Compounding Ideas for Winter & Flu Season

It’s that time of year again! Winter and Flu season are upon us. Here are a few suggestions to keep you and your family healthy so that everyone can make the most of this time of year.

DRY SKIN

A big complaint of the winter months is dry skin, or xerosis. Temperature and humidity are some of the factors that can influence the water content of the skin. Without adequate hydration, the skin can dry out and crack. This can cause itching, inflammation, scaling and rough texture, and can lead to infection. It is common to experience dryness in the winter months when we all spend more time indoors in low-humidity environments.

One of the most effective ways to treat dry skin is to increase the moisture content. This can be accomplished by using PracaSil™-Plus, which contains silicones and pracaxi oil, which is rich in fatty acids and lipids. Pavilion Compounding Pharmacy can also add other ingredients to Pracasil Plus, such as urea, which can be used to increase the water-holding capacity of the skin. It promotes hydration by increasing stratum corneum water uptake and enhances the water-binding capacity. It also has a mild keratolytic action, removing excess keratin in dry skin conditions. We normally use 20% urea in PracaSil-Plus as a topical gel.

Another option is compounding a lotion bar. Working with your healthcare provider, Pavilion Compounding Pharmacy can customize topical lotion bars to meet your specific needs. One suggestions is a topical bar containing 33% coconut oil. Coconut oil has emollient properties and significantly improves the hydration of skin. This oil also contains 62% medium-chain fatty acids, which in addition to its antioxidant properties are believed to be responsible for its anti-inflammatory activity.

XemaTop™ is another cream base we frequently use that was specifically designed for the topical delivery of medications in formulations used by patients with dry skin conditions. It replenishes the lipids within the skin and helps restore the skin’s barrier, reducing irritation and preventing water loss.

ANTI-VIRAL

Being out in the crowds, whether for shopping or traveling, can expose you and your patients to lots of germs. Our “fly-safe” formula is used in the winter months before entering crowded areas. A small amount is placed in the nostrils right before a flight, entering a shopping mall, or any other area where contracting germs is a concern.

There are two versions of our “fly-safe” formula: 1% tranilast with 0.19% 2-deoxy-D-glucose (DDG), and the second formula contains the same ingredients as mentioned but is enhanced with EGCg. Tranilast is a mast cell stabilizer and inhibits the production and/or release of many inflammatory mediators. Tranilast has antiallergic and antioxidant effects, and also helps to prevent and relieve ear and sinus problems during air travel. It also may decrease nasal congestion. DDG acts as an anti-viral. The addition of EGCg, an active polyphenol in green tea, has been shown to have antiviral, antibacterial and antifungal effects.

An alternative to compounding the “fly-safe” formula with EGCg is an over the counter supplement called Green Tea-70. This is an excellent option to have on your shelf for those wanting to strengthen their immune systems. It contains a high concentration of EGCg with 350 mg per capsule. The suggested directions are to take one capsule once or twice daily. Call our pharmacists to review this great supplement.

Remember to also take your vitamin D3 during these winter months. This time of year, vitamin D can plummet. Supplementing with Vitamin D3 can help keep the immune system doing its job well.

See below for other commonly requested formulas.

Commonly Requested Formulas for Influenza Symptoms

Zinc Gluconate 5 mg/Ascorbic Acid 100 mg/Deoxy-D-Glucose (2) 0.2% Sorbitol Lollipop Base

Zinc Gluconate 12.5 mg/Ascorbic Acid 100 mg/Glycine 50 mg Base A Troche

Commonly Requested Formulas for Patients Needing an Anti-Viral

Tranilast 1%/Deoxy-D-Glucose (2) 0.19%/Shea Butter

Tranilast 1%/Deoxy-D-Glucose (2) 0.19%/EGCg 1%/Shea Butter

EGCg 50 mg Sorbitol Lollipop Base

EGCg 50 mg Polyglycol Troche (Chocolate)

EGCg 200 mg Oral Effervescent

EGCg 0.4% Nasal Spray

Deoxy-D-Glucose 0.2% Nasal Solution

Deoxy-D-Glucose 0.2% Polyglycol Troche

Commonly Requested Formulas for Cough/Cold Symptoms

Hydrocodone Bitartrate 10 mg/5 mL/Acetaminophen 325 mg/5 mL Oral Suspension (SuspendIt™)

Hydrocodone Bitartrate 1 mg/mL/Pseudoephedrine HCl 12 mg/mL/Guaifenesin 40 mg/mL Oral Suspension (SuspendIt™)

