|COMPOUNDING FOR PODIATRISTS|
Podiatrists may have many needs for compounded medications:
Wound Healing and Circulation Improvement
Nifedipine has been used in concentrations of 0.2% to 10% PLO gel in an effort to enhance circulation in areas of ischemia. Higher concentrations are used by pharmacists, but the lower doses are a better starting point due to the hypotensive properties of this drug. The same vaso-dialation properties that make it work well orally in diseases such as hypertension, angina pectoris, and Raynaud’s syndrome could also make it work well as an agent to rub on areas around diabetic ulcers and in ischemic areas to aid in blood flow. Transdermal nifedipine PLO should be dispensed in an amber bag because of its light sensitivity. The patient should be monitored for decreased blood pressure while using the preparation, and the wound should be monitored for signs of healing (skin becoming more pink, vascularized and skin dryness around the wound.
Commercial products to treat onychomycosis include griseoflulvin, itraconazole, Terbinafine and circlopirox 8% nail lacquer (Penlac). Griseofulvin has reported poor cure rates and requires 10 – 18 months of use. Oral therapy with itraconazole and Terbinafine also present problems with drug interactions and liver toxicity. A patient with compromised liver function or a GERD patient on a PPI will not be a candidate for oral itraconazole. For patients who cannot use antifungals, Penlac is the only commercial topical treatment available. However, Penlac reportedly has only a 14% cure rate after several months of use. Having a compounded prescription medication may overcome these problems and avoid the need for extensive liver monitoring. We can dissolve an antifungal in dimethylsulfoxide (DMSO) that has superior nail penetration and it is able to deliver an antifungal to the site of infection. Examples of antifungals that can be compounded in DMSO are azole antifungals and terbinafine.
There are numerous medications that are commercially available to treat diabetic neuropathy and help return sensitization. Some of the drugs used to treat diabetic neuropathy are amitriptyline, baclofen, ketamine, gabapentin, and clonidine. Diabetic patients can benefit from topical combinations of these medications that are not commercially available. Combinations of topical medications have the advantage of fewer adverse effects as well as using one medication rather than several.
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