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Compounding Pharmacist, Enovator and Consultant.Owner of "Compounding Solutions", a pharmaceutical consultancy company in Israel.edit
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types... more
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types of cutaneous leishmaniasis in Israel are not life threatening, but the multiple skin lesions developed from the contaminated sand fly bites cause significant damage to the quality of life for a few months in patients with leishmania major and sometimes for more than a year in patients with leishmania tropica. Topical treatment for this localized skin disease is very attractive although only one medication is registered in Israel (15% paromomycin +12% methylbenzethonium chloride ointment), which is for the topical treatment of "leishmania major." Two significant disadvantages characterize this topical medication, 1) relatively low efficacy and 2) significant irritation and pain, which could result in failure of the registered treatment. This article (part 2 of a 3-part article), which also includes a compounded formulation, discusses the treatment option of paromomycin sulfate liposomal gel (free of the sensitizing methylbenzethonium chloride).
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Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, Leishmania major and Leishmania tropica. The two types... more
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, Leishmania major and Leishmania tropica. The two types of cutaneous leishmaniasis in Israel are not life threatening, but the multiple skin lesions developed from the contaminated sandfly bites cause significant damage to the quality of life for a few months in patients with Leishmania major and sometimes for more than a year in patients with Leishmania tropica. The disease ends spontaneously, often with disfiguring scars. The aim of the treatment is to significantly shorten the wound-healing process, hopefully with minimal scars and with parasite eradication. Topical treatment for this localized skin disease is very attractive, although only one medication is registered in Israel (15% paromomycin +12% methylbenzethonium chloride ointment), which is for the topical treatment of "Leishmania major." Relatively low efficacy and significant irritation and pain are two significant disadvantages that characterize this topical medication and could result in failure of the registered treatment. This article, which is presented in 3 parts, discusses three options in the treatment of cutaneous leishmaniasis, 1) amphotericin B liposomal gel and 2) paromomycin sulfate liposomal gel (free of the sensitizing methylbenzethonium chloride), both of which the author considers as efficacious in the treatment of cutaneous leishmaniasis, although to confirm these claims, randomized controlled trials must be conducted, and 3) photodynamic therapy. Most of the reports claim that the photodynamic therapy can achieve results above 90% healing of wounds in a relatively short period of time and with relatively minimal scars. However, a caveat must be held since some of these studies indicate that not all healed wounds become free of the parasite. The daylight option of photodynamic therapy is an interesting modality which abolishes the need for an expensive artificial light source and expensive hospitalization time and enables ambulatory treatment to be efficacious against both types of Leishmania in Israel. Formulations are provided for the three modalities, with the third option being based on 5-aminolevulinic acid hydrochloride as the photosensitizer for this therapy.
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Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types... more
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types of cutaneous leishmaniasis in Israel are not life threatening, but the multiple skin lesions developed from the contaminated sandfly bites cause significant damage to the quality of life for a few months in patients with leishmania major and sometimes for more than a year in patients with leishmania tropica. Topical treatment for this localized skin disease is very attractive although only one medication is registered in Israel (15% paromomycin +12% methylbenzethonium chloride ointment) for the topical treatment of leishmania major. Two significant disadvantages characterize this topical medication, 1) relatively low efficacy and 2) significant irritation and pain. This article represents part 3 of a 3-part article on the topic of cutaneous leishmaniasis. Part 1 discussed the treatment option of amphotericin-B liposomal gel, part 2 discussed the treatment option of paromomycin sulfate liposomal gel, and this final part (3) discusses the treatment option of photodynamic therapy.
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This represents part 2 of a 2-part article on the topic of primary focal hyperhidrosis. Part 1, which was published in the International Journal of Pharmaceutical Compounding's January/February 2019 issue, provided a comprehensive... more
This represents part 2 of a 2-part article on the topic of primary focal hyperhidrosis. Part 1, which was published in the International Journal of Pharmaceutical Compounding's January/February 2019 issue, provided a comprehensive review of the active pharmaceutical ingredients aluminum salts and methenamine in the treatment of primary focal hyperhidrosis. Part 2 provides a comprehensive review of the active pharmaceutical ingredients glycopyrronium salts and oxybutynin chloride in the treatment of primary focal hyperhidrosis.
