs AM. Managing head lice in an era of increasing resistance to insecticides. Am J Clin Dermatol 2004; 5(3): 169-177.
• Dreno B. Topical antibacterial therapy for acne vulgaris. Drugs 2004; 64(21): 2389-2397.
• Freyschmidt-Paul P, Happle R, McElwee KJ, Hoffmann R. Alopecia areata: Treatment of today and tomorrow. J Investig Dermatol Symp Proc 2003; 8(1): 12-17.
• Goossens A. Photoallergic contact dermatitis. Photodermatol Photoimmunol Photomed 2004; 20(3): 121-125.
• Gupta AK, Lynch LE. Management of onychomycosis: examining the role of monotherapy and dual, triple, or quadruple therapies. Cutis 2004; 74(1 Suppl): 5-9.
• Halder RM, Richards GM. Topical agents used in the management of hyperpigmentation. Skin Therapy Lett 2004; 9(6): 1-3.
• Hindsen M, Isaksson M, Persson L, Zimersson E, Bruze M. Photoallergic contact dermatitis from ketoprofen induced by drug-contaminated personal objects. J Am Acad Dermatol 2004; 50(2): 215-219.
• Huang DB, Ostrosky-Zeichner L, Wu JJ, Pang KR, Tyring SK. Therapy of common superficial fungal infections. Dermatol Ther 2004; 17(6): 517-522.
• Kormeili T, Yamauchi PS, Lowe NJ. Topical photodynamic therapy in clinical dermatology. Br J Dermatol 2004; 150(6): 1061-1069.
• Lang PG Jr. Management of actinic keratoses. Compr Ther 2003; 29(2-3): 108-114.
• Ling MR. Extemporaneous compounding. The end of the road? Dermatol Clin 1998; 16(2): 321-327.
• Loden M, Buraczewska I, Edlund F. Irritation potential of bath and shower oils before and after use: A double-blind randomized study. Br J Dermatol 2004; 150(6): 1142-1147.
• Lopez-Abad R, Paniagua MJ, Botey E, Gaig P, Rodriguez P, Richart C. Topical dexketoprofen as a cause of photocontact dermatitis. J Investig Allergol Clin Immunol 2004; 14(3): 247-249.
• MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev 2003; 8(4): 359-377.
• Moore DE. Drug-induced cutaneous photosensitivity: incidence, mechanism, prevention and management. Drug Saf 2002; 25(5): 345-372.
• Pelle MT, Crawford GH, James WD. Rosacea: II. Therapy. J Am Acad Dermatol 2004; 51(4): 499-512.
• Roos TC, Geuer S, Roos S, Brost H. Recent advances in treatment strategies for atopic dermatitis. Drugs 2004; 64(23): 2639-2666.
• Shapiro L, Knowles S, Shear N. Drug interactions of clinical significance for the dermatologist: Recognition and avoidance. Am J Clin Dermatol 2003; 4(9): 623-639.
• Silapunt S, Goldberg LH, Alam M. Topical and light-based treatments for actinic keratoses. Semin Cutan Med Surg 2003; 22(3): 162-170.
• Stratigos AJ, Katsambas AD. Optimal management of recalcitrant disorders of hyperpigmentation in dark-skinned patients. Am J Clin Dermatol 2004; 5(3): 161-168.
• Tan HH. Topical antibacterial treatments for acne vulgaris : Comparative review and guide to selection. Am J Clin Dermatol 2004; 5(2): 79-84.
• Thiers BH. Compounding is still appropriate in clinical practice. Dermatol Clin 1998; 16(2): 329-330.
• van Zuuren EJ, Graber MA, Hollis S, Chaudhry M, Gupta AK. Interventions for rosacea. Cochrane Database Syst Rev 2004; (1): CD003262.
• Vender RB. Adverse reactions to herbal therapy in dermatology. Skin Therapy Lett 2003; 8(3): 5-8.
• Witkowski JA, Parish LC. Dermatologic manifestations of complementary therapy. Skinmed 2003; 2(3): 175-180.
• Yosipovitch G, Hundley JL. Practical guidelines for relief of itch. Dermatol Nurs 2004; 16(4): 325-328.

When a cat refused medicine for abdominal problems, pharmacist Cathy Harrington devised a remedy spiked with tuna fish. She concocts prescription candies for individuals who need more immediate pain relief than pills provide, and she tailors prescription drugs to prevent allergic reactions and side effects. Children are not simply small adults. They may have some unique medical needs and require different types or doses
For full story, http://www.tcpalm.com/tcp/jc_local_news/article/0,,TCP_1114_3341019,00.html

PEOPLE'S PHARMACY | JOE GRAEDON AND TERESA GRAEDON Potassium, polymer combination said to stop bleeding in a minute
For full story, http://www.charlotte.com/mld/charlotte/living/health/10457706.htm

Women waiting for the now-delayed testosterone patch have other options to boost sexual desire, explains Dr. Judith Reichman
For full story,http://msnbc.msn.com/id/6707662/

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