Case study: Miquel has high blood pressure
Miquel's case
The challenge
The Case
Miguel (age three) has a genuine sweet tooth and healthy appetite. He happily eats any treat his mother gives him, but she is a little concerned. Last time they visited their family doctor, Miguel’s blood pressure was up in the 95th percentile for boys of his age. Today, the doctor checks his blood pressure again and diagnoses hypertension. He also tests for diabetes and wants to start Miguel on a dose of atenolol at 0.5 mg/kg/day, once-daily, to treat his hypertension [1]. [1] The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health and National Heart, Lung, and Blood Institute; 2005. NIH Publication No. 05-5267.
The challenge
The solution
The Challenge
Miguel weighs 17 kg, so his doctor wants to prescribe him 8.5 mg atenolol per day. As this dosage is commercially unavailable, he calls the pharmacist to discuss compounding an oral suspension. Although he is concerned about giving young Miguel a suspension with preservatives and a high sugar content, he is not sure whether Miguel will accept his medication without taste masking.
The solution
The Cure
The Solution
The pharmacist has the perfect solution for Miguel’s situation. He suggests compounding a 1 mg/ml atenolol suspension with the Atenolol & SyrSpend® SF PH4 kit. SyrSpend® SF PH4 is sugar and preservative-free and has excellent taste-masking properties as well as a sweet, neutral taste. Beginning with a 1 mg/ml suspension, the dose can be adjusted over time as Miguel develops.
The cure
Cases overview
The Cure
Six months later, Miguel’s blood pressure has improved and his doctor wants to try to start lowering the dose of atenolol. The pre-diabetes signs that were initially present have diminished and almost gone. His mother has also cut back on the treats, and Miguel has become a lively young fellow. The doctor hopes to eventually have Miguel come off the medication completely.
Case study: John is experiencing problems applying the product
John's case
The challenge
The Case
A 30-year-old male patient, John, required a repeat prescription for minoxidil base 5%. He complained to his pharmacist, Mrs Johnson, about the dripping and greasiness of the previous preparation when applying the product on his scalp to treat his alopecia.
The challenge
The solution
The Challenge
The scalp is, like other hairy skin parts, a difficult-to-treat area.
The solution
The Cure
The Solution
By compounding with the unique Fagron trademark vehicles from Fagron Advanced Derma, pharmacists are able to deliver exclusive solutions that add significant value and offer tailor-made treatment to patients. Patient satisfaction, therapy compliance and patients’ quality of life are thus improved.
The cure
Cases overview
The Cure
Mrs Johnson compounded minoxidil base 5% in Espumil™. To enhance treatment, she proposed to John’s prescriber that tretinoin 0.01% be added. John was very happy with the skin feel and user friendliness afforded by Espumil™. He has already brought his repeat prescription.
Case study: Josh has problems swallowing
Josh's case
The challenge
The Case
Josh (51 years old) is recovering from a Laryngeal cancer treatment. He’s doing well but he’s having problems swallowing solid food and medication. His wife is currently suffering a bad flue. Since Josh’s immune system is considered to be acquired after his cancer treatment his oncologist wants to prescribe Josh an oseltamivir treatment to prevent him from developing influenza as well.
The challenge
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The Challenge
Patient accessibility: Because Josh is having problems swallowing he needs a liquid dosage form, which is not available as a licensed product in the right dosage strength for Josh.
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The Challenge
Patient acceptance: Josh is experiencing retching when feeling an unpleasant bitter taste in his mouth. Oseltamivir has a bitter taste.
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The Challenge
Unpleasant side effects: Josh is suffering diarrhea and other gastrointestinal discomfort due to his cancer medication. Stomach distress and diarrhoea are seen with sorbitol containing suspending vehicles.
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The Challenge
Proven stability: The stability of oseltamivir in a fluid form needs special attention.
The solution
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The Solution
With the focus on patient, prescriber and pharmacist, Fagron offers unique solutions that add significant value in the individualized treatment of patients with specific needs. Also for Josh.
