Home' Australian Pharmacist : Australian Pharmacist June 2016 Contents Australian Pharmacist June 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
occupational therapy; and social/
environmental interventions such as
community support groups or work
retraining. Importantly, many non-
pharmacological modalities may be
more effective in combination.
It is recommended that patients with
refractory neuropathic pain seek
advice from a pain physician, pain clinic
or a palliative care specialist before
commencing any treatment.
Directions for use
Wash your hands well with soap and
water before opening any packaging.
Apply the topical product to the affected
area as directed by the prescriber or
Do not use sunscreens, cosmetics,
lotions, moisturisers or insect repellents
on areas where you apply the cream.
Consult your doctor or pharmacist, if the
condition gets worse.
Avoid contact with eyes, nose, mouth
and other sensitive areas.
Wash your hands after application
(unless your hands are the affected
Do not use heating pads or apply
bandages to areas where you have
applied the cream.
Avoid exposing the area to sunlight or
artificial light, such as in tanning booths.
Protect the preparation from light and
store in a cool place (below 25°C).
Keep away from children and pets.
KEY LEARNING POINTS
• Anticonvulsants, such as gabapentin,
have been compounded by
pharmacists to treat chronic
neuropathic pain because of
the unique advantage of topical
delivery over that of other routes of
• Pharmacists are able to select suitable
equipment in order to prepare a
topical application in an appropriate
base, to ensure optimum stability.
• Pharmacists are able to advise
patients/carers on the appropriate
storage and safe use of
extemporaneously prepared products
for topical application containing
1. Asbill S, Sweitzer S, Spigener S, et al. Compounded pain
formulations: What is the evidence? Int J Pharm Compd
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3. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2015.
4. Sansom LN, ed. Australian pharmaceutical formulary and
handbook. 23rd edn. Canberra: Pharmaceutical Society of
5. Heustess A, Spigener S, Sweitzer S, et al. Analgesic efficacy
and transdermal penetration of topical gabapentin creams:
Finding an optimal dose and pre-treatment time. Int J
Pharm Compd 2015;19(2):167–73.
6. Bryson E, Asbill S, Sweitzer S. Skin permeation and
antinociception of topical gabapentin formulations. Int J
Pharm Compd 2014;18(6):504–11 .
7. Carlton SM, Zhou S. Attenuation of formalin-induced
nociceptive behaviors following local peripheral injection
of gabapentin. Pain 1998;76(1–2):201–7 .
8. Todorovic SM, Rastogi AJ, Jevtovic-Todorovic V. Potent
analgesic effects of anticonvulsants on peripheral thermal
nociception in rats. Br J Pharmacol 2003;140(2):255–60 .
9. Boardman LA, Cooper AS, Blais LR, et al. Topical gabapentin
in the treatment of localized and generalized vulvodynia.
Obstet Gynecol 2008;112(3):579–85.
10. Hiom S, Patel GK, Newcombe RG, et al. Severe postherpetic
neuralgia and other neuropathic pain syndromes alleviated
by topical gabapentin. Br J Dermatol 2015.
11. Brayfielod A, ed. Martindale: The complete drug reference.
London: Pharmaceutical Press; 2015.
12. Zong Z, Desai SD, Kaushal AM, et al. The stabilizing effect
of moisture on the solid-state degradation of gabapentin.
AAPS PharmSciTech 2011;12(3):924–31.
13. Haywood A, Glass B. Anti-inflammatory preparations for
rheumatology. Aust Pharm 2013;32(1):58–61.
14. PCCA Lipoderm. Professional Compounding Centers
of America. At: www.pccarx.com/pcca-products/pcca-
15. Allen LV. High tech compounding: State-of-the-art
equipment improves products and profit. Int J Pharm
Compd 2001;5(6):412–9 .
16. Wang X, Black L. Ex vivo percutaneous absorption
of ketamine, bupivacaine, diclofenac, gabapentin,
orphenadrine, and pentoxifylline: comparison of
versatile cream vs. reference cream. Int J Pharm Compd
17. Pharmaceutical Society of Australia. Standard 10:
Compounding (also known as Extemporaneous
Dispensing). In: Professional practice standards. Version
4, 2010. At: www.psa.org.au/download/standards/
18. Gabapentin product information (PI) and consumer
medicine information (CMI). In: TGA product and consumer
medicines information. At: www.ebs.tga.gov.au/ebs/picmi/
1. Advantages of topical analgesics,
such as gabapentin for neuropathic
a) Bypassing first-pass metabolism.
b) Increasing systemic side effects.
c) Increasing potential drug-drug
d) Decreasing patient adherence.
2. What role does propylene glycol play
in gabapentin topical formulas?
b) Levigating agent.
3. How does degradation of gabapentin
in the solid-state occur?
c) Intermolecular cyclisation.
4. In the formula for Gabapentin (5%)
in Lipoderm how many grams of
propylene glycol are equivalent to
a) 2.896 g.
b) 0.290 g.
c) 3.018 g.
d) 3.108 g.
5. If you were required to prepare
Gabapentin (6%) in Lipoderm (and
the amount of propylene glycol
required was 3 mL), how much
gabapentin and Lipoderm in grams
would be required to deliver the
same amount of product?
a) 2.7 g gabapentin and 47.300 g Lipoderm.
b) 3 g gabapentin and 43.892 g Lipoderm.
c) 0.27 g gabapentin and 46.730 g
d) 3 g gabapentin and 44.000 g Lipoderm.
SOLUTIONS THROUGH COMPOUNDING
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