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St Johns 918-742-1111
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Compounding

What is Compounding?

Protect your right to free prescribing and every patient’s access to customized medications 
Visit www.savemymedicine.org for more information.

An ageless art is found in in compounding.  This is ageless art that partners up with the latest and greatest medical knowledge and state of the art, top quality, medical technology. This allows our specially trained experts to make you customized medications that can meet every single patients need, no matter how specific they may be. Compounding is so important, you may not even realize how much of a role it has. Before any medications can be mass produced, it had to go through compounding. To this day it still has such an important role in pharmacy, even retail. Do not be limited by the available strengths of your medications from manufactures, get a customized dose from your physician and your local compounding pharmacy.

Our compounding professionals can prepare

  • unique dosage forms that containing the best possible dose of medication for each and every single individual.
  • medications in dosage forms that are not commercially available in other retail pharmacies, such as transdermal gels, “chews”, troches and lollipops.
  • medications free of problem-causing ingredients such as sugar, lactose, dyes or alcohol.
  • combinations of various medications that are compatible into a single dose form for easier and improved administration.
  • medications that are not currently commercially available.
  • And even more!

Therapeutic Outcomes Maximized by Quality Compounding 

The efficacy of any formulation, no matter what it may be is directly corollated to its preparation, which is why THE SELECTION OF YOUR COMPOUNDING PHARMACY IS VERY CRITICAL. Training that is ongoing for everyone, including technicians, and pharmacists, along with the state of the art equipment, and the highest quality of chemicals are of the upmost importance. Other important factors are ingenuity and experience.  When tweaking or correcting a formula, or even developing a very unique preparation., the compounding pharmacist has to consider several different things such as chemical and physical properties of everything such as the inactive and the active ingredients, solubility, tonicity, viscosity, and what the most appropriate dosage form for administrating the medicine is. Things such as Standard Operating Procedures need to always in place. Stability studies need to be considered while compounding and the necessary sterility and potency testing should be preformed.

 Our compounding professionals can make all sorts of suitable medications as nasal sprays, lollipop  sublingual drops, oral and rectal solutions and suppositories, and other customized dosage forms. Please contact us to discuss your patients’ needs.

Compounding Problem Solving.

N-acetylcysteine to Decrease the Incidence of Contrast-Induced Renal Failure
Following Cardiac Catheterization, CT scan, Angiography, etc.

RCIN (Radiocontrast induced nephropathy) is a preventable complication of administration of radiocontrast agents used in different procedures such as; CT scan cardiac catheterization, angiography, etc. The third most common cause  of renal insufficiency that occurs in hospitalized has been reported to be RCIN. The patients who are at greatest risk of RCIN are the patients with renal insufficiency, such as patients with advanced congestive heart failure or diabetic nephropathy. The effects of RCIN are usually seen within 72 hours of administration and can range from a slight increase in serum creatinine levels to even acute renal failure.

Tepel et al. came to the decision that prophylactic oral administration of the antioxidant N-acetylcysteine (600 mg orally twice daily) and 0.45 percent saline intravenously, both before and after administration of the contrast agent, prevents the reduction in renal function that is induced by contrast agents in patients with chronic renal insufficiency.1 Duong et al. used normal standard search protocols to find and identify all published articles and abstracts of prospective trials using N-acetylcysteine (NAC) with fluid hydration compared to hydration that is alone in patients with chronic renal insufficiency undergoing contrast procedures. Raising serum creatinine by 0.5 mg/dl or 25% above baseline at 48-72 hr after contrast exposure was used as the main outcome. 14 trials of NAC with 1,584 patients published as full length, text articles met inclusion criteria for the meta-analysis. The patients that were treated received 600 mg p.o. b.i.d. (by mouth twice a day)  2 days of NAC, or equivalent dosing, in 12/14 trials. One study used 1,200 mg p.o. b.i.d (twice daily) 2 days and another used 2 g b.i.d.  3 doses. The analysis found that the use of oral NAC resulted in a significant reduction in the risk for developing RCIN.Baker et al. reported that administration of intravenous NAC should be considered in all of the patients that are at risk of RCIN before contrast exposure when time constraints preclude adequate oral prophylaxis. This is assuming the patient is even able to tolerate the volume loading.3
Oral N-acetylcysteine, along with hydration with 0.45% sodium chloride solution, is gaining significant acceptance as a very promising preventive protocol for RCIN. N-acetylcysteine is well received by patients: in fact, no major side effects have been reported. Compounding pharmacists play a very important role in preventing RCIN by being able to compound N-acetylcysteine into a palatable capsule form that will increase patient compliance and by counseling patients on the importance of keeping hydrated prior to contrast medium procedures.?4

