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Compounded Medications for Podiatrists

Podiatrists may have many needs for compounded medications.

Commonly prescribed compounds for podiatry include*:

Onychomycosis – nail fungus

Having a compounded prescription medication may overcome problems associated with other medications.  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.

Commonly prescribed formulas*:

  • Itraconazole 1%/Ibuprofen 2% in DMSO nail polish
  • Itraconazole 1%/Undecylenic Acid 17% in Tea Tree Oil-DMSO nail polish
  • Itraconazole 1%/Undecylenic Acid 17%/Salicylic Acid 10% in Tea Tree Oil-DMSO nail polish
  • Ketoconazole/Tea Tree Oil/DMSO  Antifungal Solution
  • Terbinafine 1.67% Topical Solution

Warts

There are some unique treatments for warts that can be prepared by a compounding pharmacist involving the drugs Cimetidine, trichloroacetic acid, and 5-fluorouracial.  Cimetidine at doses of 40mg/kg orally has been used to for recalcitrant multiple warts.

Commonly prescribed formulas*:

  • Cimetidine 5%/DDG 0.2%/Tea Tree Oil 10%/Ibuprofen 2% transdermal
  • Salicylic Acid 40% Ointment
  • Salicylic Acid Compound Collodion
  • Salicylic Acid 28% Polymeric Substrate
  • Trichloroacetic Acid 2%/Salicylic Acid 60%

Non-Surgical Nail Removal

There is a compounded preparation that will allow for non-surgical nail removal that may be required for non-dermatophytic fungal infections.

Possible formula*:

  • Urea 40% ointment

Diabetic Neuropathy

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 may have fewer adverse effects as well as using one medication rather than several.

Commonly Prescribed Formulas*:

  • Baclofen 5%/Ketoprofen 10%/Lidocaine 5%/Gabapentin 5% transdermal
  • Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Lidocaine 2% transdermal
  • Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Nidedipine 2% transdermal
  • Gabapentin 6%/Clonidine 0.2% transdermal
  • Clonidine 0.2%/Gabapentin 6%/Ketamine 10% transdermal

For additional information on diabetic care see our diabetic page.

Hyperhidrosis of the Feet and Foot Odor

Many of the commercial products prepared for hyperhidrosis feet contain the drugs aluminum, atropine or scopolamine, formaldehyde, methenamine and glycopyrrolate.  Methenamine is a pro-drug that is converted to the active drug formaldehyde.  Aluminum chlorohydrate is a common ingredient found in many over-the-counter antiperspirants.

Commonly Prescribed Formulas*:

  • Methenamine 5% Clear Lotion/Gel
  • Methenamine 5% Deodorant Stick
  • Methenamine 5%/Benzalkonium Chloride 2%
  • Aluminum Chlorohydrate 5% and 10% Topical Antiperspirant Cream
  • Aluminum Chlorohydrate 5% Topical Powder
  • Aluminum Chlorohydrate 7.7% Topical Paste
  • Formaldehyde Roll-on Deodorant
  • Glycopyrrolate 0.25%/Tea Tree Oil 2.5% Deodorant/Antipersirant

Inflammation and Pain

Most topicals for inflammation and pain due to sprains and strains can be made from various NSAIDs in PLO containing ketoprofen.  Of all the medications used topically in podiatry, NSAIDs probably have the most clinical data behind their use.  The NSAIDs can be combined with a muscle relaxer or topical anesthetic if desired.

Monst Commonly Prescribed Formulas*:

  • Ketoprofen 10%/Cyclobenzaprine 1-2% transdermal
  • Ketoprofen 10%/Lidocaine 5%/Bupivacaine 2% transdermal
  • ABC Cream

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. For more diabetic formulations, click here.

Commonly Prescribed Formulas:

  • Nifedipine 4-16% transdermal
  • Pentoxifylline 5% Lipoderm

For additional information on diabetic care see our diabetic page.

Additional preparations for  Podiatrists*:

  • Decubitus ulcers
  • Transdermal anti-inflammatory agents
  • Treating calluses
  • Skin softeners & moisturizers
  • Transdermal treatments for neuropathy
  • Keratinolytic agents
  • Wound Care
  • Plantar fasciitis (Heel Spurs)
  • Anti-fungal foot powders
  • Muscle & joint pain

*Consult with your healthcare provider prior to beginning any diet, exercise or nutritional program.

*Consultation with the pharmacist is not be be deemed in place of or equal to to a thorough review and check by your physician. Nothing herein is intended to replace or influence the independent judgement of any licensed professional. Consult with your healthcare professional. Our pharmacy works with prescribers to provide compounded solutions to medication problems.  No claims are made as to the efficacy, safety or use of compounded formulations.  Formulations not FDA approved. The information provided herein is for reference only and is not to be relied upon as making any representation as to the efficacy of any particular formulations. 

Check out the photos of where our tote bag has traveled!

Watch Mike Collins R.Ph. and Amy Dwyer R.Ph. , Nutritionist on the PBS, Life After 50 program
Mike Collins R.Ph., FIACP speaks about pain medications
Amy Dwyer R. Ph. Nutritionist speaks about supplements
Mike Collins R.Ph., FIACP speaks about the art of compounding

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*Products not intended to diagnose, treat, cure or prevent any disease. Statements have not been evaluated by the FDA.