Hydrocodone Bitartrate 1 mg/mL/Guaifenesin 20 mg/mL Oral Suspension

Hydrocodone Bitartrate 2.5 mg/5 mL/Phenylephrine HCl 5 mg/5 mL/ Chlorpheniramine Maleate 2 mg/5 mL Oral Solution (SF)

Hydrocodone Bitartrate 1 mg/mL/ Homatropine Methylbromide 0.3 mg/mL Oral Syrup

Guaifenesin 20 mg/mL/Menthol 4.4 mg/mL/Camphor 0.44 mg/mL Oral Syrup Menthol 0.2%/Eucalyptus 0.1% Sorbitol Lollipop Base

Menthol 0.1%/Eucalyptus 0.34% Polyglycol Troche Base Lollipop

Dextromethorphan HBr 20 mg/Menthol 15 mg/Ascorbic Acid 500 mg Sorbitol Lollipop Base

Guaifenesin 100 mg/mL Oral Suspension (SuspendIt™)

Dyphylline 100 mg/5 ml/Guaifenesin 100 mg/5ml Oral Liquid

Acetaminophen 325 mg/Phenylephrine HCl 10 mg/Dextromethorphan HBr 20 mg/Ascorbic Acid 500 mg Oral Effervescent

Acetaminophen 325 mg/Phenylephrine HCl 10 mg/Chlorpheniramine Maleate 2 mg/Dextromethorphan HBr 20 mg/Ascorbic Acid 500 mg Oral Effervescent Commonly Requested

Commonly Requested Formulas for Patients with Throat Pain Due to Various Conditions Such As: Tonsillitis; Tonsillectomy; Strep Throat; Mononucleosis; Hand, Foot and Mouth Disease; Influenza; Colds; Laryngitis; Pharyngitis

Tetracaine HCl 0.025% Popsicle (MucoLox™)

Lidocaine HCl 2% Oral Rinse (MucoLox™)

Tetracaine HCl 0.5% Sorbitol Lollipop Base

Lidocaine HCl 2%/Ascorbic Acid 500 mg Sorbitol Lollipop Base

Commonly Requested Formulas for Patients with Pain or Fever

Ketoprofen 10% Topical Lipoderm®

Ibuprofen 20% Topical Lipoderm®

Ibuprofen 400 mg Base MBK Suppository (Pink Mold)

Ibuprofen 400 mg/5 mL Oral Suspension (SuspendIt™)

Ibuprofen 200 mg Base A Troche

Acetaminophen 125 mg Gelatin Troche

Acetaminophen 650 mg Base MBK™ Suppository

Acetaminophen 360 mg Sorbitol Lollipop Base

Piroxicam 5% Topical Lipoderm®

Commonly Requested Formulas for Patients with Chronic Ear Infections

Xylitol 2 Gm Sorbitol Lollipop Base

Xylitol 40% Oral Syrup

Xylitol 66.7% Oral Syrup

Xylitol 60% Oral Syrup

Commonly Requested Formulas for Patients with Allergies

Ketotifen 0.05%/Mometasone Furoate 0.05% Nasal Spray (MucoLox™)

Xylitol 7.5%/Glycerin 2% Saline Nasal Spray

Commonly Requested Formulas for Patients with Nausea/Vomiting

Promethazine HCl 12.5 mg/Gm to 25 mg/Gm Topical Lipoderm®

Ondansetron 4 mg/0.1 mL Topical Lipoderm® ActiveMax

Ondansetron 8 mg Base MBK Suppository

Ondansetron 4 mg/5 mL Oral Suspension (SuspendIt™)

Ondansetron 4 mg/5 mL Oral Suspension

Ondansetron 8 mg Oral Effervescent

Ondansetron 4 mg Sorbitol Lollipop Base

Pyridoxine HCl 10 mg/Ginger 300 mg Oral Effervescent

Ginger Root 200 mg Sorbitol Lollipop Base™

Doxylamine Succinate 10 mg/Pyridoxine HCl 10 mg/Ginger Root Capsules

Ranitidine HCl 75 mg/15 mL/Dexamethasone 0.5 mg/15 mL/Metoclopramide 5 mg/15 mL/Chlorpromazine HCl 10 mg/15 mL/Diphenhydramine HCl 12.5 mg/15 mL/Lorazepam 0.5 mg/15 mL Oral Suspension (SuspendIt™)

Commonly Requested Formulas for Dry Lips

Lipoic Acid 1%/Vitamin E Acetate 3%/Aloe Vera Lip Gel (MucoLox™)

Gluconolactone 3%/Sunscreen Compound Lip Balm

Octinoxate 7%/Oxybenzone 3%/Shea Butter/Aloe Vera Lip Balm

Hydrocortisone 1% Lip Balm

Commonly Requested Formulas For Dry Skin

Urea 20% Topical Gel (PracaSil®-Plus)

