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Dermatology

dermatology

Dermatology

Our compounding professionals can prepare individualized therapies for a myriad of dermatologic problems. Compounding pharmacists continue to improve both the aesthetic and therapeutic aspects of customized medications, offering alternatives and advantages for dermatology. We can compound medications into cosmetically appealing creams, topical sprays and powders, as well as create customized oral dosage forms (such as flavored troches or lollipops) and various preparations for other routes of administration. Compatible drugs can be combined into a single dosage form to simplify a medication administration schedule and improve compliance. USP approved chemicals can be utilized to enhance the absorption of topically applied medications. We commonly prepare unique formulations that physicians develop to meet specific needs of their patient population, or “tried and true” formulas acquired during medical training.


Acne

We can compound customized formulations which contain numerous medications to provide a synergistic effect for treatment of resistant acne.

Int J Dermatol 1995 Jun;34(6):434-7
Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris.

Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK
Department of Dermatology, State University of New York, College of Medicine, Brooklyn, USA.

Click here to access the PubMed abstract of this article.

J Dermatol 1996 Apr;23(4):243-6
Topical spironolactone reduces sebum secretion rates in young adults.

Yamamoto A, Ito M
Department of Dermatology, Niigata University School of Medicine, Japan.

Click here to access the PubMed abstract of this article.


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Athlete’s Foot

Various synergistic combinations are used for antifungal therapy. Research points to the practicality “of using ibuprofen, alone or in combination with azoles, in the treatment of candidosis, particularly when applied topically, taking advantage of the drug’s antifungal and anti-inflammatory properties.”

J Med Microbiol 2000 Sep;49(9):831-40
Antifungal activity of ibuprofen alone and in combination with fluconazole against Candida species.

Pina-Vaz C, Sansonetty F, Rodrigues AG, Martinez-De-Oliveira J, Fonseca AF, Mardh PA.
Department of Microbiology, Porto School of Medicine, University of Porto, Portugal

Click here to access the PubMed abstract of this article.


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Chemical Peels

Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid, either alone or in combination, are effective therapy for diffuse melasma and localized hyperpigmentations (lentigo).

Dermatol Surg 1999 Jun;25(6):450-4
The use of chemical peelings in the treatment of different cutaneous hyperpigmentations.

Cotellessa C, Peris K, Onorati MT, Fargnoli MC, Chimenti S
Department of Dermatology, University of L’Aquila, Italy.

Click here to access the PubMed abstract of this article.


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Diaper Rash/Incontinence

Ann Pharmacother 1996 Sep;30(9):954-6
Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant.

White CM, Gailey RA, Lippe S.
Albany College of Pharmacy, NY 12208, USA.

Click here to access the PubMed abstract of this article.

Dis Colon Rectum 1987 Feb;30(2):106-7
Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis.

Moller P, Lohmann M, Brynitz S.

Click here to access the PubMed abstract of this article.


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Head Lice and Scabies

Concerns about emerging resistance and the potential harm of using permethrins have prompted a search for effective pediculicidal therapies that are not harmful to children with repeated use. An herbal formulation has been shown to be effective for head lice. Ivermectin can also be compounded for topical application or as an oral dose titrated for each patient for the treatment of head lice and scabies.

Clin Exp Dermatol 2002 Jun;27(4):264-7
Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin.

Del Mar Saez-De-Ocariz M, McKinster CD, Orozco-Covarrubias L, Tamayo-Sanchez L, Ruiz-Maldonado R.
Department of Dermatology, National Institute of Pediatrics, Mexico City, Mexico.

Click here to access the PubMed abstract of this article.

Trop Med Parasitol 1994 Sep;45(3):253-4
Efficacy of ivermectin for the treatment of head lice (Pediculosis capitis).

Glaziou P, Nyguyen LN, Moulia-Pelat JP, Cartel JL, Martin PM.
Institut Territorial de Recherches Medicales Louis Malarde, Papeete, Tahiti, French Polynesia.

Twenty six male and female patients aged 5 to 17 years had head lice infestation confirmed by eggs presence and received treatments with a single 200 microgram/kg oral dose of. At day 14 after treatment, 20 had responded to the treatment (77%), and 6 patients (23%) presented with a complete disappearance of eggs and all clinical symptoms. At day 28, 7 patients appeared clear of infestation (27%), but 4 of the 6 patients with no eggs at day 14 presented with signs of reinfestation. This study suggests that ivermectin is a promising treatment of head lice, and a second dose at day 10 may be appropriate.

Click here to access the PubMed abstract of this article.

J Dermatol 2001 Sep;28(9):481-4
Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion.

