Your choice of base is critical

Most pharmacists will agree that 2018 looks set to be one of those pivotal years in pharmacy.

Changes to Codeine scheduling, which became effective on 1 February 2018, have resulted in changes being made to the pain products offered to patients in Australia.

There has been a significant amount of discussion about how our patients’ pain conditions will be managed, particularly those patients suffering from chronic pain.

Doctors are regularly reminded of ongoing concerns about the over-prescription of opioids, and patients — concerned about how their individual conditions will be managed — are looking for their own solutions on the internet.

A huge opportunity exists for compounding pharmacists to step up their involvement in pain management, by offering compounded pain medications, particularly in a transdermal dosage form.

Pain involves a complex pathophysiology with multiple receptors and mechanisms in the body.

It is well recognised that a multi-modal approach to pain management may lead to improved patient outcomes, by targeting different points along the pain pathways.

Transdermal creams can often mean the difference between treatment success or failure, and the flexibility of strengths and combination of actives which can be used may lead to improved patient compliance and treatment outcomes.

These include a possible decrease in opioid dependence, and a reduction in side effects because the application of the cream can be localised to the area of greatest concern.

In order to provide optimal transdermal delivery, the choice of base is critical.
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Validated studies

PCCA Lipoderm® was the first proprietary transdermal vehicle in the compounding industry and it is the most studied one as well.

Lipoderm® is scientifically proven to deliver Active Pharmaceutical Ingredients (APIs) through the skin and is supported by an ever-growing portfolio of peer-reviewed journal articles.

The most recent studies show the delivery of up to four drugs simultaneously through the skin. The drugs studied were some of the most commonly used in treatment of neuropathic pain — gabapentin, clonidine HCl, Ketamine HCl and Baclofen.

In addition to proving Lipoderm®’s effectiveness in carrying multiple active ingredients through the skin, the findings of the study also verified that this base is highly resilient in the presence of a wide range of drugs, and increases permeation of the actives used.

Because the transdermal dosage form has a more direct path to the bloodstream, active ingredients can be administered in a lower concentration than the same medication in oral form.

Depending on the site of application and formulation makeup, the transdermal method can provide optimal delivery either locally or systemically.

PCCA compounding pharmacists also have the support of a significant number of BUD (Beyond Use by Date) studies for formulations using Lipoderm®.

Unlike previous transdermal preparations which required preparation of a two-part system known as Pluronic Lecithin Organogel, Lipoderm preparations don’t separate with refrigeration, resulting in a stable, cosmetically elegant preparation.

The smooth, non-sticky preparation is absorbed quickly, leading to improved patient satisfaction.
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Hypo-allergenic

Many of our patients who require compounded products also have significant allergies, so it is critical that the pharmacist has access to bases which avoid the most common allergens. Lipoderm® is formulated without eggs, milk, peanuts and tree nuts (almond, macadamia, hazelnut, walnut, pecan), and is gluten free.

The patented Lipoderm® core technology has also led to the development of an entire line of transdermal bases. Lipoderm Active Max ® is available for preparations which contain active ingredients in salt form at high concentrations, and Anhydrous Lipoderm is available for incorporation of active ingredients which are unstable in water.
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Conditions commonly treated

A wide variety of pain conditions can be helped by transdermal medication. Pharmacists have the flexibility to work with prescribers to tailor-make the product depending on the condition.

For example, a patient with joint or arthritic pain may benefit from the inclusion of an NSAID such as ketoprofen; whereas a patient suffering from post-herpetic neuralgia (shingles pain) may require a neuropathic pain agent such as amitriptyline.

Pharmacists have helped a wide cross-section of the community, treating conditions such as trigeminal neuralgia, diabetic neuropathy, shingles pain and muscle cramps.

For more information on getting started in the industry, or expanding your independent pharmacy’s practice, contact PCCA Australia on (02) 9316 1500 or visit pccarx.com.au/join-pcca