Home' Australian Pharmacist : Australian Pharmacist January 2013 Contents 60 Australian Pharmacist January 2013 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
supplier for packaging options. The use
of dosing cards described in Voltaren
gel patient information sheets2 may be
useful for ensuring the correct dose. It is
important that patients are counselled
on the correct use, storage and
appropriate disposal of the packaging.
The formulation should be stored in a
cool, dry place out of reach of children
and pets. Compounded products are
to be labelled according to regulatory
requirements16 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 the
preparation is not a pharmacopoeial
formulation. Ancillary labels should
specify storage conditions, provide an
expiry date and indicate specific usage
conditions. Include Label K to indicate
FOR EXTERNAL USE ONLY.
FOR EXTERNAL USE ONLY
Pharmacists are 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 documented.17
In the preparation of compounded
products, the pharmacist is guided
by the professional standards,16 the
prescriber and the needs of the patient.
Patient counselling and education may
be adapted from CMIs available for
commercially available products, such
as Orudis Gel,7 Feldene Gel,8 or Voltaren
Gel.2 Note that the likelihood of systemic
side effects occurring following topical
NSAIDs is minimal compared with the
frequency of side effects following oral
administration of NSAIDs.9 Essential
information would include:
Patient advice and counselling
The Therapeutic Guidelines1 outline
a number of nonpharmacological
treatments for osteoarthritis, primarily
• Patient education and self
management: Improving patients'
knowledge about their condition, and
providing counselling about modifiable
risk factors and self-management
techniques, have been shown to have
beneficial effects on pain, function and
quality of life in patients with arthritis.1
• Exercise therapy: Physiotherapy,
incorporating both strengthening and
flexibility exercises, can relieve pain
in osteoarthritis. Psychosocial factors
should also be considered. Exercise has
been shown to reduce pain and improve
function in osteoarthritis of the knee and
hip.1 In the care of a debilitated patient
with chronic rheumatological pain,
physiotherapy is best used in conjunction
with other forms of therapy, such as
psychotherapy and occupational therapy.1
• Weight loss: Obesity is a risk factor for
both development and progression of
knee osteoarthritis. Improvements in
pain and function are greater if exercise
and weight loss are combined.1
• Other nonpharmacological treatments:
Adjunctive treatments, such as the
topical application of cold or heat
that might reduce pain and allow
continuation or resumption of physical
activity, may be helpful.1
SOLUTIONS THROUGH COMPOUNDING
Figure 2. Electronic mortar and pestle (EMP) and
Figure 3. NSAID in Lipoderm base formula and method of preparation.
NSAID x% in Lipoderm (100 g)
1. Accurately measure the required amount of each ingredient.
2. Transfer the active ingredient(s) into a mortar and mix with a small amount of
Lipoderm base to form a paste.
3. Transfer the above mixture into a tared EMP jar and then add the required
amount of Lipoderm base, to the final weight.
4. Mix until a uniform consistency achieved.
5. Transfer the above mixture to an ointment mill and run it through 2--3 times.
6. Transfer the final product to an appropriate container.
7. Package and label.
'Exercise has been
shown to reduce pain
and improve function
in osteoarthritis of the
knee and hip.'
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