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Family pratices compounding

FAMILY PRACTICE COMPOUNDING

At Agewell we customize each prescription formulation specifically to each patients' individual requirements.  We strive to provide the utmost in customer care on every order.  Please call us with any questions pertaining to your compounding request, we are here to discuss any questions or concerns you may have pertaining to your prescription.  

 

BIO-IDENTICAL VS. NON-BIO-IDENTICAL  HORMONES:

 

Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The term "bio-identical" does not indicate the source of the hormone, but rather refers to the chemical structure. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original.  Bio-identical hormones are able to follow normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy.

There are significant differences between hormones that are natural to humans (bio-identical) and non-bio-identical (including horse) preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer. A patented drug can be profitable to mass produce, and therefore a drug company can afford to fund research as to the medication's use and effectiveness. However, bio-identical substances can not be patented, so scientific studies are less numerous on natural hormones, because medical research is usually funded by drug companies. Structural differences that exist between bio-identical human, and non-bio-identical synthetic and animal hormones may be responsible for side effects that are experienced when non-bio-identical hormones are used for replacement therapy.

Bio-identical hormones include estrone (E1), estradiol (E2), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone. Our compounding specialists work together with patients and prescribers to provide customized bio-identical hormone replacement therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman's specific needs. Hormone replacement therapy should be initiated carefully after a woman's medical and family history has been reviewed. Every woman is unique and will respond to

therapy in her own way. Close monitoring and medication adjustments are essential.

 

 

HEMORRHOIDS:

Hemorrhoids are particularly problematic for catchers, coaches, and others who are regularly in a squatting position. Treatment often involves use of a novel dosage form known as the "rectal rocket", a suppository that permits simultaneous internal and external application of anti-inflammatories, anesthetics, antibiotics, or other medications.

 

 

TOPICAL vs. ORAL NSAIDs

Non‐steroidal anti‐inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs worldwide and are responsible for approximately one‐quarter of all reported adverse drug reactions. NSAIDs are widely prescribed for patients with rheumatic disease‐ a population at increased risk for serious gastrointestinal (GI) complications. Topical administration of NSAIDs offers the advantage of local, enhanced drug delivery to affected tissues with a reduced incidence of systemic adverse effects, such as peptic ulcer disease and GI hemorrhage. NSAIDs administered topically penetrate slowly and in small quantities into the systemic circulation; bioavailability and maximal plasma NSAID concentration after topical application are generally less than 5 and 15%, respectively, compared with equivalent oral administration. Topical application leads to NSAID concentrations in the muscle tissue below the site of application which are at least equivalent to that obtained with oral administration. Mason et al. conducted a systematic review and reported that topical NSAIDs were effective in relieving pain in chronic conditions like osteoarthritis and tendonitis, as well as in acute conditions like sprains and strains, with differences between individual drugs for efficacy. 26 randomized double blind trials involving 2,853 patients which compared topical NSAID with either placebo or another active treatment. Topical NSAID was significantly better than placebo in 19 of the 26 trials. Indirect comparisons of individual topical NSAIDs showed that ketoprofen was significantly better than all other topical NSAIDs, while indomethacin was barely distinguished from placebo. Local adverse events, systemic adverse events, or withdrawals due to an adverse event were rare, with no difference between topical NSAID and placebo. Rolf et al. studied the kinetics of ketoprofen in synovial fluid and intra‐articular tissues in relation to plasma, and reported that topical applications of ketoprofen allows the attainment of high intra articular tissue concentrations. Topically applied NSAIDs have a superior safety profile to oral formulations. Adverse effects secondary to topical NSAID application occur in approximately 10 to 15% of patients and are primarily cutaneous in nature (rash and pruritus at site of application). GI adverse drug reactions are rare with topically applied NSAIDs, compared with a 15% incidence reported for oral NSAIDs

 

TOPICAL ANESTHETICS:

The below mentioned article describes the use of LAT Gel (Lidocaine, adrenaline, and tetracaine) for use on facial and scalp lacerations.

 

 "LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) worked as well as TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children."

 

Pediatrics 1995 Feb;95(2):255-8

 

Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.

Ernst AA, Marvez E, Nick TG, Chin E, Wood E, Gonzaba WT
Department of Medicine, Louisiana State University, New Orleans.

 

In order to access the PubMed abstract of this article, visit this website link.

 

The following article reported that a triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine ("BLT") applied prior to treatment with a 532-nm KTP laser resulted in significantly lower pain scores than with 3 other topical anesthetics at 15, 30, 45, and 60 minutes after application.

Cosmetic Dermatology 2003 Apr;16(4):35-7

Topical Triple-Anesthetic Gel Compared With 3 Topical Anesthetics

Lee MWC
Department of Dermatologic Surgery, University of California, San Francisco

TOPICAL OPIOIDS:

The below mentioned article describes how topical morphine gel has proved a rapid reduction in pain when acute inflammatory pain was present.

 

"The use of topical morphine gel is reported in two children with epidermolysis bullosa, where acute inflammatory pain is a major symptom and where effective analgesia is a major clinical problem. The gel provided rapid reduction in pain scores in the patients and without any reported adverse effects or tolerance. A topical route of analgesia might be extremely beneficial for children with other painful skin lesions, including burns or post-surgical wounds, and further studies are now required."

 

Arch Dis Child. 2004 Jul;89(7):679-81
Peripheral opioids in inflammatory pain.

 

In order to access the PubMed abstract of this article, visit this website link.

 

Morphine sulfate 10 mg in Intrasite gel was applied topically to skin ulcers of hospice inpatients. The topical morphine was not absorbed in the majority of patients, suggesting any analgesic effect was mediated locally rather than systemically.

 

J Pain Symptom Manage. 2004 May;27(5):434-9
The bioavailability of morphine applied topically to cutaneous ulcers.

 

In order to access the PubMed abstract of this article, visit this website link.

 

 

Family Practice Categories:

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Bio-Identical vs. Non-Bio-Identical Hormones

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Hemorrhoids

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Topical vs. Oral NSAIDs

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Topical Anesthetics

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Topical Opioids

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