1 N Engl J Med 2000 Jul 20;343(3):180-4. Click here for abstract.

2 Catheter Cardiovasc Interv. 2005 Apr;64(4):471-9. Click here for abstract.

3 J Am Coll Cardiol. 2003 Jun 18;41(12):2114-8. Click here for abstract.

4 Int?l Journal of Pharmaceutical Compounding, Mar/Apr 2005; 9(2):99-103

Call our compounding pharmacy when a needed medication is not commercially available.

Topical glycopyrrolate 0.5% solution is effective in treating craniofacial hyperhidrosis
and is associated with few adverse effects.

South Med J 2002 Jul;95(7):756-8
Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate.

Luh JY, Blackwell TA.
Department of Internal Medicine, University of Texas Medical Branch at Galveston, 77555-0570, USA.

Click here to read the PubMed abstract.

All purpose nipple ointment also known as APNO,  is a combination of 3 different ingredients which helps relieve many causes of sore nipples that occurs during breastfeeding. Erosions and cracks in the nipple can harbor bacteria that can delay healing or cause infection. In addition, the presence of Candida albicans can cause nipple cracking and soreness. Inflammation associated with injury and infection can cause great pain. It is always good to try to get the best latch possible, because improving the latch helps with any cause of pain.

A pediatrician whose name is Jack Newman, MD, FRCPC, started the first breastfeeding hospital-based clinic in Canada in 1984. He has been a UNICEF consultant for the Baby Friendly Hospital Initiative in Africa. Dr. Newman has noted that ointments work much better than creams to treat and relieve sore nipples, and recommends a preparation containing betamethasone 0.1% ointment 15 grams, mupirocin 2% ointment 15 grams,, with miconazole powder added so that the final concentration is 2% miconazole. Dr. Newman suggests that it is sometimes helpful to include ibuprofen powder as well, so that the final concentration of ibuprofen is 2%. The combination is applied after each feeding sparingly. In Canada, according to Dr. Newman,, Kenacomb (easier to find) or Viaderm KC (less expensive) ointments (not cream) can be changed out for the above combination, but are distinctly less effective.

http://www.breastfeedingonline.com/newman.shtml accessed March 29, 2007

Sterile Compounding

 Erectile Dysfunction

“Triple Mix” Injection for Erectile Dysfunction

Men who suffer erectile dysfunction (ED) who have used the triple therapy (papaverine/phentolamine/prostaglandin-E1) by intracavernosal injection (ICI) and then changed to sildenafil (oral) found they had a greater preference that was expected for triple therapy. Overall, the quality of erection with ICI was better than that with sildenafil.1  The fear of pain with intracavernosal injection (ICI) therapy may make people wary about its use. Yet, a Cleveland Clinic study has shown that in the majority of ED patients, discomfort is very minimal

Treatment with self-injections of vasoactive drugs in men with  both type 1 a d type 2 diabetes  and severe ED is a effective and safe alternative in the long term. The adjustment of the therapeutic method and dosage to optimal levels for satisfactory erections is key.3

Early intracavernosal injections that follow radical prostatectomy facilitated early sexual intercourse, patient satisfaction and potentially earlier return of natural erections, according to a Glickman Urological Institute, Cleveland Clinic Foundation study. Early combination therapy with sildenafil allowed a lower dose of intracavernous injections, minimizing the  penile discomfort.4

Positive responses had a higher percentage in patients with erectile dysfunction was achieved with the trimix modality. Choice of more potent ICI regimens can improve efficacy.5

BJU Int. 2003 Aug;92(3):277-80.
Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year.
Click here to access the PubMed abstract of this article.

