Compounding

            Today I had the opportunity to spend the afternoon in the compounding pharmacy. The use of powdered formulations was influenced by traditional Chinese medicine. The pediatric population often takes their medication in a powder form because it is easier to taken than tablets. Also, because many of the medications are dosed based on weight, smaller patients will likely need a dosage that is less than the tablet it is available in.

            There are three conditions that the compounding pharmacy strictly enforces. The first rule is that you need to check the medication to make sure that it’s correct. In the compounding pharmacy, there is an automation system that helps individually package the powder formulation into the correct dosage. It is important to only use one medication at a time with this machine to prevent any cross contamination. Second, the correct dose must be used. No modifications can be made in the middle of making the powder formulation. Third, the correct quantity must be used.

            When working in this environment, one must take note of special precautions to prevent contamination. You must wear a gown, a cap, and a special mask that prevents small particles from entering. You also have to wash your hands twice, making sure to pay special attention to the nail beds and the knuckles, which are areas that tend to have more germs. There is a special brush available as well to help get rid of the dead skin. When you are done, you can spray 75% ethyl alcohol on your hands before putting on your gloves.  You are now ready to start compounding.

            Our goal that afternoon was to make urso at three different strengths (16.7 mg, 25 mg, and 33.3 mg) using a 100 mg tablet. Urso is often used to treat small gallstones or to treat primary biliary cirrhosis. The first ingredient we work with is lactose monohydrate. This is somewhat equivalent to the syrup that we have in the US that is used to make liquid formulations. The purpose of the lactose is to make the medication taste better and to also increase the volume (which is important for medications where we’re only using a small fraction).

How to create a powder formulation

       1) Accurately measure out how much lactose you need. 

       2) Add the appropriate amount of tablets for your medication into the blender.

       3) For medications that are likely to stick to the blender (such as urso), add a little bit of  

       the lactose in as well.

       4) After blending the lactose and the medication, pour the contents into the mortar. 

       5) Make sure that you use the brush to get the remaining powder in the blender.

       6) Add the lactose and use the pestle to mix the powder.

       7) After you have made 60-80 rotations (both clockwise and counterclockwise), pour the  

       contents onto wax paper. 

       8) Use a brush to get the remaining powder in the mortar and pestle

       9) Add the contents into the automatic machine to separate the medication into unit dose  

       packaging. 

            Overall I had a great time compounding the urso tablets into a power formulation. While this can be somewhat of a labor intensive process, it is definitely help in creating a formulation that is appropriate for the pediatric population.