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The Solution
Patient accessibility: With SyrSpend® SF PH4 it is possible for a pharmacist to easily compound a 15 mg/ml oseltamivir suspension for Josh, based on oseltamivir capsules. SyrSpend® SF PH4 can be used with a broad variety of active pharmaceutical ingredients (APIs) so the pharmacist can keep SyrSpend® SF PH4 on stock for similar cases similar cases.
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The Solution
Patient acceptance: SyrSpend® SF PH4 is available in cherry flavour and unflavoured, both with taste-masking capacities to cover the bitter taste of oseltamivir. Flavouring concentrates from the SyrSpend® SF Flavouring Kit may be added to the neutral versions to customise to Josh’s individual preference.
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The Solution
Unpleasant side effects: Low osmolality of SyrSpend® SF PH4 minimizes the risk of stomach distress and diarrhoea seen with traditional sorbitol containing suspending vehicles. The suspension prepared with SyrSpend® SF PH4 is free from alcohol, parabens, sorbitol, sugars, gluten and colourants. SyrSpend® SF PH4 is also available as a preservative-free powder for reconstitution.
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Proven stability: Stability tests have proven a 30 days stability of a suspension of SyrSpend® SF PH4 with oseltamivir*.
The cure
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The Cure
A simple process of mixing the oseltamivir capsule contents with SyrSpend® SF PH4 enables the pharmacist to prepare a stable suspension in just minutes for Josh.
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The Cure
Josh is doing really well. He did not get caught by the influenza virus, his energy level is improving and he’s eating more and more solid food again. Last week he and his wife booked a holiday out of their dreams to Hawaii and he’s looking forward to it. Josh is enjoying life. * Voudrie MA, Allen DB. Stability of oseltamivir phosphate in SyrSpend® SF, cherry syrup, and SyrSpend® SF (for reconstitution). Int J Pharm Compd. 2010;14(1):82-85.
Case study: Steve has an unpleasant dry skin feeling
Steve's case
The challenge
The Case
Steve required a repeat prescription of benzoyl peroxide 5% and clindamycin HCl 1% in a gel for his acne. He complained to his pharmacist, Mr Nguyen, about the amount of time needed to apply the two products and an unpleasant dry skin feeling after frequent use.
The challenge
The solution
The Challenge
Due to Steve’s dehydrated skin condition, a cream would be better for his skin type than a gel, and combining both APIs in a single formulation would be preferable.
The solution
The Cure
The Solution
By compounding with the unique Fagron trademark vehicles from Fagron Advanced Derma, pharmacists are able to deliver exclusive solutions that add significant value and offer tailor-made treatment to patients. Patient satisfaction, therapy compliance and patients’ quality of life are thus improved.
The cure
Cases overview
The Cure
Mr Nguyen compounded benzoyl peroxide 5% and clindamycin HCl 1% in Versatile™ and was able to deliver an elegant single cream solution to Steve.
Case study: Sabine experiences a dehydrated skin
Sabine's case
The challenge
The Case
Sabine, a 40-year-old female patient with hyperpigmentation, required a prescription for hydroquinone 4% cream from her pharmacist, Simon Smith. She had been using this prescription for a long time and told Simon that she had recently started to experience dehydrated skin, which was vulnerable to winter conditions. Sabine asked him for advice on the best skin care option.
The challenge
The solution
The Challenge
Hydroquinone is an API susceptible to oxidation. For Sabine’s dehydrated skin, a solution containing hydroquinone in a single formulation would be preferable.
The solution
The Cure
The Solution
By compounding with the unique Fagron trademark vehicles from Fagron Advanced Derma, pharmacists are able to deliver exclusive solutions that add significant value and offer tailor-made treatment to patients. Patient satisfaction, therapy compliance and patients’ quality of life are thus improved.
The cure
Cases overview
The Cure
Simon Smith compounded hydroquinone 4% in Nourivan™ Antiox and was able to deliver an elegant single treatment skin care solution to Sabine. She commented that applying just one product was much more convenient and that there had been a marked improvement in her skin condition. She also requested additional advice about a tailor-made, anti-ageing solution.

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