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Pain Management Compounding

PHYSICAL MEDICINE

& REHABILITATION 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.

 

Compounded Medications:

  • Amantadine---NMDA receptor antagonst

  • Amitryiptyline---Symatholytic

  • Baclofen---GABA(b) agonist

  • Bupivicaine---Anesthetics

  • Carbamazepine---NMDA sodium channel antagonist

  • Clonidine---Alpha 2 agonist

  • Dextromethorphan---NMDA receptor antagonst

  • Gabapentin---Glutamate antagonist

  • Guaifenesin---Skeletal muscle relaxants

  • Ketamine---NMDA receptor antagonst

  • Lidocaine---Anesthetics

  • Loperamide---Mu agonist

  • Morphine---Mu agonist

  • Nifedipine---L type calcium channel antagonist

  • Orphenadrine---NMDA receptor antagonst

  • Pentoxiphylline---TNF 1alpha antagonist

  • Tetracaine---Anesthetics

MIGRAINE:

The below mentioned article portrays how A set combination of indomethacin, prochlorperazine dimaleate and caffeine is considerably more effective than sumatriptan in the acute treatment of migraine attacks versus sumatriptan which are both rectal suppositories.

 

Headache. 2003 Sep;43(8):835-44

 

Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine versus sumatriptan in acute treatment of multiple migraine attacks: a multicenter, randomized, crossover trial.

Di Monda V, Nicolodi M, Aloisio A, Del Bianco P, Fonzari M, Grazioli I, Uslenghi C, Vecchiet L, Sicuteri F.
Neurology Division I, Spedali Civili di Brescia, Italy.

 

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

 

 

The below mentioned article depicts how Oral therapy with a combination of LAS (equivalent to 900 mg ASA) and metoclopramide 10 mg was superior to placebo with therapeutic gains for the first treated attack, and was comparable to 100 mg sumatriptan.

 

Funct Neurol. 2000;15 Suppl 3:196-201

 

The effectiveness of combined oral lysine acetylsalicylate and metoclopramide (Migpriv) in the treatment of migraine attacks. Comparison with placebo and oral sumatriptan.

Tfelt-Hansen P.
 

Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, DK-2600 Glostrup, Denmark.

 

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

 

NEUROPATHIC PAIN:

Topical and transdermal formulations are a great alternative to over the counter or prescribed oral medications. These compounded synergistic drugs are specifically compounded to meet the needs of the patient with chronic pain.  

The below mentioned article describes the use of topical ketamine 0.5% (5 mg/ml) gel, applied as a thin film two to three times daily over the skin where pain was severe. Topical ketamine reduced pain for patients with postherpetic neuralgia with no systemic side effects.

 

Neurology 2003;60:1391-1392


Topical ketamine treatment of postherpetic neuralgia

No abstract available. In order to purchase the full article on line, visit this
website link.

 

The following randomized, double-blind, placebo-controlled study assessed the analgesic efficacy of topical administration of 3.3% doxepin hydrochloride, 0.025% capsaicin or a combination applied daily for 4 weeks in 200 adult patients with chronic neuropathic pain, and reported that all three preparations significantly reduced overall pain.

Br J Clin Pharmacol 2000 Jun;49(6):574-9


Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study.


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

 

 

NSAID THERAPY:

 

Agewell Pharmacy can compound topically applied NSAID’s such as ibuprofen and ketoprofen in order to avoid the risks of COX-2 inhibitors. Topical NSAIDs have a safety profile which far exceeds that of oral formulations. Topical NSAID administration offers the advantage of local, enhanced delivery to painful sites with a reduced incidence of systemic adverse effects. We customize our topical preparations with a combination of medications in order to cater to the specific needs of each patient. Topical preparations can be customized to contain a combination of medications in order to meet the specific needs of each patient.

 

Topical NSAIDs for Acute Pain:

 

“Topical non-steroidal anti-inflammatory drugs have a lower incidence of gastrointestinal adverse effects than the same drugs when they are taken orally. The low incidence of systemic adverse effects for topical NSAIDs probably results from the much lower plasma concentration from similar doses applied topically to those administered orally. Topical application of ibuprofen resulted in measurable tissue concentrations in deep tissue compartments, more than enough to inhibit inflammatory enzymes.”1 Topical NSAIDs have not been associated with renal failure.2

1 BMJ. 1995 Jul 1;311(6996):22-6

 

Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study.

Evans JM, McMahon AD, McGilchrist MM, White G, Murray FE, McDevitt DG, MacDonald TM.
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee.

 

View full text article at bmj.com, visit this website link.

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

 

 

The following article concludes: “Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.”

BMJ. 1998 Jan 31;316(7128):333-8

 

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington, UK

 

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

 

 

The following article reports “The systemic concentrations of ketoprofen have also been found to be 100 fold lower compared to tissue concentrations below the application site in patients undergoing knee joint surgery. Topically applied ketoprofen thus provides high local concentration below the site of application but lower systemic exposure.”

 

Pharm Res. 1996 Jan;13(1):168-72
Percutaneous absorption of ketoprofen from different anatomical sites in man.

Shah AK, Wei G, Lanman RC, Bhargava VO, Weir SJ.
Pfizer Inc., Central Research Division, Groton, Connecticut 06340

 

View full text article at bmj.com, visit this website link.
 

 

Sever disease is the most common cause of heel pain in pre-pubertal children. This inflammatory condition is a result of minor repetitive trauma and typically occurs during a growth spurt or at the beginning of a new sport season. A case report described the use of topical ketoprofen 10% gel to relieve pain and inflammation.

Phys Ther. 2006 Mar;86(3):424-33
Ketoprofen gel as an adjunct to physical therapist management of a child with Sever disease.

 

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

 

 

ORAL PAIN MEDICATIONS:

  • Hydrocodone 1mg to 10mg

  • Hydromorphone 1mg to 8mg/ml

  • Ibuprofen 100mg to 600mg

  • Ibuprofen 120mg/ml

  • Indomethacin 10mg to 50mg

  • Ketamine 25mg/ml to 100mg/ml

  • Meperidine 1mg to 100mg

  • Methadone Suspension 1mg/ml to 29mg/ml

  • Morphine 1mg to 10mg

  • Morphine 1mg to 50mg

  • Morphine extended release 1mg to 200mg

  • Morphine extended release 1mg to 200mg w/DM 30mg to 60mg

  • Morphine extended release 1mg to 50mg

  • Morphine IR liquid 1mg/ml to 30mg/ml

  • Morphine SR Suspensions 0.5mg/ml to 10mg/ml

  • Opiates (desired strength) with DM (30mg to 60 mg)

  • Opiates (desired strength) with Ibuprofen 200mg

  • Opiates (other) (various strengths)

  • Opiates (other) with APAP (various strengths)

  • Opiates (other) without APAP (various strengths)

  • Oxycodone 0.5mg/ml to 10mg/ml

  • Oxycodone 1mg to 50mg

  • Oxycodone extended release 1mg to 200mg

  • Oxycodone extended release 1mg to 200mg w/DM 30mg to 60mg

  • Oxycodone SR Suspensions 0.5mg/ml to 10mg/ml

 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.

  


 

Physical Medicine Categories:

 

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Migraine

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Neuropathic Pain

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NSAID Therapy  

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Oral Pain Medications  

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Topical Anesthetics

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Topical Opioids

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