J Sex Med. 2005 May;2(3):428-31.
Use of a visual analog scale to assess pain of injection with intracavernous injection therapy.
Click here to access the PubMed abstract of this article.

Asian J Androl. 2006 Mar;8(2):219-24.
Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction.
Click here to access the PubMed abstract of this article.

Int J Impot Res. 2006 Sep-Oct;18(5):446-51. Epub 2006 Feb 16.
Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections.
Click here to access the PubMed abstract of this article.

5 Arch Esp Urol. 2001 May;54(4):355-9.

[Response to intracavernous administration of 3 different drugs in the same group of patients with erectile dysfunction]
Click here to access the PubMed abstract of this article.

 Injectables

Examples of sterile injections that can be compounded by prescription order include:

  • 17P (17 alpha hydroxyprogesterone)*
  • Riboflavin
  • Intracavernosal injections of papaverine  and phentolamine, sometimes with prostaglandin E1 (“tri-mix”) in customized doses*
  • Vitamin B-12
  • Glutathione
  • Diagnostic preparations (i.e., methylene blue)

*see more info below

Ask us about all of the combinations to meet specific needs that you may have or medications that are currently unavailable or have been stopped for non-safety reasons (such as when a newer therapy reduces the need and therefore decreased use results in the medication no longer being profitable to manufacturer).

17-Alpha Hydroxyprogesterone Caproate (17P) lowers the risk of pre-term delivery (PTD) in women that are pregnant with a history of spontaneously giving birth before 37 weeks gestation, and who are therefore at risk of experiencing another pre-term birth. Typically, women receive intramuscular injections weekly of 250 mg of 17P, ideally starting at 16 weeks gestation and continuing to 36 weeks and 6 days.

N Engl J Med. 2003 Jun 12;348(24):2379-85.
Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.
Meis PJ, Klebanoff M et al.
Click here to access the PubMed abstract of this article.

Obstet Gynecol. 2005 May;105(5 Pt 1):1128-35.
17 hydroxyprogesterone for the prevention of preterm delivery.
Meis PJ; Society for Maternal-Fetal Medicine.
Click here to access the PubMed abstract of this article.

Manag Care. 2005 Oct;14(10):58-63.
17 alpha-hydroxyprogesterone caproate (17P) usage in a Medicaid managed care plan and reduction in neonatal intensive care unit days.
Mason MV et al.
Click here to access the PubMed abstract of this article.

Am J Obstet Gynecol 2007;196:224.e1-224.e4.
Increased recurrence of preterm delivery with early cessation of 17-alpha-hydroxyprogesterone caproate.
Andrei Rebarber et al.

Am J Obstet Gynecol 2007;196:453.e1-453.e4.
Cervical length changes during preterm cervical ripening: effects of 17-α-hydroxyprogesterone caproate.
Fabio Facchinetti et al.

Obstet Gynecol. 2007 Oct;110(4):865-72.
Follow-up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo.
Northen AT et al.
Click here to access the PubMed abstract of this article.

 Intracavernosal injections

Intracavernosal injection of drugs such as phentolamine, papaverine and prostaglandin E1 is an effective treatment for patients with erectile dysfunction (ED).

Clin Cornerstone. 2005;7(1):37-45.
Available and future treatments for erectile dysfunction.
Click here to access the PubMed abstract of this article.

Asian J Androl. 2006 Mar;8(2):219-24
Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction.
Click here to access the PubMed abstract of this article.

Int J Impot Res. 2006 Feb 16
Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections.
Click here to access the PubMed abstract of this article.

BJU Int. 2003 Aug;92(3):277-80
Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year.
Click here to access the PubMed abstract of this article.

Ophthalmics

We can compound sterile ophthalmic drops, sprays, ointments, injections and pre-op solutions, including anesthetics, antibiotics, antivirals, antioxidants, cataract therapies, corticosteroids, ophthalmic decongestants, mydriatics, miotics and lubricants.

Preparations can contain a combination or a single drug in the most appropriate concentration and strength for a specific use, such as fortified antibiotic or pre-op drops.