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A Correction to this paper has been published: https://doi.org/10.1007/s00520-021-06141-9
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Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated... more
Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. This article addresses oral mucositis and discusses its prevalence, risk factors, clinical and economical impacts, etiology, and clinical management in view of the most recent evidence. Despite clear progress and the development of clinical guidelines on this topic, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. This article offers two compounded preparations supported by evidence-based data to treat oral mucositis. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.
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Radiotherapy and epidermal growth factor receptor inhibitors, as important representatives of current chemotherapy, are crucial and irreplaceable treatments of modern oncology. These two types of treatments frequently cause severe... more
Radiotherapy and epidermal growth factor receptor inhibitors, as important representatives of current chemotherapy, are crucial and irreplaceable treatments of modern oncology. These two types of treatments frequently cause severe dose-dependent dermatologic adverse events that can negatively affect a patient's quality of life and compliance and cause inappropriate dose reductions and even treatment brakes. This article aims to emphasize new scientific data, published in peer reviews, regarding new possibilities to manage these debilitating dermatological adverse events. Since part of the scientific findings is new, the responsibility to enable pharmacologic treatment is in the compounding pharmacist domain. The article also suggests new formulations to the new pharmacologic treatment.
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Tetracycline is known as an effective agent in the treatment of recurrent aphthous stomatitis. A less-known treatment option for this pathology is minocycline. Many articles have been published in the International Journal of... more
Tetracycline is known as an effective agent in the treatment of recurrent aphthous stomatitis. A less-known treatment option for this pathology is minocycline. Many articles have been published in the International Journal of Pharmaceutical Compounding about recurrent aphthous stomatitis, however, this is the first article published in the journal that concentrates on the evidence-based data of minocycline as a promising agent to treat this pathology in what some scientific reports indicate to be a more efficacious manner than tetracycline. Few options to compound topical preparations based on minocycline and other evidence-based agents are proposed in the treatment of recurrent aphthous stomatitis.
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Schizophrenia is a serious, disabling, enduring, and relapsing mental illness which causes problems with the ability to think, feel, and perceive things clearly. One cause of relapse and readmission to a hospital is poor compliance with... more
Schizophrenia is a serious, disabling, enduring, and relapsing mental illness which causes problems with the ability to think, feel, and perceive things clearly. One cause of relapse and readmission to a hospital is poor compliance with antipsychotic medication, often due to its adverse effects. Schizophrenia may also affect a person's insight, interfering with their ability to appreciate the benefit of taking medication long term. The relapse rate is significantly higher in those who have discontinued antipsychotic medication. Penfluridol is an unusual, potent, long-acting, first-generation, oral antipsychotic agent indicated for the treatment of chronic schizophrenia, acute psychosis, and Tourette syndrome. It may be considered a depot medication, as it is administered once a week. Despite this positive analysis, and the unique added value of this medication to psychotic, non-compliant patients, Janssen-Cilag, the sole manufacturer of penfluridol worldwide, decided to stop pro...
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Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types... more
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, leishmania major and leishmania tropica. The two types of cutaneous leishmaniasis in Israel are not life threatening, but the multiple skin lesions developed from the contaminated sand fly bites cause significant damage to the quality of life for a few months in patients with leishmania major and sometimes for more than a year in patients with leishmania tropica. Topical treatment for this localized skin disease is very attractive although only one medication is registered in Israel (15% paromomycin +12% methylbenzethonium chloride ointment), which is for the topical treatment of "leishmania major." Two significant disadvantages characterize this topical medication, 1) relatively low efficacy and 2) significant irritation and pain, which could result in failure of the registered treatment. This...