Madan V, Jaskiran K, Gupta U, Gupta DK.
Department of Dermatology, NSCB, Medical College, Jabalpur, MP, India.

Two hundred scabies patients were randomly allocated to receive either oral ivermectin in a single dose of 200 micrograms/kg body weight, or 1% lindane lotion for topical application overnight. Patients were assessed after 48 hours, two weeks and four weeks. After a period of four weeks, 82.6% of the patients in the ivermectin group showed marked improvement; only 44.44% of the patients in the lindane group showed a similar response. Oral ivermectin is easy to administer as a single oral dose, induces an early and effective improvement in signs and symptoms, and compliance is accordingly increased.

Click here to access the PubMed abstract of this article.

Isr Med Assoc J. 2002 Oct;4(10):790-3
The in vivo pediculicidal efficacy of a natural remedy.

Mumcuoglu KY, Miller J, Zamir C, Zentner G, Helbin V, Ingber A.
Department of Parasitology, Hebrew University Medical School, Jerusalem, Israel.

Click here to access the PubMed abstract of this article.


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Molluscum Contagiosum

The following study found that 5% KOH aqueous solution proved to be as effective and less irritating when compared to the 10% KOH solution. This trial also emphasizes the effectiveness of topical KOH in the treatment of molluscum contagiosum, sparing affected children from more aggressive physical modalities of treatment.

Pediatr Dermatol 2000 Nov-Dec;17(6):495
Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum.

Romiti R, Ribeiro AP, Romiti N.
Department of Dermatology, University of Sao Paulo, Sao Paulo, Brazil.

Click here to access the PubMed abstract of this article.


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Nail Removal

Although surgical excision is the most popular method for removing nails, the use of concentrated urea plasters applied under occlusion may be superior. The use of urea plasters has inherent advantages – they are inexpensive, several nails can be treated in one session, and the procedure is essentially painless. Various synergistic combinations and topical medications with penetrant enhancers can be compounded for antifungal therapy. Topical medications usually have a lower adverse drug-reaction profile than systemic medications.

Cutis. 1980 Jun;25(6):609-12
Urea ointment in the nonsurgical avulsion of nail dystrophies–a reappraisal.

South DA, Farber EM.

Click here to access the PubMed abstract of this article.

Cutis. 1980 Apr;25(4):397, 405
Combination urea and salicyclic acid ointment nail avulsion in nondystrophic nails: a follow-up observation.

Buselmeier TJ.

Click here to access the PubMed abstract of this article.

JAMA 1979 Apr 13;241(15):1559, 1563
Urea plasters alternative to surgery for nail removal.

Montgomery BJ.
PMID: 430701 (No abstract available)

Clin Exp Dermatol 1982 May;7(3):273-6
The treatment of fungus and yeast infections of nails by the method of “chemical removal”.

White MI, Clayton YM.
PMID: 7105479 (No abstract available)


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Onychomycosis

Management of onychomycosis, a fungal infection of the fingernails and toenails, usually consists of systemic antifungal medications, topical therapy (e.g., urea ointment, desiccating solutions, keratolytics, vital dyes), or surgical intervention (e.g., nail plate avulsion, laser therapy). Topical prescription antifungal preparations, containing the active ingredient of your choice, may be less likely to cause the serious systemic side effects that can occur with oral antifungal therapy and can provide a more economical alternative, as lower doses are needed when the medication is applied topically at the site. Penetrant enhancers can be included in the preparation to improve the effectiveness of topical antifungals.

Trop Med Int Health 1999 Apr;4(4):284-7

Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream.

Syed TA, Qureshi ZA, Ali SM, Ahmad S, Ahmad SA
Department of Dermatology, University of California, San Francisco, USA. tasyed@itsa.ucsf.edu

Click here to access the PubMed abstract of this article.


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Pigmentation Abnormalities

Patients with vitiligo have low catalase levels in their epidermis in association with high levels of hydrogen peroxide. Topical application of a UVB-activated pseudocatalase cream can successfully remove epidermal H2O2 resulting in a remarkable repigmentation.

J Investig Dermatol Symp Proc 1999 Sep;4(1):91-6
In vivo and in vitro evidence for hydrogen peroxide (H2O2) accumulation in the epidermis of patients with vitiligo and its successful removal by a UVB-activated pseudocatalase.

Schallreuter KU, Moore J, Wood JM, Beazley WD, Gaze DC, Tobin DJ, Marshall HS, Panske A, Panzig E, Hibberts NA.
Clinical and Experimental Dermatology, Department of Biomedical Sciences, University of Bradford, UK.

Click here to access the PubMed abstract of this article.


