E-DRUG: RFI: Formulas for compounding of Essential drugs? (4)
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Dear E-druggers,
I have been a keen follower of e-drug but this is my maiden contribution on this forum. [Welcome! WB]
Extemporaneous compounding is a big challenge in developing countries including here at the Mater Hospital in Nairobi, Kenya where I practice.
Dermatological preparations remain the most commonly compounded products even in the community pharmacies in Kenya. Most of these preparations involve compounding different strengths of hydrocortisone, salicylic acid, urea, di-iodohydroxyquinoline etc in emulsifying ointment or aqueous cream base. In the recent past, hydrocortisone powder for making such preparations has not been available in the market.
However, the biggest challenge comes to compounding of pediatric formulations where no authorized preparations exist in the local market. The Mater Hospital has a cardiac program that caters for disadvantaged children with congenital heart defects through the support of external partners such as Terre des Hommes of Netherlands and the Chain of Hope Mission of the UK among others.
Most children undergoing heart operations are usually prescribed cardiovascular medications that are not available in pediatric strengths such as captopril, carvedilol, sildenafil, indomethacin, spironolactone, furosemide etc. [Furosemide Oral Solution manufactured by Rosemont (UK) sometimes has to be imported but comes at a huge cost].
Our pharmacy is generally not very well equipped to carry out extemporaneous compounding of such pediatric formulations. We often have to manufacture Syrup Simplex by dissolving icing sugar in potable water using non-standardized containers thus relying on the ingenuity of the pharmacist.
We have been relying on formula compiled by David J.Woods in emixt www.pharmainfotech.co.nz to make most of the pediatric preps. However, OraSweet® and Oraplus® recommended for use in making most of these preparations are not available locally. Therefore most of the preparations end up being manufactured without a suspending agent, preservative or agents for adjusting pH. Stability information in tropical conditions is also not readily available
There is definitely a need for a reliable source of information on extemporaneous compounding that takes into account the resource limitations in developing countries.
Regards
Benjamin Maronda Ongeri
The Mater Hospital,
Nairobi
Kenya
bmaronda@yahoo.com