Although pilocarpine hydrochloride tablets are currently indicated for the treatment of xerostomia, their adverse effects are frequently reported. The development of a new, low-dose pilocarpine solution for topical oral-cavity use is... more
Although pilocarpine hydrochloride tablets are currently indicated for the treatment of xerostomia, their adverse effects are frequently reported. The development of a new, low-dose pilocarpine solution for topical oral-cavity use is needed. This article discusses a few clinical trials to formulate a topical low-dose solution of pilocarpine hydrochloride for the treatment of xerostomia and presents two low dose, stable formulations of pilocarpine topical spray that can improve the patient's quality of life with minimal adverse effects.
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Compounding pharmacists throughout the world are compounding a special type of capsule called "slow-release." This type of capsule is a compounding pharmacy application of the commercial hydrophilic matrix tablets. It is a... more
Compounding pharmacists throughout the world are compounding a special type of capsule called "slow-release." This type of capsule is a compounding pharmacy application of the commercial hydrophilic matrix tablets. It is a relatively simple system that allows formulating a robust, reliable, and consistent drug system based on 30% w/w to 40% w/w of specific types of hydroxypropyl methylcellulose. The main purpose of these capsules is to attenuate the drug release when there is a clinical need and no commercial medication exists. Five in vitro trials verified and proved this kind of preparation can be compounded by specialized pharmacists achieving substantial attenuation of drug release that resembles the pharmacokinetic profiles of commercial slow-release medications. An in-depth explanation of the mechanism of action of the slow-release capsules is provided. Since the pharmaceutical calculations needed to compound this preparation are time consuming, a suggestion of a fas...
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A thrombosed external hemorrhoid is a complication of external hemorrhoids. Usually, this disease is accompanied by severe pain that lasts for several days. The common conservative treatment is a slow, ineffective pain reliever. Surgery... more
A thrombosed external hemorrhoid is a complication of external hemorrhoids. Usually, this disease is accompanied by severe pain that lasts for several days. The common conservative treatment is a slow, ineffective pain reliever. Surgery produces a lot of discomfort and inconvenience, affects the patient's quality of life, and presents some risks of post-operative complications. The purpose of this article is to propose an elegant compounded preparation to quickly treat the pain associated with thrombosed external hemorrhoids with a minimum of side effects and complications.
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The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control... more
The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control and an acceptable quality of life could be achieved. The next to optimal treatment was obtained by meticulously adjusting drugs and combining systemic drugs with topical ones. Compounding pharmacists play an important role in offering potent topical preparations that give an important analgesic added value to complex treatments.
Research Interests:
Cardiology, Quality of life, Treatment Outcome, Pain Management, Humans, and 11 moreFemale, Adult, Time Factors, Combination drug therapy, Pain Measurement, Analgesics, Neuralgia, reflex sympathetic dystrophy, Ankle injuries, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
Eosinophilic esophagitis is a clinicopathologic disease isolated to the esophagus. It is caused by immunologic reactions to ingested and inhaled allergans. Symptoms include regurgitation, vomiting, pain, anorexia, and dysphagia. Endoscopy... more
Eosinophilic esophagitis is a clinicopathologic disease isolated to the esophagus. It is caused by immunologic reactions to ingested and inhaled allergans. Symptoms include regurgitation, vomiting, pain, anorexia, and dysphagia. Endoscopy with biopsy is currently the only reliable diagnostic test for eosinophilic esophagitis. The disease should remit with treatments of dietary exclusion, topical corticosteroids, or both. Oral viscous budesonide is one of the promising options of topical corticosteroid to treat eosinophilic esophagitis. Since there are no commercial medicines of oral viscous budesonide, it is solely a compounded medication. This article briefly discusses the properties of the disease and covers a few compounding possibilities to oral viscous budesonide.
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Sodium cromoglicate (cromolyn sodium) is a very well-known medicine that has been used for many years for various allergic conditions. The topical use of this medicine is less known, and there are no commercial medicines of cream, gel, or... more
Sodium cromoglicate (cromolyn sodium) is a very well-known medicine that has been used for many years for various allergic conditions. The topical use of this medicine is less known, and there are no commercial medicines of cream, gel, or lotion in most of the world. This article summarizes the clinical data accumulated from seventeen trials that checked the topical efficacy and safety of sodium cromoglicate and analyzes the clinical implementations of this medicine in the topical treatment of atopic dermatitis and other skin allergies. In addition, this article analyzes the various formulations that have been used in the clinical trials in an attempt to find the optimal formulation. The topical use of sodium cromoglicate seemed to have a promising potential, and implementing the data of this article can allow the compounding pharmacist a very interesting professional activity in very common and widespread allergic pathologies.