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Plantar Warts

Phys Ther. 2002 Dec;82(12):1184-91
Treatment of plantar verrucae using 2% sodium salicylate iontophoresis.

Soroko YT, Repking MC, Clemment JA, Mitchell PL, Berg L.
Marshfield Clinic-Wausau Center, 2727 Plaza Dr, Wausau, WI 54401-4192, USA.

Click here to access the PubMed abstract of this article.


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Rosacea

Clin Exp Dermatol 2003 Jan;28(1):61-3
Topical application of NADH for the treatment of rosacea and contact dermatitis.

Wozniacka A, Sysa-Jedrzejowska A, Adamus J, Gebicki J.
Department of Dermatology, Medical University, and the Institute of Applied Radiation Chemistry, Technical University, Lodz, Poland.

Click here to access the PubMed abstract of this article.


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Scarring and Keloids

Br J Plast Surg 1998 Sep;51(6):462-9
Topical tamoxifen–a potential therapeutic regime in treating excessive dermal scarring?

Hu D, Hughes MA, Cherry GW
Department of Dermatology, Churchill Hospital, Headington, Oxford, UK.

Click here to access the PubMed abstract of this article.


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Topical Anesthetics

Topical anesthesia is needed for common procedures such as suturing, wound cleaning, and injection administration. The ideal topical anesthetic would provide complete anesthesia following a simple pain-free application, not contain narcotics or controlled substances, and have an excellent safety profile. The combination of topical anesthetics lidocaine and tetracaine and the vasoconstrictor epinephrine has been used successfully for anesthesia prior to suturing linear scalp and facial lacerations in children. A triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine (“BLT”) has also been reported to be effective when applied prior to laser and cosmetic procedures. Convenience of application without need for occlusion is an advantage of these topical anesthetics.

The following article concludes: “LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) worked as well as TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.”

Pediatrics 1995 Feb;95(2):255-8
Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.

Ernst AA, Marvez E, Nick TG, Chin E, Wood E, Gonzaba WT
Department of Medicine, Louisiana State University, New Orleans.

Click here to access the PubMed abstract of this article.

The following article reported that a triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine (“BLT”) applied prior to treatment with a 532-nm KTP laser resulted in significantly lower pain scores than with 3 other topical anesthetics at 15, 30, 45, and 60 minutes after application.

Cosmetic Dermatology 2003 Apr;16(4):35-7
Topical Triple-Anesthetic Gel Compared With 3 Topical Anesthetics

Lee MWC
Department of Dermatologic Surgery, University of California, San Francisco


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Sun Protection/Photoaged Skin/Wrinkles

Topical Application of Phytonadione, Retinol and Vitamins C and E to Reduce Infraorbital Dark Circles and Wrinkles of the Lower Eyelids

Infraorbital dark circles and wrinkles of the lower eyelids are cosmetic problems that worsen with age. Fifty-seven healthy adult volunteers with dark under-eye circles and wrinkles were enrolled in an open label study to determine whether a gel containing 2% phytonadione, 0.1% retinol and 0.1% vitamins C and E is effective in reducing dark under-eye circles and wrinkles of the lower eyelids. The gel formulation was applied twice daily to the lower eyelid site for 8 weeks. Hemostasis, pigmentation and wrinkles were evaluated by a physician and by the patients after 4 and 8 weeks of treatment. Topical application of the gel decreased not only hemostasis but also wrinkles after 8 weeks of treatment. Of 57 patients, 27 (47%) had reductions in hemostasis. However, pigmentation was not clearly removed by this gel.

J Cosmet Dermatol. 2004 Apr;3(2):73-5

The effects of topical application of phytonadione, retinol and vitamins C and E on infraorbital dark circles and wrinkles of the lower eyelids.

Mitsuishi T, Shimoda T, Mitsui Y, Kuriyama Y, Kawana S.
Department of Dermatology, Nippon Medical School, Tokyo, Japan.

Click here to access the PubMed abstract of this article.

Protection and Reversal of Photodamage with Topical Antioxidants

Topical vitamins C and E, as well as topical selenium, protect skin against sunburn, suntan and skin cancer and also reverse the mottled pigmentation and wrinkles of photoaging. However, only certain forms of these antioxidants are stable and active after percutaneous absorption. Benefits of topical application are that the skin attains far higher levels of each antioxidant than can be achieved by taking these vitamins orally and topical application arms the skin with a reservoir of antioxidants that cannot be washed or rubbed off, protecting the skin for several days after application.

J Cosmet Dermatol. 2004 Jul;3(3):149-55

Photodamage of the skin: protection and reversal with topical antioxidants.

