Q I have a patient with encephalopathy and a tracheotomy who is unable to swallow tablets. Do you have a suggestion for oral suspension of glycopyrrolate 1 mg/5 mL?
A Glycopyrrolate is soluble 1:4.2 in water. It is available as a shelf-stable aqueous injection. The drug is shelf-stable at pH below 6. This information supports the conclusion that an extemporaneously compounded oral solution could be shelf-stable.
Beyond-use dating is a matter for professional judgment, based on guidance in USP 27 <795>, Pharmaceutical Compounding: Nonsterile Preparations. The monograph stipulates that, in the absence of applicable stability and beyond-use information for a specific drug and preparation, water-containing compounds from ingredients in solid form may be assigned a beyond-use date not later than 14 days from the date of compounding when stored at cold temperatures.
Here is a suggestion for your compound: Dilute the glycopyrrolate powder in water, or use the injectable form, and combine it with flavored syrup.
For a nasogastric, gastrostomy, or jejunostomy tube, the aqueous, unflavored form would suffice. Adjust to pH 6 with sodium hydroxide or hydrochloric acid.
E-mail your compounding questions to firstname.lastname@example.org
Mr. Erickson is director of professional affairs at Gallipot Inc.
In Seniors: Consider CMV Serostatus
When Recommending Flu Vaccine
Older people who have cytomegalovirus seem to have less robust responses to the trivalent influenza vaccine than those who do not have CMV.
News from the year's biggest meetings
Clinical features with downloadable PDFs