Home' Australian Pharmacist : Australian Pharmacist May 2015 Contents Australian Pharmacist May 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
SOLUTIONS THROUGH COMPOUNDING
carers are counselled on the correct use,
storage and appropriate disposal of the
packaging. The suspension should be
stored out of reach of children and pets
and under refrigeration.
Compounded products are to be
labelled according to regulatory
requirements24 and should include
the approved pharmacopoeial name
(where applicable) and the name and
strength of any preservatives used.
All active ingredients and their amounts/
proportions should be included if a
pharmacopoeial formulation is not used.
Ancillary labels should specify storage
conditions, provide an expiry date
(28 days) and indicate specific usage
conditions. Label 9, 10a, 18 and J should
DO NOT STOP TAKING THIS
MEDICINE ABRUPTLY unless
otherwise advised by your doctor.
Do not take more than one aspirin
tablet or capsule each day while
being treated with this medicine.
Avoid eating grapefruit or drinking
grapefruit juice while being
treated with this medicine.
BEFORE EACH USE
The pharmacist is responsible for ensuring
the quality of compounded products and
should verify that products are prepared
according to documented procedures and
meet product specifications before release
to the patient. Reviews of processes and
procedures should be conducted regularly
in order to identify areas for improvement
and the resulting actions should be
In the preparation of compounded
products, the pharmacist is guided by the
professional standards,24 the prescriber
and the needs of the carer and patient.
Patient counselling and education
may be adapted from consumer
medicines information (CMI) available
for commercially available products.
Essential information should include:
Patient advice and counselling
• Adverse effects and special precautions
would be as for the tablets, and are
outlined in the Australian Medicines
• It is important to check with your doctor
before using any anti-inflammatories or
medicines containing aspirin, including
those available over the counter from
the pharmacy or supermarket (it is safe
to take paracetamol).21
• If you develop any signs of bleeding
(e.g. nose bleeds, unexplained
bruising, dark or blood-stained bowel
motions, dark urine), or bleeding that
will not stop, tell your doctor as soon
• Make sure that your doctors,
pharmacist, dentist and other health
professionals know that you are taking
• CYP2C19 metabolises clopidogrel to
its active metabolite, consequently
combining clopidogrel with inhibitors
of CYP2C19, may decrease its
• Variations in gene expression of
CYP2C19 metabolising enzyme have
been shown to contribute to some of
the variation in response to clopidogrel.
Individuals with reduced CYP2C19
enzyme function may have a reduced
clinical response and increased risk
of ischaemic events compared to
individuals with normal CYP2C19
• Should be stopped at least 5 days
before any surgery for which
antiplatelet effects are undesirable --
• Contraindicated in patients with active
bleeding disorders (e.g. peptic ulcer).21
Directions for use
• Shake well before use to ensure an
• Use the measuring device supplied to
accurately measure the required dose.
• The preparation should be
stored protected from light,
under refrigeration, and kept away
from children and pets.
Clopidogrel oral suspension
Clopidogrel tablets, sufficient (qs)
Vehicle for Oral Solution NF* and
Vehicle for Oral Suspension NF (1:1), to 100 mL
1. Place the required number of tablets into a mortar and crush to a fine powder.
2. Add a small amount of the vehicle to wet the powder and mix to form a uniform
3. Continue adding most of the vehicle using the method of doubling (geometric
dilution) and mix thoroughly to form a smooth mixture.
4. Transfer to a tared, child-resistant, amber prescription bottle.
5. Rinse the mortar with the remaining vehicle and make up to the final volume.
6. Shake well and label.
*For a sugar-free preparation, use Vehicle for Oral Solution, Sugar Free NF.
Figure 2. Formula and method of preparation
Clopidogrel has also been shown to
be effective at decreasing platelet
aggregation in cats and has been
used in the prevention of feline
aortic thromboembolism, associated
with various heart diseases such
as cardiomyopathy and mitral
valve dysplasia.10 Where tablets
are difficult to administer orally
to cats, an oral suspension can be
formulated as described in Figure 2
with the addition of tuna flavouring.
See previous article11 in this series
on tramadol suspension for a further
detailed formula and method.
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