Burke KE.
River Court, New York, USA.

Click here to access the PubMed abstract of this article.

Topical application of niacinamide (such as in a 2% cream) has a stabilizing effect on epidermal barrier function, seen as a reduction in transepidermal water loss and an improvement in the moisture content of the horny layer, and it may be used as a treatment adjunct in atopic dermatitis. In aging skin, topical application of niacinamide improves the surface structure and pigmentary disorders, smoothes out wrinkles and inhibits photocarcinogenesis.

Cutis 2006 Jan;77(1 Suppl):11-6.

Click here to access the PubMed abstract of this article.

Int J Dermatol 2005 Mar;44(3):197-202.

Click here to access the PubMed abstract of this article.

J Cosmet Dermatol 2004 Apr;3(2):88-93

Click here to access the PubMed abstract of this article.


Niacinamide can be combined with other active ingredients such as DMAE, sodium hyaluronate, benzoyl peroxide, or metronidazole in a customized medication that can be used as anti-wrinkle or anti-aging therapy or to treat acne or rosacea

Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin.

Br J Dermatol. 2003 Oct; 149(4): 841-9

Beitner H.
Department of Dermatology, Karolinska Hospital, 17176 Stockholm, Sweden.

Click here to access the PubMed abstract of this article.

Estrogen Therapy to Prevent or Reverse Skin Aging

Declining estrogen levels are associated with a variety of cutaneous changes, many of which can be reversed or improved by topical or systemic estrogen supplementation. Studies of postmenopausal women indicate that estrogen deprivation is associated with declining dermal collagen content, diminished elasticity and skin strength, loss of moisture in the skin, epidermal thinning, atrophy, fine wrinkling, and impaired wound healing. Keratinocytes, Langerhans’ cells, melanocytes, sebaceous glands, collagen content and the synthesis of hyaluronic acid are under hormonal influence. Estrogen may attenuate inflammation in psoriatic lesions. Alone or together with progesterone, estrogen prevents or reverses skin atrophy, dryness and wrinkles associated with chronological or photo-aging. Estrogen and progesterone stimulate proliferation of keratinocytes while estrogen suppresses apoptosis and thus prevents epidermal atrophy. Estrogen maintains skin moisture by increasing acid mucopolysaccharide or hyaluronic acid levels in the dermis, and accelerates cutaneous wound healing.

Low estrogen levels that accompany menopause exacerbate the deleterious effects of both intrinsic and environmental aging. Estrogens clearly have a key role in skin aging homeostasis as evidenced by the accelerated decline in skin appearance seen in the perimenopausal years.

At Yale University School of Medicine, the effects of long-term hormone replacement therapy (HRT) on skin rigidity and wrinkling at 11 facial locations was assessed using the Lemperle scale by a plastic surgeon who was blinded to HRT use. Skin rigidity at the cheek and forehead was measured with a durometer. Demographics including age, race, sun exposure, sunscreen use, tobacco use, and skin type were similar. Rigidity was significantly decreased in HRT users compared to nonusers at both the cheek and forehead. Average wrinkle scores were lower in hormone users than in nonhormone users. The study concluded that long-term postmenopausal HRT users have more elastic skin and less severe wrinkling than women who never used HRT, suggesting that hormone therapy may have cosmetic benefits.

In another study, the dermal collagen of 15 postmenopausal women who had received systemic estrogen replacement was analyzed before and after using a topical 0.01% estrogen treatment. Epithelial and dermal thickness improved after topical estrogen therapy. Facial skin collagen significantly increased after 16 weeks of treatment. Systemic estrogen levels did not significantly increase after topical therapy.

Exp Dermatol. 2004;13 Suppl 4:36-40
Exp Dermatol. 2006 Feb;15(2):83-94
Eur J Obstet Gynecol Reprod Biol. 2006 Jun 22
J Am Acad Dermatol. 2005 Oct;53(4):555-68; quiz 569-72
Fertil Steril. 2005 Aug;84(2):285-8
Am J Clin Dermatol. 2003;4(6):371-8
Am J Clin Dermatol. 2001;2(3):143-50
J Dermatol Sci. 2005 Apr;38(1):1-7
In the following study, the effects of topical 0.01% estradiol and 0.3% estriol compounds were measured in preclimacteric women with skin aging symptoms. After treatment for 6 months, elasticity and firmness of the skin had markedly improved; wrinkle depth and pore sizes had decreased by 61 to 100%; skin moisture had increased; and wrinkle depth decreased significantly.

Int J Dermatol 1996 Sep;35(9):669-74
Treatment of skin aging with topical estrogens.

