Gastroenterology & Colon Rectal Surgery

When talking with doctors in the field of Gastroenterology, I am always asked, “What specifically can you make for us in your compounding pharmacy?” So, I have made a list of compounds relevant to your specialty. This is not everything we can do, our compounding database has thousands of formulas, but I hope it is a good starting place for us. We pride ourselves in being the medicinal problem solvers so that together we can better improve the quality of life for patients.This service is designed to create medications and tailor them to the specific needs of individual patient.

Diltiazem 2% cream for anal fissure        click here for the study

GI Cocktail (green goddess)
The use is for acute GI upset. It is a mixture of Maalox/Mylanta 30ml +viscous lidocaine 10ml +Donnatal 10ml administered orally in a single dose. Source- Pharmacopeia Pocket 1997;pg.36. H.D.

Phenylephrine gel in the treatment of fecal incontinence
Phenylephrine gel at 10% has been shown to increase the resting anal sphnicter pressure in healthy volunteers.

Budesonide for inflammatory bowel disease
Oral and rectal forms of budesonide have been used for IBD. It is suggested the 9mg/d be administered for acute exascerbations of Crohns disease and reduced to 3mg/d for maintenance. An enema solution containing 0.002% is available.

Butyrate Enemas for ulcerative colitis:
The results of one study suggest that nightly treatments with a butyrate enema consisting of 60mL of 80mM sodium butyrate are not efficacious in the treatment of ulcerative colitis. A second study of patients with refractory ulcerative colitis utilized twice daily enemas containing sodium acetate 60mM, sodium propionate 30mM, and sodium butyrate 40mM. The combination treatment achieved a 50% response rate based on clinical and endoscopic improvements. An identical formulation has also demonstrated effectiveness in accelerating the healing process in chronic radiation proctitis.
Steinhart AH, et al. Treatment of left-sided ulcerative colitis with butyrate enemas. Aliment Pharmacol Ther 1996; 10(5):729-36.

Allopurinol Suspension  & Mouthwash

Anal Fissure Ointment - Nitroglycerin 0.2%/Misoprostol 0.002%/ Phenytoin 0.2%

Anal Fissures - Diltiazem 2% Cream 

Nausea Suppository - Prochlorperazine 25 mg Base MBK Suppository 

Gastrointestinal Lavage - Electrolyte Evacuant Solution Low Sodium

Zantac [R] Suspension - Ranitidine 30 mg/ml NG Tube Suspension 

Zantac [R] Suspension  - Ranitidine 150 mg/5 mL Suspension 

Zantac [R] Syrup - Ranitidine 15 mg/mL Syrup

Budesonide for inflammatory bowel disease
Oral and rectal forms of budesonide have been used for IBD. It is suggested the 9mg/d be administered for acute exascerbations of Crohns disease and reduced to 3mg/d for maintenance. An enema solution containing 0.002% is available. AHFS Drug Information.

Glutamine Therapy for Leaky Gut Syndrome (LGS)-
Glutamine is an important substrate for the maintenance of intestinal metabolism, structure, and function. Patients with intestinal mucosal injury secondary to chemotherapy or radiation may benefit from glutamine supplementation . Doses are 3-5 glutamine complex oral caps daily, 4 gm swish and swallow twice a day oral suspension with chemotherapy, and 400 mg 4 times a day 1 hr before meals and before bedtime (showed complete healing on x-ray within 4 weeks) Source- Nutritional Influences on Illness 1996;2: 603.

5-Aminosalicylic Acid for Oral Ulcers
5-aminosalicylic acid (5-ASA) is generally used orally or rectally for ulcerative colitis. It has also been shown to shorten healing time and reduce the difficulty in eating in patients with oral ulcerations. The study used a 5% 5-ASA cream applied to the ulcers three times daily for up to 14 days. Daily discomfort was reduced by half and less pain was experienced by the treated group.

Rowachol: A Treatment for Cholesterol Gallstones-
Rowachol is a combination product of cyclic monoterpenes and chenodeoxycholic acid. The dose is 7-10.5 mg/kg/d or one capsule daily. Stones disappeared completely in 37% of the patients within 1 year and in 50% within 2 years. A second dose is two capsules 3x a day for 48 hrs. Rowachol significantly lowered the cholesterol solubility of both all bladder and bile.The MAO is it dissolves cholesterol gallstones. It remains to be proven that the terpene mixture will prevent recurrence of gallstones after dissolution. Source- British Med J Clin Research Ed 1984: 289:153-6. HD

Crohn’s Disease
It is well-known that corticosteroids are useful in the treatment of Crohn's disease. However, the systemic side effects of corticosteroids are often problematic.
Budesonide is a potent corticosteroid that has been found to have low systemic side effects. Its low side effect profile is possibly because it undergoes extensive first-pass metabolism. It was found that administration of budesonide 9 mg once daily or 4.5 mg twice daily was comparable to prednisolone. Campieri M, et al. Gut 41(2): 209-14, 1997 

Gastric Reflux Remedies
Current treatment of GERD includes the use of antacids, histamine2 receptor antagonists (H2RA) and proton pump inhibitors (PPI). PPIs are shown to be more effective than H2RA in resolving GERD symptoms, healing erosive esophagitis, and preventing esophageal. PPI are also effective in duodenal and gastric ulcers.
A starting dose of domperidone 20mg po four times a day has been used in patients with Parkinson's to reduce upper gastrointestinal symptoms and accelerate the gastric emptying time.

Testosterone vs Osteoporosis and Crohn's Disease
Men with Crohn's disease (CD) are at risk for osteoporosis. A study aimed at investigating the sex hormone status of men with CD and establishing the influence of sex hormones on bone metabolism showed that there was a significant association between total testosterone and osteocalcin, independent of age and current steroid use. Hypogonadism is an uncommon cause of low bone density in men with CD. The independent association between testosterone and the bone formation marker osteocalcin suggests sex hormones influence bone metabolism in men with Crohn's disease. The study shows testosterone replacement could be effective treatment for men with osteoporosis and Crohn's disease.
Robinson RJ, Iqbal SJ, Al-Azzawi F, et al. Sex hormone status and bone metabolism in men with Crohn's disease. Aliment Pharmacol Ther 1998 Jan; 12(1): 21-5.

Tranexamic Acid Rinse-hemostatic agent for anti-coagulate patients on medications such as Coumadin (Warfarin) 

KLMP cream (contains: ketoprofen, lidocaine, misoprostol, and phenytoin) for healing ulcers

Triamcinolone 0.2% Mouth Rinse, flavored, for canker sores

Transdermals NSAIDs - ketoprofen, ibuprofen, piroxicam, plus amitriptyline, baclofen, gabapentin, carbamazepine, cyclobenzaprine, guiafenasin. Alternatives are troches, gels, mucosal bandages

Burning Mouth Syndrome—clonazepam 0.25mg troche, capsaicin troche, Misoprostol, NSAIDs and tricyclics

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