compounding HOTLINE

DECEMBER 01, 2007
Martin A. Erickson III, RPh

Mr. Erickson is director of professional affairs at Gallipot Inc.

I know most sources of testosterone come from soy. A patient at our pharmacy had an allergic reaction to a testosterone in petrolatum compound. The physician believes it is due to the soy protein, but from what I have read, the testosterone micronized USP is so purified that patients with a soy allergy should not have a problem with it. Are there other sources of testosterone?

Occasionally, dermatitis from petrolatum is diagnosed as an allergic reaction to congeners and other byproducts in the active ingredient. Has the physician tried a blinded application of petrolatum under the same conditions the patient experienced when using the compounded prescription? The testosterone can be derived from soy or, more often, from wild yam. Your supplier should be able to ascertain the source and provide written verification. If the source is soy, and no dermatitis reaction was observed in the trial, switching the patient to the wild yam source testosterone may alleviate the condition.

I would like to compound a tasty itraconazole suspension for a cat.

OItraconazole is not available in a commercially prepared drug product for administration to animals. The oral capsules contain sugar spheres with gelatin and a cellulosic component. The powder also is available. Several studies indicate, however, that administration of an extemporaneously compounded oral suspension does not provide therapeutic blood levels.

The liquid drug product for human use contains itraconazole 10 mg/mL with hydroxypropyl-β-cyclodextrin and other excipients. The hydroxypropyl-β-cyclodextrin is complexed with the itraconazole for improved bioavailability (in humans, compared with capsules, bioavailability is about 25% lower when the solution is administered). Data indicate the commercially manufactured solution is preferred for therapeutic compliance. Reportedly, this solution is not well accepted by felines. Addition of a bitterness-masking agent and liver or fish flavoring may provide a preparation more acceptable to the cat.

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