Compounding Plavix Suppository

[Kimmyrph]

I haven't seen this topic in thread, so I guess I'll ask it here.

I am looking to compound Plavix (clopidogrel) Suppositories, but I cannot find any recipes.

Where do you guys usually go to find compounding information that would not cost money to get the recipe. And if anyone here has one to post up, it will be much appreciated.

-Thanks in advance

---

Members don't see this ad.

 

[KidPharmD]

There aren't really any good resources for compounding odd things that are free. I doubt you are going to find a plavix suppository. The erratic absorption of suppositories would probably not be the best idea.

 

[npage148]

bioactivation

 

[zelman]

bioactivation

Are you implying that rectal prodrugs are ineffective? Or is that the name of a resource?

 

[npage148]

I'm suggesting finicky prodrugs may have altered bioactivation when given non-orally. This isn't simply hydrolysis by plasma esterases

 

[BidingMyTime]

I can't imagine why anyone would want to give Plavix rectally....if the person is NPO for a limited time, why not just hold the drug or use an injectable alternative if necessary?

 

[zelman]

I'm suggesting finicky prodrugs may have altered bioactivation when given non-orally. This isn't simply hydrolysis by plasma esterases

You really think cytochrome P450 2C19 in the liver cares how it got in the blood? The GI doesn't play a role for this drug's activation. I don't know about absorption, but the dose could just be adjusted to account for that.

 

[fewaopi]

Besides IJPC journals which might have it and cost money, search for compounding pharmacies that are not local to you or competitors. I contacted a compounding pharmacy some time zones away asking about a formula they probably had and they responded back to me although it did take a while to get a response I did get one. Don't count on a local compounder to help you out though as many of them see their compounds as their patents.

 

[npage148]

Yeah. One time I contacted a local pharmacy to get the recipe to compound a topical nitro. Basically told me I'm not qualified and to go f-off

 

[KidPharmD]

Yeah. One time I contacted a local pharmacy to get the recipe to compound a topical nitro. Basically told me I'm not qualified and to go f-off

A LOT of independent and sole compounding are very protective of the recipes that they sometimes pay thousands of dollars a year to have access to. Also, topical nitro is now available commercially, so I hope this wasn't recently as it wouldn't be appropriate to compound in most cases. (might be able to make a case if patient was allergic to an exciepent in the commercial product).

 

[npage148]

Well, it was before the commercial gtn ung for fissures was commercially available and it was for an employee of our store who I'd doubt go to this compounding pharmacy regardless. But I ended up finding the info I needed in some commercial source like drug topics or clinical pharmacology or something similar. It was really their attitude that was unappreciated

 

[Wheresmyaricept]

The independent I did a rotation at called Fagron whenever they needed a recipe and it would be faxed to them.

 

[Tom Applewood]

A true pharmacist makes his own recipe.

However... why rectal Plavix? What prevents the patient from taking oral meds, in this case, and ...
WHY is Plavix a crucial element of their quality of life and overall care plan.

Most patients able to only take rectal meds have got such severe other problems will not have any measurable benefit in QoL / QALY from a reduction in clotting risk. Consider making your patient's life better by reducing the # and complexity of their medications. Novel idea for a pharmacist, I know but it's a good one.

 

[zelman]

A true pharmacist makes his own recipe.

However... why rectal Plavix? What prevents the patient from taking oral meds, in this case, and ...
WHY is Plavix a crucial element of their quality of life and overall care plan.

Most patients able to only take rectal meds have got such severe other problems will not have any measurable benefit in QoL / QALY from a reduction in clotting risk. Consider making your patient's life better by reducing the # and complexity of their medications. Novel idea for a pharmacist, I know but it's a good one.

Muscular disorder preventing adequate ambulation to prevent dvt as well as swallowing? Broken jaw temporarily wired shut? There are plenty of possibilities.

 

[BidingMyTime]

Muscular disorder preventing adequate ambulation to prevent dvt as well as swallowing? Broken jaw temporarily wired shut? There are plenty of possibilities.

Well, how is the patient getting nutrition? I highly doubt they have a TPN for broken jaw wired shut or a muscular disorder. In the muscular disorder, the person would have a feeding tube (crush the Plavix and give through the feeding tube.) In the broken jaw scenario, the person is most likely sipping Ensure and other nutritional drinks (once again, crush the Plavix and give orally with the nutritional drink.) If someone is on a TPN, probably a LMWH is going to be a better choice than Plavix.

 

[zelman]

Well, how is the patient getting nutrition? I highly doubt they have a TPN for broken jaw wired shut or a muscular disorder. In the muscular disorder, the person would have a feeding tube (crush the Plavix and give through the feeding tube.) In the broken jaw scenario, the person is most likely sipping Ensure and other nutritional drinks (once again, crush the Plavix and give orally with the nutritional drink.) If someone is on a TPN, probably a LMWH is going to be a better choice than Plavix.

Very good point. The only thing I can think of is that I don't know what crushed plavix tastes like. Might be intolerable.

 

[PharmDstudent]

Was the patient NPO, scared of needles, and allergic to aspirin?!

 

[BidingMyTime]

Very good point. The only thing I can think of is that I don't know what crushed plavix tastes like. Might be intolerable.

True, but then a compounding pharmacist could mix it up in a yummy cherry syrup or Orabase.

 

[Ackj]

Very good point. The only thing I can think of is that I don't know what crushed plavix tastes like. Might be intolerable.

Brillinta or Effient could taste better. If they've got a tube, the taste shouldn't be a huge issue aside from some reflux. Which of course does bring up the PPI issue again.

 

[Sparda29]

Yeah. One time I contacted a local pharmacy to get the recipe to compound a topical nitro. Basically told me I'm not qualified and to go f-off

Which is why before I completed a compounding rotation I went into the computer at the place, plugged in a flash drive and saved all the recipes and MSDS sheets and whatnot to my flash drive. Unfortunately, I lost the flash drive before I got a chance to move it onto my main computer.

 

[zelman]

Please check www.usapharmacyexams.com and join for NEW YORK COMPOUDING TEST

Oooooh! Compouding! I can't want to make a compoud! Compoud compoud compoud.