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Nausea and vomiting in pregnancy can have serious adverse effects on the quality of a woman's life, affecting her occupational, social, and domestic functioning, and her general well-being; therefore, it is very important to treat... more
Nausea and vomiting in pregnancy can have serious adverse effects on the quality of a woman's life, affecting her occupational, social, and domestic functioning, and her general well-being; therefore, it is very important to treat this condition appropriately and effectively. Evidence-based algorithms support the use of oral pyridoxine alone or combined with doxylamine as first-line treatment. Promethazine or dimenhydrinate, known as a second-line treatment, should be added to the first-line treatment or should be added only to pyridoxine according to different algorithms. In most of the world, there is a lack of approved medicines using this combination approach known as the first-line treatment. Therefore, compounding pharmacists should supply the demand by compounding 10-mg pyridoxine hydrochloride and 10-mg doxylamine succinate slow-release capsules. Since transdermal promethazine does not exist world wide, and, since this medicine has significant added values compared to th...
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Barrett's esophagus refers to an abnormal change in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by columnar epithelium... more
Barrett's esophagus refers to an abnormal change in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by columnar epithelium cells which are usually found lower in the gastrointestinal tract. The medical significance of this pathology is approximately 0.5% risk to develop esophageal adenocarcinoma (per patient diagnosed with Barrett's esophagus per year). Diagnosis requires endoscopy and biopsy. In general, high-grade dysplasia and early stages of adenocarcinoma can be treated by endoscopic resection and/or endoscopic ablative therapy, whereas advanced stages (submucosal) are generally advised to undergo surgical treatment. Patients who undergo endoscopic resection and/or endoscopic ablative therapy might suffer from retrosternal discomfort and transient dysphagia, adverse effects that sometimes accompanies these procedures. One of the common post-procedural treatments ...
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a... more
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a combination of both therapies was discussed. his article continues that discussion but in respect to the injury that these rapies cause to the gastrointestinal tract. Like oral mucositis, gastrointestinal mucositis is a significant problem in oncology, as it causes very serious pathologies along the alimentary tract, damaging the quality of life of the oncologic patient, and sometimes the damages are life-threatening. The most vulnerable organs of the gastrointestinal tract to radiation and chemotherapy toxicities are the small intestine, colon, and rectum. This article concentrates on the chronic rectum and anus toxicities of radiotherapy and escribes two compounding preparations to treat chronic radiation induced proctitis with rectal bleeding. As in ...
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Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, Leishmania major and Leishmania tropica. The two types... more
Cutaneous leishmaniasis is the most common form of leishmaniasis with global incidence of about 1.5 million cases annually. The disease is endemic in Israel and caused by two types, Leishmania major and Leishmania tropica. The two types of cutaneous leishmaniasis in Israel are not life threatening, but the multiple skin lesions developed from the contaminated sandfly bites cause significant damage to the quality of life for a few months in patients with Leishmania major and sometimes for more than a year in patients with Leishmania tropica. The disease ends spontaneously, often with disfiguring scars. The aim of the treatment is to significantly shorten the wound-healing process, hopefully with minimal scars and with parasite eradication. Topical treatment for this localized skin disease is very attractive, although only one medication is registered in Israel (15% paromomycin +12% methylbenzethonium chloride ointment), which is for the topical treatment of "Leishmania major.&qu...
