Fagron | Pharmaceutical compounding

Case study: Omar has suffered outbreaks of tonsillitis
Omar's case
The challenge
The Case
Omar is an athletic, 14 year-old boy who loves to play football. Over the past year, however, he has had several episodes of tonsillitis, which have affected his school performance and caused him to miss important football matches. When his tonsils are infected, Omar is easily fatigued and his breathing becomes more difficult, giving him restless nights. His physician decides to remove the tonsils when Omar experiences yet another episode of tonsillitis.
The challenge
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The Challenge
When Omar recovers from surgery and the anaesthetic effect weakens, his throat starts to hurt badly. His physician does not want to prescribe a painkiller that contains either acetylsalicylic acid (associated with an increased risk of post-operative bleeding) or paracetamol associated with an increased risk of post-operative nausea [1].

[1] Rømsing J, Østergaard D, Drozdziewicz D et al. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiologica Scandinavica. 2000; 44(3):291-95.

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The Challenge
Diclofenac seems the most suitable option. Since Omar will not be able to swallow a solid dosage for a couple of days following surgery, his physician decides to prescribe suppositories. Omar is going through puberty, however, and feels uncomfortable with this route of administration. His physician therefore consults the hospital pharmacy about compounding a diclofenac suspension, although he is a little worried about diclofenac’s very bitter taste.
The solution
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The Solution
Omar’s physician calls the hospital pharmacist and explains his concerns. The pharmacist is quick to respond, as she has recently added Fagron’s Diclofenac sodium & SyrSpend® SF PH4 kit to her stock. The pharmacy can compound a 5 mg/ml diclofenac suspension within minutes. The kit comes with pre-weighed diclofenac, which can be compounded directly into the patient dispenser, preventing compounding errors and saving valuable time in the pharmacy. The kit has a three-year shelf life, so it is always in stock.
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The Solution
SyrSpend® SF PH4 is a sweetened, starch-based suspension that has excellent taste-masking properties and a neutral flavor. It is therefore highly suitable for compounding with bitter-tasting diclofenac. A flavor concentrate can be added to customize the suspension to Omar’s liking. The suspension form further allows the physician to customize the dose of diclofenac to Omar’s specific needs. As it is stored in the refrigerator, the suspension also helps to soothe his sore throat.

The cure
Cases overview
The Cure
Three days after surgery, Omar’s throat is healing successfully. The pain has eased and Omar has switched to incidental oral paracetamol. He is expected to make a full recovery in time to play for his team against its biggest rival next Saturday!
Case study: Laura has been struggling with the symptoms of mild psoriasis
Laura's case
The challenge
The case
Laura has been struggling with the symptoms of mild psoriasis for the past few years. She recently had an interview for a position as a flight attendant - her dream job. She visits her dermatologist to inquire about treating her symptoms with a more comfortable preparation than the one she already uses.
The challenge
The solution
The challenge
Psoriasis is often treated with traditional ointments, which can be very greasy and highly uncomfortable. Especially considering the fact that Laura will have to wear a uniform for stretches of time.
The solution
The Cure
The solution
Laura’s dermatologist has positive experiences with combinations of topical corticosteroids and emollients. Considering the dryness of the affected skin, he suggests an innovative ointment-based preparation. To guarantee Laura maximum comfort and results during therapy, he proposes Occluvan™, a Fagron Advanced Derma vehicle.
The cure
Cases overview
The cure
The dermatologist asks Laura’s pharmacist to compound clobetasol proprionate 0.05% and dexpanthenol 3% in Occluvan™, an innovative ointment base with minimal tackiness. Laura is very satisfied with the preparation’s elegance and comfortable skin feel. She now has her symptoms under control and recently received the news that she has been hired as a flight attendant.
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: 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 unflavored, both with taste-masking capacities to cover the bitter taste of oseltamivir. Flavoring concentrates from the SyrSpend® SF Flavoring Kit may be added to the neutral versions to customize 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 colorants. SyrSpend® SF PH4 is also available as a preservative-free powder for reconstitution.
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The Solution
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.

Josh has problems swallowing

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