Urea 15%/PracaSil™-Plus Topical Gel (Spira-Wash™)

Urea 10%/Sodium Hyaluronate/PracaSil™-Plus Topical Gel (Spira-Wash™) Moisturizing Topical Cream

Commonly Requested Nutritional Products for Support of a Healthy Immune System

Green Tea-70 – contains the highest concentration (70%) of the potent immune system enhancer epigallocatechin (EGCg). Articles in the medical literature have noted the viral inhibitive effects of EGCg in influenza, hepatitis B & C, and even Ebola, to name a few. Not only has EGCg been recognized for its immune enhancement capabilities with viral infections, it has also been shown to be beneficial in minimizing cancer risk and as a valuable option in anti-aging medicine.

Immuno-DMG Chewable -Synergistic and powerful blends of immune stimulants have been shown to provide a boost when the immune system is being challenged. Such a product is Immuno-DMG Chewable, a combination of vitamin D3, black elderberry, larch tree, beta-1-3 glucan, astragalus root and maitake mushroom fraction. This combination can be used at the first sign of immune challenge, and the product can be dosed from children all the way up to adults.

Immune Health Support -A combination of antioxidants, B-vitamins, mushroom extracts and herbals designed to specifically support the immune system as needed.

Echinacea & Goldenseal- will also help to enhance immune response when it is being challenged.

Zinc Lozenges -Zinc is a critical component for proper immune function. When coming down with a cold, zinc lozenges can shorten the duration of a cold and actually prevent a cold from occurring. Using zinc lozenges while traveling on an airplane can reduce your chances of getting an infection from other passengers. For immune enhancement, use zinc lozenges every two hours while awake.

Vitamin D 5000 IU-Vitamin D3 has been shown to provide general cellular support and daily immune system support.

Viracid–Viracid includes a powerful combination of key nutrients and botanical extracts that provide immediate support for immune challenges. Viracid boosts immune defenses by providing nutrients such as L-lysine vitamin A, C, pantothenic acid, B12 and zinc, as well as the synergistic blend of botanical extracts black elderberry, astragalus, echinacea and andrographis that have been used traditionally for their clinically effective immunomodulating properties.

Every patient is unique, and formulas should be adjusted to meet their individual needs.

Have any questions? Contact Pavilion Compounding Pharmacy to discuss! Call or E-mail our pharmacists to review any information. We look forward to keeping you healthy and happy in the new year!

REFERENCES

1. Allen, L.V. (2003) ‘Basics of compounding for dry-skin conditions’, International Journal of Pharmaceutical Compounding, 7 (6), pp. 460-3.

2. Clinical Pharmacology (2014) Urea. Available at: http://www. clinicalpharmacology-ip.com/Forms/Monograph/monograph. aspx?cpnum=634&sec=monmech&t=0.

3. Agero, A.L. and Verallo-Rowell, V.M. (2004) ‘A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis’, Dermatitis, 15 (3), pp. 109-16.

4. Evangelista, M.T., Abad-Casintahan. F. and Lopez-Villafuerte, L. (2014) ‘The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial’, International Journal of Dermatology, 53 (1), pp. 100-8

5. Darakhshan, S. and Pour, A.B. (2015) ‘Tranilast: A review of its therapeutic applications’, Pharmacological Research, 91, pp. 15-28.

6. Namazi, M.R. and Soma, J. (2005) ‘Tranilast: A novel weapon against insulin resistance’, Medical Hypotheses, 64 (6), pp. 1135-1137.

7. Vail, J. (2007) ‘Innovative uses of compounded Tranilast: An interview with compounding pharmacist Larry J. Frieders, RPh’, International Journal of Pharmaceutical Compounding, 2007 Mar-Apr; 11(2): 130-3.

8. Wang, Y., Li, J.R., Sun, M.X., Ni, B., Huang, C., Li, H., Li, C., Fan, H.J., Ren, X.F. and Mao, X. (2014) ‘Triggering unfolding protein response by 2-DeoxyD-glucose inhibits porcine epidemic diarrhea virus propagation’, Antiviral Research, 106, pp. 33-41.

9. Stinmann, J., Buer, J., Pietschmann, T. and Steinmann, E. (2013) ‘Anti-infective properties of epigallocatechin-3-gallate (EGCG), a component of green tea’, British Journal of Pharmacology, 168 (5), pp. 1059-73.

10. DECEMBER 2015 APOTHAGRAM PCCA Compounding for Winter Conditions By Ranel Larsen, RPh, PCCA Pharmacy Consultant