Primary focal hyperhidrosis is idiopathic, localized, uncontrollable, excessive, and unpredictable sweating beyond what is necessary to regulate body temperature. Primary hyperhidrosis is thought to affect approximately 2% to 3% of the... more
Primary focal hyperhidrosis is idiopathic, localized, uncontrollable, excessive, and unpredictable sweating beyond what is necessary to regulate body temperature. Primary hyperhidrosis is thought to affect approximately 2% to 3% of the population, and its effect on a patient's quality of life is very significant. Primary focal hyperhidrosis can be managed using various therapeutic options, including drugs (topical and systemic), nonsurgical interventions (e.g., iontophoresis, botulinum toxin injections), and surgery. This article, which is presented in 2 parts, is a comprehensive review of the topical, evidence-based treatments of primary focal hyperhidrosis, and it covers the following active pharmaceutical ingredients: aluminum salts, methenamine, glycopyrronium salts, oxybutynin chloride; the latter 2 ingredients will be discussed in part 2 of this article. This article discusses the evidence-based data that exists from clinical trials that support the use of topical medicati...
Burning mouth syndrome is a complex pathology for which there is very little information about the etiology and pathogenesis. This lack of knowledge leaves patients with suboptimal treatments. This article discusses the existing... more
Burning mouth syndrome is a complex pathology for which there is very little information about the etiology and pathogenesis. This lack of knowledge leaves patients with suboptimal treatments. This article discusses the existing scientific evidence about this disease. Since topical oral use of clonazepam have been shown to be effective and safe to treat some patients suffering with burning mouth syndrome, formulations including clonazepam are included with this article. Compounding topical preparations of clonazepam offers opportunities for compounding pharmacists to be more involved in improving the quality of life of burning mouth syndrome patients.
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Background: Infantile hemangiomas (IHs) are the most common vascular tumors in children. In the past few years, topical beta-blockers (bBs) have been reported to be an effective treatment of superficial IHs. Objective: We sought to... more
Background: Infantile hemangiomas (IHs) are the most common vascular tumors in children. In the past few years, topical beta-blockers (bBs) have been reported to be an effective treatment of superficial IHs. Objective: We sought to evaluate the clinical effectiveness and safety profile of enhanced percutaneous delivery of bBs for the treatment of IH. Methods: A retrospective study of all cases of IHs treated with enhanced percutaneous delivery of bBs between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. Results: The study included 11 patients with a total of 11 IHs. Of the total number of IHs, 7 (63.7%) showed a good response to treatment and 4 (36.3%) had a partial response; thus all patients (100%) had good or partial response to treatment. No systemic or local adverse effects were reported. Limitations: This is an uncontrolled retrospective study. Conclusion: Enhanced percutaneous delivery of bBs...
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In their article, Casiraghi, A. et al. describe a few relevant methods to assess the quality of a pharmaceutical preparation of oral viscous budesonide, intended to be swallowed, and treat the esophagus in eosinophilic esophagitis... more
In their article, Casiraghi, A. et al. describe a few relevant methods to assess the quality of a pharmaceutical preparation of oral viscous budesonide, intended to be swallowed, and treat the esophagus in eosinophilic esophagitis patients. They choose the following methods for this purpose: rheological properties, syringeability, mucoadhesiveness, and in vitro penetration of budesonide in porcine esophageal tissue. At the end of the article, they concluded that the best formulation of oral viscous budesonide was the one already being used in hospitals, based on xanthan gum. In their article, the authors did not emphasize that this specific formula was developed by the compounding pharmacist Eyal Zur from Israel and was published eight years before, as part of an article in the International Journal of Pharmaceutical Compounding. The purpose of this comment is to give the appropriate credit to the pharmacist who first developed and published this well designed formulation.
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The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control... more
The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control and an acceptable quality of life could be achieved. The next to optimal treatment was obtained by meticulously adjusting drugs and combining systemic drugs with topical ones. Compounding pharmacists play an important role in offering potent topical preparations that give an important analgesic added value to complex treatments.