Examples of preservative-free preparations include drops or sprays containing the following medications, alone or in combination:

  • Cyclopentolate
  • Phenylephrine
  • Proparacaine
  • Homatropine
  • Scopolamine
  • Tetracaine
  • Tropicamide

We use only the highest quality ingredients from an FDA registered supplier. Ask us about medications that are commercially unavailable or have been discontinued (for reasons other than safety concerns). We welcome the opportunity to answer your questions, and to work with you to compound medications that meet the specific needs of your practice. Please contact our compounding pharmacist with questions or to discuss any unique needs.


Autologous Serum Eye Drops

Conventional treatment of dry eye mainly consists of the use of artificial eye drops that are preservative-free  and punctal occlusion. None of the commercially available artificial tear preparations include important tear components such as epidermal growth factor, fibronectin, hepatocyte growth factor, neurotrophic growth factor, and vitamin A – all of which have been shown to play extremely important roles in the maintenance of a healthy ocular surface epithelial milieu. Autologous serum (AS) eye drops contain these factors that are essential and are beneficial in the treatment of ocular surface diseases such as persistent epithelial defects (PED), superior limbic keratoconjunctivitis, keratoconjunctivitis sicca, and neurotrophic keratopathy. AS treatment has been demonstrated to be more effective than artificial tears in a randomized control study. In in vivo and in vitro experiments, AS eye drops showed marked suppression of apoptosis in the conjunctival and corneal epithelium. Albumin, the serum’s major protein, improved ocular surface damage in vivo and rescued apoptosis after serum deprivation in vitro.

Autologous serum eye drops are non-allergenic and their biomechanical and biochemical properties are similar to normal tears. The protocol by Tsubota and associates entails obtaining a total of 40 ml of blood by venopuncture and centrifuging for 5 minutes at 1,500 rpm. The serum is then carefully separated in a sterile manner and diluted with saline that is sterile (preservative free) to prepare 20-50% autologous serum drops. Typically, aliquots of the final preparation are prepared in 5 ml vials with ultraviolet light protection, because vitamin A is very easily degraded by light. Patients are instructed to keep the vials they are currently using in a refrigerator at the temperature 4 C and to store the other vials in a freezer until they are needed.

A study by Kojima et al showed that none of the patients had punctal occlusion, which allowed further evaluation of the solitary effect of autologous serum drops. They found significant improvements in tear stability, ocular surface vital staining scores, and pain symptom scores in patients treated with autologous serum eyedrops compared with those assigned to nonpreserved artificial tears It was concluded that autologous serum is superior to conventional treatment with artificial tears for improving ocular surface subjective comfort and health.

Am J Ophthalmol. 2005 Feb;139(2):242-6
The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case-control study.
Click here to access the PubMed abstract of this article.


Acta Med Croatica. 2005;59(4):337-40.
[Comparison of local acetylcysteine and artificial tears in the management of dry eye syndrome].[Article in Croatian] Pokupec et al.
Click here to access the PubMed abstract of this article.


Intravitreal Bevacizumab for Neovascular AMD

Bevacizumab (Avastin™) is taken from the same monoclonal antibody precursor as ranibizumab (Lucentis™), yet bevacizumab costs a lot less than ranibizumab when it is administered as an intravitreal injection. Results of triple therapy using bevacizumab and intravitreal injections of dexamethasone or triamcinolone in combination with photodynamic therapy are  extremely encouraging.

N Engl J Med. October 5, 2006; 355(14):1409-1412

Acta Ophthalmol. 2010 Aug;88(5):594-600. Epub 2009 May 22.
Effect of intravitreal bevacizumab (Avastin) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month results.
Leydolt C et al.
Click here to access the PubMed abstract of this article.

Retina. 2008 Oct;28(9):1325-37.
Long-term safety and efficacy of intravitreal bevacizumab (Avastin) for the management of central retinal vein occlusion.
Gregori et al.
Click here to access the PubMed abstract of this article.

Ophthalmic Surg Lasers Imaging. 2009 May-Jun;40(3):293-5.
Sustained elevation in intraocular pressure associated with intravitreal bevacizumab injections.
Kahook et al.
Click here to access the PubMed abstract of this article.

