Home' Australian Pharmacist : Australian Pharmacist December 2013 Contents 58
Australian Pharmacist December 2013 I ©Pharmaceutical Society of Australia Ltd.
In the preparation of compounded
products, the pharmacist is guided by the
professional standards,11 the prescriber
and the needs of the patient. Essential
information would include:
Patient advice and counselling
The Therapeutic Guidelines1 outline a
number of nonpharmacological measures
for managing atopic dermatitis, primarily
relating to limiting exposure to irritants and
maintaining a good long‐term moisturising
regimen. It is also important to improve
and maintain the general skin condition.
Examples of bath additives and soap
and shampoo substitutes and choices of
emollients are provided in the Therapeutic
Guidelines. Avoidable aggravating factors
include overheating, contact with irritants,
infections and allergies.1
Directions for use
• Wash your hands well with soap and
water before opening any packaging.
• Apply the cream to the affected area as
directed by the prescriber.
• Do not use sunscreens, cosmetics,
lotions, moisturizers or insect repellents
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
• Store the preparation in a cool place
(below 25 °C), protected from light and
away from children and pets.
In the review by Zur2 it is recommended
in most cases to begin with combined
topical treatment of SCG and a
corticosteroid for 7–10 days until
remission is achieved. It is then advisable
to proceed with the topical SCG alone
for chronic maintenance treatment
of the condition and to use topical
corticosteroids only for flare‐ups for a short
period of time.2,8,13 In the trial8 that used
4% w/w SCG in Altoderm, parents were
instructed to apply the lotion generously
to the affected skin area(s) twice daily, in
the morning (after rising) and evening
SOLUTIONS THROUGH COMPOUNDING
1. Topical sodium cromoglycate is
indicated in the management of
a) Although not effective in relieving
all the symptoms of the condition,
including the itch.
b) In combination with corticosteroids,
despite the lack of benefit over
c) Because of the resulting reduction in
the required use of corticosteroids.
d) Due to its lipophilic nature.
e) Because its efficacy is independent of
the type of vehicle or base used in the
2. Sodium cromoglycate is a white
crystalline powder which is:
a) Soluble in alcohol and insoluble in
c) A lipophilic, ionic (charged) molecule
d) Susceptible to photodegradation.
e) A hydrophilic, non‐ionic molecule.
3. Sodium benzoate is commonly
used as a preservative, but this
preservative activity is reduced at
a) Decreased stability.
b) Being ionized and unable to penetrate
the bacterial cell membrane.
c) Remaining unionised.
d) Decreased solubility.
e) Presence of sodium ions.
4. The role of caprylic/capric
triglycerides in the Basiscream DAC
formula is as a:
5. The strength (in mg/g) of sodium
cromoglycate in the cream is:
a) 400 mg/g.
b) 40 mg/g.
c) 100 mg/g.
d) 4 mg/g.
e) 1 mg/g.
Key learning points
• Topically applied sodium
cromoglycate is effective in relieving
symptoms, especially the itch
associated with atopic dermatitis.
• Pharmacists are aware of the
importance of using an appropriate
formulation, specifically optimising
the choice of base or vehicle to ensure
penetration of the SCG.
• Pharmacists are able to prepare a
product extemporaneously, which is
appropriately preserved, has a smooth
texture and an elegant appearance
for the topical delivery of sodium
1. Therapeutic Guidelines: eTG Complete (electronic resource).
North Melbourne: Therapeutic Guidelines; 2013.
2. Zur E. Topical use of sodium cromoglicate (cromolyn sodium)
to treat atopic dermatitis and other skin allergies. Int J Pharm
Compd. 2012;16(5):386–93 .
3. Vieira Dos Santos R, Magerl M, Martus P, et al. Topical sodium
cromoglicate relieves allergen- and histamine-induced dermal
pruritus. Br J Dermatol. 2010;162(3):674–6.
4. Edwards AM, Stevens MT, Church MK. The effects of topical
sodium cromoglicate on itch and flare in human skin induced
by intradermal histamine: a randomised double-blind vehicle
controlled intra-subject design trial. BMC Res Notes. 2011;4:47.
5. Martindale: The complete drug reference (electronic resource).
London: Pharmaceutical Press; 2012.
6. Australian Medicines Handbook. 13th Ed. Adelaide: Australian
Medicines Handbook; 2012.
7. Gastrocrom®. http://dailymed.nlm.nih.gov/dailymed/drugInfo.
cfm?id=729 [accessed: 28/08/2013].
8. Stainer R, Matthews S, Arshad SH, et al. Efficacy and acceptability
of a new topical skin lotion of sodium cromoglicate (Altoderm)
in atopic dermatitis in children aged 2–12 years: a double-
blind, randomized, placebo-controlled trial. Br J Dermatol.
9. Edwards AM, Matthews S, Arshad SH. Systemic absorption
of sodium cromoglicate from a new cutaneous emulsion
(Altoderm (R)) in children with atopic dermatitis. Eur J Dermatol.
10. Rowe RC, Sheskey PJ, Quinn ME. Handbook of pharmaceutical
excipients. 6th ed. London: Pharmaceutical Press; 2009.
11. PSA. Pharmaceutical Society of Australia. Professional Practice
Standards. Version 4, 2010. Standard 10: Compounding.
standards-v4.pdf [accessed 28/08/2013].
12. Australian Pharmaceutical Formulary and Handbook. 22nd Ed.
Canberra: Pharmaceutical Society of Australia; 2012.
13. Moore C, Ehlayel MS, Junprasert J, et al. Topical sodium
cromoglycate in the treatment of moderate-to-severe atopic
dermatitis. Ann Allergy Asthma Immunol. 1998;81(5 Pt 1):452–8.
Links Archive Australian Pharmacist Nov 2013 Australian Pharmacist January 2014 Navigation Previous Page Next Page