DISPENSING 2 (PHARM 22) 3RD YEAR – PHARMACY – A

Prepared by: Theresa May R. Niala, RPh

EXTEMPORANEOUS COMPOUNDING
• Defined as the timely preparation of a drug product according to a physician’s
prescription, a drug formula, or a recipe in which calculated amounts of ingredients are
made into a homogenous(uniform) mixture.
• It is done when certain medical needs of individual patients cannot be met by the use of
an approved commercial drug product.
• the preparation of a therapeutic product for an individual patient in response to an
identified need. It is a practical way to have medicines supplied when there is no other
option.

PURPOSE OF EXTEMPORANEOUS COMPOUNDING

• Unavailable dosages, strengths, and route of commercial products.
• Dilution of adult doses of medications to Pediatric/Geriatric strengths.
• Conversion of solid dosage forms to solutions or suspensions.
• Combination of topical dermatological products not available by the manufacturer.
• Inactive ingredients of commercial products which may cause allergic reaction.

HOW IS COMPOUNDING PERFORMED?

• The active ingredient may be derived from commercially available medications or the
pure chemical. Sometimes compounding is as simple as mixing a crushed tablet or the
contents of a capsule in water to form a solution or suspension. However, this may not
be suitable and depends on the solubility of the active ingredient. For example, insoluble
tablet excipients can lead to blockages in enteral feeding tubes. In the majority of
compounded products, additional non-active components (excipients) are included to
ensure the active ingredient dissolves or remains suspended, or to adjust palatability or
viscosity.

ADVANTAGE OF EXTEMPORANEOUS COMPOUNDING

• Advantage of extemporaneously prepared medicines including combining different
proprietary brands within the same formulation, includes:
1. Two or more active ingredients combined in one preparation may have a synergistic
effect.
2. Ease of administration leading to better patient compliance.
3. May lead to reduction in course of treatment.
4. Ability to prepare a formulation when no suitable/equivalent proprietary preparation
is available.

DISADVANTAGE OF EXTEMPORANEOUS COMPOUNDING

• Extemporaneous preparations are generally considered as high-risk products. Common
risks compounded products include calculation error, microbial contamination,
therapeutic failure, and adverse reaction.
• Unpredictable interactions
• Decreased stability of the active ingredients, either rendering them virtually inactive or
converting the active form of the drug into a less active form.
• Reduced activity of any preservative present as a result of varying combinations of
products.
CORRECT LABELLING
• Primary packaging of the product must be fit for purpose and adequately protect the
product from the environment whilst being compatible with the product.
• Ideally the product must be labelled with the necessary particulars, including any special
requirements for the safe handling or storage of the product.
• Common name of product.
• Statement of the active ingredients expressed qualitatively and quantitatively per
dosage unit or for a given volume or weight.
• Dose and route of administration
• Content of the container by weight, volume, or number of doses
• Expiry date
• Batch number
• Name and address of patient

DOSAGE REGIMEN FOR MEDICATION ORDER

DOSAGE REGIMEN
- the schedule of doses of a medicine, including the time between doses, the duration of
treatment and the amount to be taken each time. Dose regimens also includes how a
medicine is to be taken, and in what formulation (dosage form).

- describes the specific instructions and schedule for administering a drug to a patient. It
considers factors such as drug dosage, frequency, route of administration, and duration
of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a
target drug concentration at the site of action.

DOSAGE AND ADMINISTRATION

• The dose is the amount of drug taken at any one time. This can be expressed as the
weight of drug (e.g. 250 mg), volume of drug solution (e.g. 10 mL, 2 drops), the number
of dosage forms (e.g. 1 capsule, 1 suppository) or some other quantity (e.g. 2 puffs).
The dosage regimen is the frequency at which the drug doses are given. Examples
include 2.5 mL twice a day, one tablet three times a day, one injection every four weeks.
The total daily dose is calculated from the dose and the number of times per day the
dose is taken.
• The dosage form is the physical form of a dose of drug. Common dosage forms include
tablets, capsules, creams, ointments, aerosols, and patches. Each dosage form may also
have a number of specialized forms such as extended-release, buccal, dispersible, and
chewable tablets. The strength is the amount of drug in the dosage form or a unit of the
dosage form (e.g. 500 mg capsule, 250 mg/5 mL suspension).
• The route of administration is the way the dosage form is given. Common routes of
administration include oral, rectal, inhalation, nasal and topical.
• The optimal dosage is the dosage that gives the desired effect with minimum side
effects.
• There are many factors taken into consideration when deciding a dose of drug - including
age of the patient, weight, sex, ethnicity, liver, and kidney function and whether the
patient smokes. Other medicines may also affect the drug dose.
• Dosage instructions are written on the doctor's prescription or hospital chart, and on the
pharmacy label of a prescribed medicine. Dosage instructions are also found on the
packaging and inserts of over-the-counter medicines.
PRESCRIPTION WITH SPECIAL INSTRUCTION

In order to facilitate the safe and effective administration of medicines, all individuals involved
in the prescribing, monitoring and administration of medication should ensure that the relevant
cautionary and advisory labels regarding administration of medication. Many medicine labels
have special instructions and warning statements on them. The list are the types of things you
should or should not do while taking the medicine. If the medicine has any of the following
instructions, make sure to take the medicine in that way. The following are some of the special
instructions used in prescription or medication order.