Retina. 2009 May;29(5):573-8.
Same-day triple therapy with photodynamic therapy, intravitreal dexamethasone, and bevacizumab in wet age-related macular degeneration.
Bakri SJ, Couch SM, McCannel CA, Edwards AO.
Click here to access the PubMed abstract of this article.

Acta Ophthalmol. 2010 Aug;88(5):558-63. Epub 2009 Apr 27.
Macular function after intravitreal triamcinolone acetonide injection for diabetic macular oedema.
Karacorlu M, Ozdemir H, Senturk F, Karacorlu SA, Uysal O.
Click here to access the PubMed abstract of this article.


Cycloplegic (Mydriatic) Eye Spray

Children often do not want instillation of mydriatic drops for dilated fundus evaluation. As cycloplegic sprays have proven useful, two studies in children that are between the years 3-13, compared administration of one drop each of 1% tropicamide and 2.5% phenylephrine in each eye or one application of mydriatic spray (containing concentrations of 0.5% tropicamide and 2.5% phenylephrine) to each eyelid that was closed. These studies showed that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes, and is even the preferred method of administration for children.

Mydriatic sprays are compounded so this gives the physicianflexibility in prescribing the concentration and combinations of medications, and may also include scopolamine, homatropine or proparacaine.

Optom Vis Sci. 1997 Mar;74(3):160-3.
Efficacy of a mydriatic spray in the pediatric population.
Click here to access the PubMed abstract.

Binocul Vis Strabismus Q. 1999;14(2):107-10
A randomized comparison study of drop versus spray topical cycloplegic application.
Click here to access the PubMed abstract.

Comparative study of cyclopentolate drops versus spray in cycloplegia in children.
[Article in French]
Chafai A, Ajdnik S, Lejeune L, Cordonnier M.
Click here to access the PubMed abstract.


Combination Therapy / Pre-op Drops

All types of procedures require multiple eye drops administered in a quick period of time. The problem is that drops that are consecutive, wash out and dilute the preceding medication, causing lowered effectiveness and repeated administration. While some clinics will mix all of the drops together right before administrated, this results in a significant dilution of active ingredients from their therapeutic concentration. We can prepare combination eye drops that keep the original therapeutic concentration in each drop. Also, the viscosity can be increased to maintain tissue contact time. Other benefits include reduced staff time (fewer drops), simplified administration, improved accuracy and less waste.

 Veterinary

Examples of sterile veterinary preparations that can be compounded by prescription order include:

  • Methocarbomol
  • Mitomycin C
  • Guaifenesin
  • Methylene Blue*
  • Ophthalmic Preparations*

*see more info below

Ask us about combinations to meet specific needs or medications that are currently unavailable or have been discontinued for non-safety reasons (such as when a newer therapy reduces the need and therefore decreased use results in the medication no longer being profitable to manufacturer).

Pluronic Gels Enhance Platinum Drug Sensitivity

Platinum based chemotherapy drugs (cisplatin, oxiliplatin carboplatin) are often used in the treatment of neoplasia and other solid tumors in both animals and humans. In spite of positive results being achieved in these cases, therapy is often limited due to severe systemic adverse effects (myelosuppression, nephrotoxicity) and also by the emergence of resistance to tumors. By delivering these drugs locally through regional administration or intratumoral, systemic toxicities have been lowered, but the problem of drug resistance remains as a large issue.

Thermoreversible pluronic gels (solid gels at body temperature and liquid at cold temperatures) have properties that are desirable that would facilitate local infusion of antineoplastic drugs to limit systemic toxicity, and are also amphiphilic allowing incorporation of many drug moieties. A 2001 investigation showed that pluronic polymers interact with cancer cells that are resistant, sensitizing them to various antineoplastic agents and change drug efflux transporter and detoxification systems. The tumor cell resistance to the platinum drugs is thought to be mediated by elevated glutathione, because a pathway also affected by pluronic polymers, the combination of plutonic and platinum drugs could be a useful construct. A group of experts recently showed that pluronics enhanced and increased the cytotoxicity of carboplatin two-fold in an in vitro experimental cell culture of colorectal carcinoma cells.