Research Interests:
Cardiology, Quality of life, Treatment Outcome, Pain Management, Humans, and 11 moreFemale, Adult, Time Factors, Combination drug therapy, Pain Measurement, Analgesics, Neuralgia, reflex sympathetic dystrophy, Ankle injuries, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both... more
This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both patients for a long time. A patient-tailored approach, including a combination of systemic and topical compounds, required multiple adjustments for each patient before finally achieving adequate pain control. The first patient achieved pain control with a combination of systemically-administered drugs: dipyrone (1 g 3 times a day), pregabalin (300 mg twice a day), duloxetine (60 mg once daily in the morning), and dextromethorphan (60 mg 3 times/day), plus topical compounds (10% ketamine, 5% lidocaine, and 10% ketoprofen) in penetrating enhancing gel, and sublingual ketamine (10 mg) for breakthrough pain. The second patient achieved optimal pain control with dipyrone (500 mg three times per day), pregabalin (150 mg twice a day), dextromethorphan (60 mg thre...
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A thrombosed external hemorrhoid is a complication of external hemorrhoids. Usually, this disease is accompanied by severe pain that lasts for several days. The common conservative treatment is a slow, ineffective pain reliever. Surgery... more
A thrombosed external hemorrhoid is a complication of external hemorrhoids. Usually, this disease is accompanied by severe pain that lasts for several days. The common conservative treatment is a slow, ineffective pain reliever. Surgery produces a lot of discomfort and inconvenience, affects the patient's quality of life, and presents some risks of post-operative complications. The purpose of this article is to propose an elegant compounded preparation to quickly treat the pain associated with thrombosed external hemorrhoids with a minimum of side effects and complications.
Research Interests:
Nausea and vomiting in pregnancy can have serious adverse effects on the quality of a woman's life, affecting her occupational, social, and domestic functioning, and her general well-being; therefore, it is very important to treat... more
Nausea and vomiting in pregnancy can have serious adverse effects on the quality of a woman's life, affecting her occupational, social, and domestic functioning, and her general well-being; therefore, it is very important to treat this condition appropriately and effectively. Evidence-based algorithms support the use of oral pyridoxine alone or combined with doxylamine as first-line treatment. Promethazine or dimenhydrinate, known as a second-line treatment, should be added to the first-line treatment or should be added only to pyridoxine according to different algorithms. In most of the world, there is a lack of approved medicines using this combination approach known as the first-line treatment. Therefore, compounding pharmacists should supply the demand by compounding 10-mg pyridoxine hydrochloride and 10-mg doxylamine succinate slow-release capsules. Since transdermal promethazine does not exist world wide, and, since this medicine has significant added values compared to th...
Research Interests:
Tetracycline is known as an effective agent in the treatment of recurrent aphthous stomatitis. A less-known treatment option for this pathology is minocycline. Many articles have been published in the International Journal of... more
Tetracycline is known as an effective agent in the treatment of recurrent aphthous stomatitis. A less-known treatment option for this pathology is minocycline. Many articles have been published in the International Journal of Pharmaceutical Compounding about recurrent aphthous stomatitis, however, this is the first article published in the journal that concentrates on the evidence-based data of minocycline as a promising agent to treat this pathology in what some scientific reports indicate to be a more efficacious manner than tetracycline. Few options to compound topical preparations based on minocycline and other evidence-based agents are proposed in the treatment of recurrent aphthous stomatitis.
Research Interests:
Eosinophilic esophagitis is a clinicopathologic disease isolated to the esophagus. It is caused by immunologic reactions to ingested and inhaled allergans. Symptoms include regurgitation, vomiting, pain, anorexia, and dysphagia. Endoscopy... more
Eosinophilic esophagitis is a clinicopathologic disease isolated to the esophagus. It is caused by immunologic reactions to ingested and inhaled allergans. Symptoms include regurgitation, vomiting, pain, anorexia, and dysphagia. Endoscopy with biopsy is currently the only reliable diagnostic test for eosinophilic esophagitis. The disease should remit with treatments of dietary exclusion, topical corticosteroids, or both. Oral viscous budesonide is one of the promising options of topical corticosteroid to treat eosinophilic esophagitis. Since there are no commercial medicines of oral viscous budesonide, it is solely a compounded medication. This article briefly discusses the properties of the disease and covers a few compounding possibilities to oral viscous budesonide.