• TAKE EACH DOSE WITH A LARGE GLASS OF WATER.

- All tablets and capsules should be taken with water.
- Some medicines can cause stomach problems, indigestions and problems with
your throat and esophagus if they are not swallowed properly.
- Taking them with a large glass of water helps to wash them down.

• TAKE EACH DOSE ON AN EMPTY STOMACH – ONE HOUR BEFORE OR TWO HOURS
AFTER FOOD.
- Taking some medicine at the same time as eating may prevent your body
absorbing the medicine and it may not work as well as it should be.
- This is because food, and even some drinks can affect the way these medicines
work.
- To take your medicines on an empty stomach, take your medicine first and eat
one hour, or you can eat first and take the medicine 2 hours later.

• DO NOT DRINK ALCOHOL WHILE BEING TREATED WITH THIS MEDICINE.

- Taking some medicines with alcohol can cause problems.
- In most cases, it increases the risk of side effects such as sleepiness and changes
the effect the medicine has.

• DO NOT STOP TAKING THIS MEDICATION WITHOUT CONSULTING YOUR DOCTOR.

- It is dangerous to stop some medicines suddenly, especially if you have been
taking them for a few weeks or months.
- For these medicines, it is best to talk to your doctor and plan to reduce your dose
slowly.
- If you think your medicine has caused a side effect, talk to your doctor. They may
be able to lower your dose or change the medicine.
- Do not suddenly stop taking your medicine unless your doctor tells you to.

• GRAPEFRUIT OR GRAPEFRUIT JUICE MAY INTERACT WITH THIS MEDICINE.

- Eating grapefruit or drinking grapefruit juice can affect some medicines. In most
cases, it increases the level of the medicine in your blood. This can increase the
risk of the side effects or change the effect the medicine has.

• DO NOT TAKE INDIGESTION REMEDIES, IRON OR CALCIUM WITHIN TWO HOURS OF

TAKING THIS MEDICINE.
- Taking some medicines at the same time as indigestion remedies(antacids), iron
or calcium may prevent your body absorbing the medicine, and it may not work
as well as it should.
- The warning about calcium includes vitamins and medicines that contain calcium
and calcium-containing food such as milk and cheese.
• THIS MEDICINE MAY MAKE YOU SLEEPY AND MAKE IT DANGEROUS TO DRIVE OR
OPERATE MACHINERY. LIMIT ALCOHOL INTAKE.
- Taking some medicine with alcohol can cause problems. In most cases, it can
increase the risk of side effects such as sleepiness or change the effect the
medicine has.
- You should NOT stop taking the medicine if you need to drive or operate
machinery. Instead, you should take special care until you know how the
medicine affects you, or arrange not to drive or operate machinery while you are
taking the medicine.
- The term “limit” means that you should only have a moderate amount of alcohol.
This is to avoid you stopping your medicines because you choose to drink
alcohol, even though it’s best not to drink alcohol with these medicines.
- There are some medicines that have bad side effects and make you feel very
unwell if they are taken with alcohol. Your pharmacist will tell you about this.

• PROTECT YOURSELF FROM TOO MUCH NATURAL OR ARTIFICIAL SUNLIGHT WHILE

BEING TREATED WITH THIS MEDICINE.
- Some medicines may make your skin more sensitive if you are in the sun and
increase your risk of sunburn. This is due to a chemical reaction in your skin from
the medicine.

• KEEP IN THE FRIDGE/ DO NOT FREEZE.

- Every medicine should be stored as recommended because storage information
is based on stability tests done at certain temperatures for certain periods of
time.
- For medicine that need to be kept in the fridge, store them between 2° to 8°C.
- This medicine should not be frozen because freezing may affect the medicine.

• DO NOT USE AFTER MM/DD/YY. DO NOT USE __ DAYS AFTER OPENING.

- Some medicines are given a short expiry date because they are less stable or
there is a risk if they are used for a longer time.
- It is best not to use a medicine that has expired. The shelf life or expiry date of a
medicine is the length of time that tests have shown it stays effective and safe if
properly stored.