A potential application area for this concept is in equine sarcoidosis. Traditionally, equine sarcoid cells have been injected with a 1:1 mixture of either carboplatin or cisplatin in sesame oil and injected directly into the sarcoid masses. As injection of oily vehicles can result in local irritation and restrict the bioavailability of anti-neoplastic agents, veterinary clinicians are beginning to consider replacement of the sesame oil vehicle with pluronic gel polymers which can be prepared by compounding pharmacists

Br J Cancer. Dec 2001;85(12):1987-1997.
Mechanism of sensitization of MDR cancer cells by Pluronic block copolymers: Selective energy depletion.
Batrakova EV, Li S, Elmquist WF, Miller DW, Alakhov VY, Kabanov AV.
Click here to access the PubMed abstract of this article.

J Control Release. 2005 Aug 18;106(1-2):188-97.
Enhancement of carboplatin toxicity by Pluronic block copolymers.
Exner AA, Krupka TM, Scherrer K, Teets JM.
Click here to access the PubMed abstract of this article.

Methylene Blue for Drought-Affected Animals

There is an exceptional drought that is affecting many areas in the United States. This  has caused many problems for livestock producers and their stock.  This exceptional drought is forcing many pharmacists and veterinarians  to think about use of the chemical agents listed in Appendix A in the FDA’s Compliance Policy Guide for Compounding of Drugs For Use in Animals. The appendix – which lists ammonium tetrathiomolybdate, ammonium molybdate, ferric ferrocyanide, picrotoxin, methylene blue, pilocarpine, sodium nitrite, sodium thiosulfate, and tannic acid – represents the most effective antidotes used to treat livestock  that have been poisoned. 

When drought occurs, plants are no longer able to convert proteins from nitrogen. When livestock graze on nitrogen-saturated plants, they not only suffer from poor protein intake, but also become poisoned by nitrate. Goats, sheep, and cattle intoxicated with nitrate show signs of staggering gait, abored breathing and sudden death, all of which are due to oxidative injury to hemoglobin, leading to hypoxia and methemoglobinemia. These animals if left untreated will functionally suffocate, even while breathing air.

While it is generally a good idea to steer clear of compounding for food animal patients, compounding pharmacists can save animals lives by the hundreds by compounding methylene blue 1% injection for nitrate poisoned livestock. Solutions of methylene blue powder and sterile water are very easily autoclaved in 500ml plastic, autoclavable serum bottles, which is the normal volume required to treat an adult cow suffering from nitrate poisoning. For more information on methylene blue treatment of nitrate toxicity in livestock, see Nitrate and Nitrite Poisoning: Introduction, in the Merck Veterinary Manual, Merck & Co., Inc., Whitehouse Station, NJ, 2006.

Veterinary Ophthalmic Preparations

A ton of agents used in veterinary ophthalmology are not or never even were commercially available.  Some xamples of agents that commonly are used by veterinarians but are not commercially available currently include idoxuridine ophthalmic solution and ointment, oxytetracycline ophthalmic ointment, vidarabine ophthalmic solution, miconazole solution, tetracycline ophthalmic solution, trifluridine ophthalmic solution, rose bengal solution, and chloramphenicol ophthalmic ointment. Even if these are commercially available, products may not have a appropriate concentration to achieve a therapeutic effect in a given patient (e.g. cyclosporin A) or may have excipients and agents that have negative effects in animal patients (e.g. neomycin sulfate in cats). In other cases, no product is commercially available and the needed preparation must be compounded from other non-ophthalmic drugs or from bulk chemicals (e.g. acetylcysteine ophthalmic solution and disodium edetate ophthalmic solution). For these reasons, pharmacists are frequently called upon to compound sterile preparations for use in the animal eye. To ensure adequate stability, uniformity, and sterility, both the American Society of Health-Systems Pharmacists and the United States Pharmacopoeial Convention have published guidelines for pharmacy-prepared ophthalmic preparations. These guidelines address the following areas of concern:

