Martin A. Erickson, III, RPh
Do you have any information (or a recipe) on vancomycin
enemas? Our gastrointestinal (GI) specialist wrote an order
for them for a patient with extensive pseudomembranous colitis.
Anecdotal reports of the use of vancomycin enemas as
alternative treatment for this condition indicate positive
results.The vancomycin HCl has generally been compounded as
500 mg in 1000 mL of 0.9% sodium chloride for injection. Other
reports of use of these retention enema formulations varied from
1 g of vancomycin HCl in 1000 mL of 0.9% sodium chloride for
injection q6h to 500 mg vancomycin HCl in 500 mL 0.9% sodium
chloride for injection bid. The solution should be freshly prepared,
if no preservative is present.
I have a 2-month-old patient who has maple syrup urine
disease. The physician wants the patient to have 300 mg of
thiamine (vitamin B1) each day. Currently, the mom and dad are
trying to dissolve 3 x 100-mg tablets in water. Do you have a formula
for preparing thiamine suspension?
Thiamine HCl occurs as colorless-to-white crystals or as a
white crystalline powder, has a bitter taste, and is soluble
approximately 1 g in 1 mL of water. In solution, it is incompatible
with reducing agents such as sulfites; the resultant molecular
cleavage increases with increased pH. Also, reports that it
degrades in the presence of amino acids in solution with thiosulfites
have been found. When the concentration of sulfite did not
exceed 0.05%, thiamine was more stable. The drug is well
absorbed from the GI tract, following oral administration.
The US Pharmacopeia has an official monograph for an elixir
of thiamine HCl, but, because this patient is a child, it seems reasonable
to suggest compounding an aqueous solution and to
suggest the use of a syrup, such as simple syrup, as a base for
the preparation. After compounding the thiamine HCl in syrup,
the pH should be adjusted to less than 4 with HCl.
E-mail your compounding questions to