Research Interests:
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a... more
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a combination of both therapies was discussed. his article continues that discussion but in respect to the injury that these rapies cause to the gastrointestinal tract. Like oral mucositis, gastrointestinal mucositis is a significant problem in oncology, as it causes very serious pathologies along the alimentary tract, damaging the quality of life of the oncologic patient, and sometimes the damages are life-threatening. The most vulnerable organs of the gastrointestinal tract to radiation and chemotherapy toxicities are the small intestine, colon, and rectum. This article concentrates on the chronic rectum and anus toxicities of radiotherapy and escribes two compounding preparations to treat chronic radiation induced proctitis with rectal bleeding. As in ...
Research Interests:
Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated... more
Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. This article addresses oral mucositis and discusses its prevalence, risk factors, clinical and economical impacts, etiology, and clinical management in view of the most recent evidence. Despite clear progress and the development of clinical guidelines on this topic, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. This article offers two compounded preparations supported by evidence-based data to treat oral mucositis. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.
Research Interests:
Compounding pharmacists throughout the world are compounding a special type of capsule called "slow-release." This type of capsule is a compounding pharmacy application of the commercial hydrophilic matrix tablets. It is a... more
Compounding pharmacists throughout the world are compounding a special type of capsule called "slow-release." This type of capsule is a compounding pharmacy application of the commercial hydrophilic matrix tablets. It is a relatively simple system that allows formulating a robust, reliable, and consistent drug system based on 30% w/w to 40% w/w of specific types of hydroxypropyl methylcellulose. The main purpose of these capsules is to attenuate the drug release when there is a clinical need and no commercial medication exists. Five in vitro trials verified and proved this kind of preparation can be compounded by specialized pharmacists achieving substantial attenuation of drug release that resembles the pharmacokinetic profiles of commercial slow-release medications. An in-depth explanation of the mechanism of action of the slow-release capsules is provided. Since the pharmaceutical calculations needed to compound this preparation are time consuming, a suggestion of a fas...
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Cardiology, Quality of life, Pain Management, Complication, Humans, and 15 moreFemale, Male, Cardiac Catheterization, Middle Aged, Adult, Lidocaine, Pain Measurement, Analgesics, Amitriptyline, Forearm, Radial Artery, Neuralgia, Ankle injuries, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of... more
The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of NP are mostly systemic (affecting the central nervous system) and are dose limited because of serious and debilitating adverse effects. Scientific evidence suggests that localized cutaneous NP can be treated effectively and safely by topical medications; however, only a few topical medications are indicated for NP. This lack of topica medications stems from the limited resources that have been dedicated to exploring the role of the peripheral nervous system in NP or to the development of peripherally active topical analgesics. To explore the evidence supporting the role of topical medications and the role of an expert compounding pharmacist in compounding effective and safe topical preparations to treat NP. A narrative review. Well-designed randomized control trials and increasing number of case reports have shown positive results regarding a few topical compounded medications for the treatment of various pathologies of NP. This review summarizes the relevant scientific data supporting the use of topical medication in treating certain types of NP. This article discusses the role of topical medications in treating localized cutaneous NP and the role of the compounding pharmacists in applying this therapeutic approach (eg, the scientific considerations that the pharmacist should take into account).
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The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of... more
The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of NP are mostly systemic (affecting the central nervous system) and are dose limited because of serious and debilitating adverse effects. Scientific evidence suggests that localized cutaneous NP can be treated effectively and safely by topical medications; however, only a few topical medications are indicated for NP. This lack of topica medications stems from the limited resources that have been dedicated to exploring the role of the peripheral nervous system in NP or to the development of peripherally active topical analgesics. To explore the evidence supporting the role of topical medications and the role of an expert compounding pharmacist in compounding effective and safe topical preparations to treat NP. A narrative review. Well-designed randomized control trials and increasing number of case reports have shown positive results regarding a few topical compounded medications for the treatment of various pathologies of NP. This review summarizes the relevant scientific data supporting the use of topical medication in treating certain types of NP. This article discusses the role of topical medications in treating localized cutaneous NP and the role of the compounding pharmacists in applying this therapeutic approach (eg, the scientific considerations that the pharmacist should take into account).