Schmidt JB, Binder M, Demschik G, Bieglmayer C, Reiner A.
Department of Dermatology, University of Vienna Medical School, Austria.

Click here to access the PubMed abstract of this article.

A low-dose, topical gel form of diclofenac sodium has been developed in Europe for pain relief and reduction of redness after sunburn.

Eur J Dermatol. 2004 Jul-Aug;14(4):238-46

The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn.

Click here to access the PubMed abstract of this article.


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Psoriasis

Topical vitamin B12 offers a new therapeutic approach for eczema (atopic dermatitis) and psoriasis, and may be suitable for long-term therapy as no long term adverse effects have been reported.

British Journal of Dermatology 2004; 150: 977-983.

Click here to access the PubMed abstract of this article.

Dermatology 2001;203:141-147

Click here to access the PubMed abstract of this article.
Arch Dermatol. 2005;141:43-46
Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment.

Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR.
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA

Salicylic acid has been used alone as a treatment for psoriasis, but is most commonly used to increase the penetration of other topical preparations, primarily corticosteroids. In this small study, the use of 6% salicylic acid gel in conjunction with tacrolimus ointment showed statistically significant improvement for the treatment of plaque psoriasis compared with the use of salicylic acid alone.

For patients with localized psoriasis, and for many of those with moderate psoriasis as well, the mainstay of treatment is still topical therapy. The quality of life is greatly affected in such patients, and they often express high levels of dissatisfaction with current treatment options. Safe, convenient, and effective topical regimens, such as combination therapy with topical tacrolimus and salicylic acid, can be of great benefit in this large population.

Click here to view the abstract or FREE FULL TEXT of this complete article.

J Cutan Med Surg 2001; 299-302
Management of psoriasis vulgaris with methotrexate 0.25% in a hydrophilic gel: a placebo-controlled, double-blind study.

Methotrexate has been used as an effective systemic chemotherapeutic drug for psoriasis by dermatologists for over 30 years. Nevertheless, pharmacokinetic data indicate that oral methotrexate can cause a decrease in red and white blood cell and platelet counts and can also cause severe liver damage, diarrhea, and stomach irritation, as dose-related drug-induced side effects. Such indications have limited its prescription by physicians. However, [Syed and Nordstrom of the Department of Dermatology, University of California-San Francisco, and researchers from three other locations note that] if its incorporation in a gel as a topical agent, in a proper dosage… imparts better results without the cited side effects, then such a formulation appears to justify a clinical evaluation. Furthermore, published data have indicated that 70% of patients prefer topical therapy for treating psoriasis.

This article concludes: “methotrexate 0.25% in a hydrophilic gel is well tolerated and significantly more effective than placebo as a patient-applied topical medication to treat psoriasis vulgaris.”.

Click here to view the PubMed abstract for this article.

J Dermatol 2004 Oct;31(10):798-801
Topical 0.25% methotrexate gel in a hydrogel base for palmoplantar psoriasis.

This article concludes: “Methotrexate 0.25% in a hydrophilic gel is well tolerated but is not very effective in controlling the lesions of psoriasis on the palms and soles; however, a higher concentration in a different base with better penetration could possibly provide better results.”

Click here to access the PubMed abstract of this article.

Int J Dermatol. 2003 Feb;42(2):157-9
Topical methotrexate delivered by iontophoresis in the treatment of recalcitrant psoriais–a case report.

Tiwari, Kumar, et al. published a case report of topical methotrexate delivered by iontophoresis for the treatment of recalcitrant palmoplantar psoriasis. In a 46 y.o. male with well-defined bilateral palmar plaques of 6 years duration which were resistant to several therapies, the right palm was treated, as it had more severe lesions. Iontophoresis was performed using cotton gauze soaked in 4 to 6 ml of methotrexate disodium solution 10 mg/ml, once a week for four weeks. The researchers reported 75% improvement after four weeks of therapy. Iontophoresis allows high concentrations of drug to be delivered to a limited area, and may offer a method of reducing total drug accumulation and reduced side effects.

Click here to view the citation for this article.


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Custom Prescription Dosage Forms

The Health Dimensions, Inc. pharmacists are problem solvers in the community, working with patients and physicians to gain positive outcomes. With our expertise in custom preparing medications, Health Dimensions, Inc. can compound any of the following dosage forms:

  • Capsules: immediate release or slow release
  • Drops: ear and nasal
  • Injectables: intravenous, subcutaneous, intra muscular, intra spinal
  • Nutritional and herbal therapies
  • Pellets
  • Sprays: nasal, inhalers, topical ear and oral
  • Suppositories: rectal and vaginal
  • Transdermals: cream, gel ointment, powder

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