Validation of Formulation
Documentation
Sterility and use of Preservatives
Clarity
Tonicity
Buffering and pH
Viscosity Enhancers
Quality Control
Packaging
Expiration Dating
Considerations for use of ophthalmics in veterinary patients
General Principles of ocular penetration
Corneal penetration
Key points for corneal penetration of drugs:

    • lipophilic
    • equilibrium between ionized and non-ionized forms
    • small molecular weight (<350)
    • high local concentrations

Intravitreal penetration

Topical Mitomycin C Adjunct Therapy for Equine Ocular Squamous Cell Carcinoma

During surgery for SCC, many equine ophthalmologists also treat the eye with a topical solution of mitomycin C at a concentration of 0.4mg – 4mg/ml applied to the eye for 1-5 minutes. Following surgery, some clinicians will apply mitomycin C 0.4mg/ml topical solution to the affected eye three times daily for 7 days in repeating cycles until tumor resolution.  Mitomycin C is a potent anti-neoplastic, cytotoxic agent and should be handled and disposed of accordingly.

Aust Vet J. 2006 Jan-Feb;84(1-2):43-6.
The use of mitomycin C as an adjunctive treatment for equine ocular squamous cell carcinoma.
Click here to access the PubMed abstract of this article.

Stanozolol

In a study conducted at the Animal Health Unit and Gastrointestinal Sciences, University of Calgary, Alberta, ten healthy, intact, adult male sled dogs received either stanozolol tablets, 2 mg/dog PO, q12h, for 25 days or an intramuscular injection of stanozolol 25 mg on Days 7, 14, 21, and 28. A 15N amino acid (5.27 mmol) was infused intravenously into each dog on Day 0 (before stanozolol treatment) and on Day 31 (after stanozolol treatment). Both oral and injectable stanozolol resulted in significant increases in amino acid nitrogen retention compared to pretreatment values. Oral stanozolol increased nitrogen retention from 29.2 +/-8.2% to 50.3 +/- 9.2%, while stanozolol injection increased nitrogen retention from 26.6 +/- 9.9% to 67.0 +/- 7.5%. The nitrogen retention action of stanozolol may be beneficial in dogs under stress of surgical trauma and chronic disease.

In a separate blinded crossover trial at the College of Veterinary Medicine, Kansas State University, 22 castrated Beagles with experimentally induced chronic renal failure were treated with stanozolol. Cowan et al. concluded that for dogs with mild-to-moderate, nonuremic, experimentally induced, chronic renal failure, stanozolol had positive effects on nitrogen balance and lean body mass. Stanozolol did not have a significant effect on body fat, bone mineral content, or food consumption per kilogram of body weight.

Anabolic steroids such as stanozolol have been used to treat geriatric dogs. These drugs can increase nitrogen and mineral retention so that the body can better utilize dietary protein. As a result, the dog’s appetite may improve, resulting in more strength, energy, and weight gain. There is one reported case of the use of stanozolol (0.5 mg/kg, SQ, BID, PRN) to stimulate appetite in a rabbit. However, this class of drugs is not without potentially serious side-effects which must be considered before using them. Anabolic steroids should be used with caution in animals with heart, liver, or kidney problems, or in animals with breast or prostate cancer. Stanozolol should not be used in pregnant animals, during lactation, in young animals, or in male breeding animals. Anabolic steroids may increase the effects of warfarin and other anticoagulants.

In dogs, reported side effects are mainly androgenic, including increased aggression, increased activity, weight gain and mood alterations. However, in cats with and without chronic renal failure, there are reported cases of hepatotoxicity that appear to be related to the use of stanozolol.

J Am Vet Med Assoc. 1997 Sep 15;211(6):719-22
Effect of stanozolol on body composition, nitrogen balance, and food consumption in castrated dogs with chronic renal failure.
Click here to access the PubMed abstract of this article.

Can J Vet Res. 2000 Oct;64(4):246-8
The effect of stanozolol on 15nitrogen retention in the dog.
Click here to access the PubMed abstract of this article.

Veterinary Forum. April 1999
Effect of stanozolol on body composition, nitrogen balance, and food consumption in castrated dogs with chronic renal failure.
Click here to access the PubMed abstract of this article.