Topical pharmaceutical compounding technology has greatly advanced over the last several years. Topical compounding has become a big part of conversations at podiatry meetings all across the country.
Why is topical compounding so important?
Topical compounding allows the delivery of high doses of medication to a localized area. It allows more medication to be applied to solve the problem than would be possible if the medication were taken systematically through orals. For example, when using a topical medication for pain management or post-surgery pain, large doses can be administered to just the affected area. Similarly, a medication applied topically reduces the risk of drug interactions and dependencies greatly.
Topical compounded medications are especially useful in podiatry. When systematic drug interactions between pain medications and others keep patients from receiving the pain relief they need, that’s when a topical solution could be utilized. Topical solutions are also helpful for patients who are uncomfortable with needles or are already on many medications.
A particular aspect of topical compounded medications is the fact that they are medication(s), allowing me to combine multiple agents with multiple mechanisms of action. As a result, my ability to provide a patient with pain relief is substantially greater.
Take the case of inferior heel pain. Variously referred to as plantar fasciitis, plantar fasciopathy or plantar fasciosis, components of pathology may include inflammation, scarring, fibromatosis type histologic changes, irritation or compression of the medial plantar nerve or first branch of the lateral plantar nerve, tarsal tunnel compression, bursitis or osseous edema/inflammation.
Typically, I employ a topical compounded medication with a nonsteroidal anti-inflammatory drug (NSAID) (usually ketoprofen or flurbiprofen (Ansaid, Pfizer)), a topical anesthetic (typically lidocaine or bupivacaine) and verapamil, in addition to all of the usual therapeutics one would employ to treat inferior heel pain. This gives me a better chance of resolving the pain for which the patient is seeking relief.
Another example is that of symptomatic diabetic neuropathy. Here again, many podiatric physicians are reluctant to utilize antidepressants, anti-seizure medications or opioid analgesics. However, one may apply these same medications, such as gabapentin (Neurontin, Pfizer), clonidine (Catapres, Boehringer Ingelheim) or ketamine in combination topically, not infrequently reducing patient symptoms while averting adverse side effects.
Many patients presenting to our offices are under care for problems such as hypertension, reflux, congestive heart failure and renal disorders, and are on anti-coagulant therapy. Although we may desire to utilize NSAID therapy for such patients, their concurrent medical conditions or drug therapy typically preclude the use of these agents systemically. The topical application of NSAIDs, however, provides a safe and very effective alternative for the treatment of common problems such as Achilles tendinosis, plantar fasciitis or hallux limitus with osteoarthritis.
~ Allen Jacobs DPM FACFAS, Podiatry Today
Another way topical compounding can benefit a patient is during the process of wound care. By compounding a topical treatment for a patient, we can focus on precisely what the needs are of that individual wound. Instead of going down a list of potential final drug products, a physician can identify what drug ingredients would work best for the patient and allow a pharmacist to create custom wound care medications. In the same way, topical compounding can be utilized at different stages of the wound’s healing to target what that wound needs at a specific stage of care.
“One can mix a debriding agent (e.g. collagenase, (Santyl, Healthpoint)) with an agent to increase vascular perfusion (e.g. nifedipine, pentoxifylline (Trental, Sanofi Aventis)) with an antibiotic or antiseptic (e.g. mupirocin, metronidazole (Flagyl, Pfizer)) with something to stimulate cell growth (e.g. phenytoin (Dilantin, Pfizer)), and so forth. Furthermore, I can utilize such agents to enhance the effectiveness of various grafting techniques, e.g. Dermagraft (Shire Regenerative Medicine), Apligaf (Organogenesis), Primatrix (TEI Biosciences), etc. ( Jacobs).”
Nail and Skin Disorders
Topical compounding provides a lot of assistance to dermatology patients in their management and/or treatment of nail and skin disorders. Solutions don’t need to be restricted by preset medical component, compounded medications can be made to the specifications the patient’s needs.
As a patient, when should you consider topical compounding:
- Already taking too many pills
- In pain but only in a specific external area
- Difficulty swallowing pills
- Suffer from GI disorders
To consider other compounding options or medical limitations, please discuss these with your doctor or schedule time to speak with a pharmacist. More information is available if you believe topical compounding is right for you