The Pharmacy Chick

Flying the Coop in Retail

Attention: compounders! I need a formula

Filed under: Uncategorized — pharmacychick at 6:48 pm on Wednesday, December 24, 2008

Pharmacy chick got an odd one today, for diltiazem ointment.  My first thought was electronic rx goof up. However after doing a bit of research I see Dr’s are using this product to help healing of anal fissures. I would have to wonder ….Who’d have thought to try THIS for THAT? 

Regardless, my internet search for a formula came up empty handed.  Are any of you compounders?  Have you made this?  What base?  just grind up tablets?  I am looking for 2% ointment.

I beseech thee for help!

8 Comments »

713

Comment by Frantic Pharmacist

December 24, 2008 @ 8:51 pm

I have made it — we used ground up tablets in white petrolatum. The tricky part was finding immediate-release diltiazem tablets to use, but they’re still out there….

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Comment by persimmon

December 24, 2008 @ 11:19 pm

I had a gentleman getting nifedipine 0.5% ointment last week for just this purpose. All I had was XR reservoir-type tabs. I ground them pretty fine in a mortar, solvated them in a couple mLs of propylene glycol, mixed by geometric dilution with white petrolatum, and ran it through the ointment mill until it looked homogeneous. I would NOT try defeating XR tablets without an ointment mill–the pt and I agreed to go for the less elegant product because he wanted it rather urgently.

I’ve been known to cheat and use a lyophilized powder for injection if we’re doing a rush on something, because I can get it next day from Cardinal.
Thanks, I don’t have an ointment mill. A pill tile and a spatula will have to do so I’ll either use the immediate release tabs or the powder for injection…thats a great idea.

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Comment by RPh1982

December 26, 2008 @ 5:46 am

I use Diltiazem powder (I had to go to an outside wholesaler) in Dermabase. I’ve also had to add Hydrocortisone 1% powder to a few of them. Don’t you just love this according to the art business when there are no references available? Thank goodness I live in a friendly area…pharmacists around here all help each other out.

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Comment by JOE

December 26, 2008 @ 1:17 pm

As a compounder, I would tell you to refer the patient to a compounding pharmacy because without an ointment mill, you will NEVER get a small enough particle size within the ointment base (I use Aquaphor Healing Ointment) for the final product to be as effective as it should be. Oh, and I use pure Diltiazem powder from a reputable compounding supplier. I still don’t understand why pharmacists in busy, non-compounding stores (usually chains) don’t refer ALL compounds elsewhere. I’m sure you have plenty of other work to do, don’t you???
I would prefer to refer all my compounding elsewhere but sometimes its not practical. We have one pharmacy in our metro area that specializes in compounds and its quite a ways a way. I try to limit my compounding to pretty simple cream mixes because I dont have time frankly anymore to labor over it. I also do not have accounts with any compounding supply houses. If my wholesaler doesnt’ stock it, I don’t get it. Since it was Christmas eve, I told the patient to call his Dr on friday and find out where he usually sends his patients with this. I am sure he knows who makes it for him.
Thanks Joe.

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Comment by The Ole' Apothecary

December 26, 2008 @ 5:12 pm

Especially considering the emerging war on compounding from government, I’m with Joe. If I read the new Texas regulations correctly, the amount of care and documentation required for compounding in my home state these days takes an expert, and that expertise is best found in pharmacies that have the most experience in modern compounding.

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Comment by Sir Dispensalot

December 27, 2008 @ 1:36 am

There’s a company over in the UK i use to get regular supplies of diltiazem 2% ointment from called Quantum Specials – they make up all kinds of special stuff and would have a stable formulation list for you to use if you asked them really nicely. Not 100% sure but they may even know how to get some of their product to you (with a 6 month shelf life instead of the 30 day one you get when you make up your own). All the pharmacists do there is compounding and preparation of ‘specials’ – they really know their stuff when it comes to the ol’ grinding and mixing…

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Comment by Rx-consumer

February 4, 2009 @ 10:05 pm

“Who’d have thought to try THIS for THAT?”

The reason given why anal fissures do not heal is high muscle tone which interferes with the good blood flow needed to heal the torn tissue. Frequently the treatment is surgery to cut the sphincter muscle to weaken it, thus lowering the muscle tone and allowing the blood to flow better. I know, it seemed barbaric to me, too. Another treatment I was offered was a botox injection, you know where (!!!).

Diltiazem is a vasodilator, so the originator must have thought it would increase the local blood flow enough to finally stimulate healing.

After suffering for months going on years with a severe, non-healing anal fissure, I was skeptical that a stupid topical cream would do anything, but vs. the botox injection or rectal surgery, I was willing to humor the doctor and give it a try. To my great amazement and relief, it worked, and it only took a few weeks.

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Comment by Jim Bates

April 9, 2011 @ 7:36 am

My doctor prescribed this for anal fissures. My pharmacist makes it up as follows – directly from the perscription label: Diltiazem powder 2% in glaxal base cream – 30 gram mix – apply to peri-anal area twice a day when needed. Hope this helps

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