This is by no means a comprehensive list of our compounds, but a sampling of compounds which have specific application to Podiatry Compounding. Our transdermal products are formulated in a lecithin/oranogel complex. It is a true transdermal transporter of drugs and allows for delivery of drugs through the epidermis and into the blood stream.
Recent reports indicate that N-Methyl-D-Aspartate (NMDA) receptor antagonists and GABA agonists, either alone or in combination, are being successfully used to relieve neuropathic pain.
- Ketamine (NMDA antagonist) 5% to 10% transdermal gel SIG: Apply TID
- Amitriptyline 2% Baclofen 2% transdermal gel (an NE Reuptake inhibitor and GABA agonist respectively) SIG: Apply TID
- Addition of 10% lidocaine to amitriptyline/baclofen gel SIG: apply TID
- Use of oral amitriptyline 10-20mg TID in conjunction with topical preparations
Fluconazole and Ibuprofen in DMSO nail solution
Fluconazole is a synthetic azole antifungal agent. It is fungistatic and is active against fungi including yeast dermatophytes. Oral medications involve major expense and long duration so a topical medication is desirable. Ibuprofen exerts a synergistic effect with fluconazole and most other antifugals by increasing nitric oxide which increases the action of the fungicide or fungistatic agent. The solution is dispensed in a "nail polish" applicator bottle and the patient simply paints it on. This is also effective in a cream form for skin fungus (i.e., athlete's foot) or applied to a softened nail bed. SIG: Apply BID to affected nails.
Iontophoresis & Phonophoresis
Dexamethosone 0.4% (4 mg/ml) is a very potent and effective anti-inflammatory steroid. It can be substituted for hydrocortisone and used in small quantities with more satisfying and efficient results. It is 25 times stronger than hydrocortisone and has a biological half-life of 36 to 54 hours.
For iontophoresis, the solution is made with pure dexamethasone sodium phosphate and buffered to a pH of 8.4. For ultrasound, dexamethasone is solubilized and incorporated into sonigel, and ultrasound gel. It is a primitive transdermal transporter of the dexamethasone molecule and can be left on after treatment since absorption of the dexamethasone will occur to a certain extent without use of ultrasound.
NSAID Transdermal Gels
The clinical success with these compounds is widely recognized. Many orthopedic groups and college sport programs are using them. Although we are able to put almost any NSAID into a topical gel, the one we recommend is Ibuprofen 20% Piroxicam 1%.
Advantages of transdermal NSAIDs:
- no dilution of drug throughout the body
- therapeutic action at the specific site of injury
- no GI irritation; it can be used safely in patients who have GI/ulcer conditions
- can also be used as an adjunct to oral NSAID therapy.
SIG: Apply 2-3 times daily; one application to be at bedtime.