Topical Compounds

Steve Mamchur, owner and pharmacist at Kenron Pharmacy, a local Calgary compounding pharmacy, provided a very informative talk on topical compounds. Some notes from the talk are provided below.

Topical Compound Options

For treatment of nerve pain the following compounds were suggested:

• Ketamine 10%/ Gabapentin 10%/ Lidocaine 5%
  • (Note: this requires a triple script)
  • Mitte: 10g Sig: Apply a pea sized drop TID

• Ketoprofen 10%/ Gabapentin 10%/ Lidocaine 10%
  • Mitte: 30g Sig: Apply TID

For treatment of joint or muscle pain the following compound was suggested:

• Ketoprofen 10%/ Cyclobenzaprine 2%/ Pentoxifylline 2%
  • Mitte: 30g Sig: Apply TID

For treatment of tight muscles the following compound was suggested:

• Ketoprofen 10%/ Cyclobenzaprine 2%/ Pentoxifylline 2%
  • Mitte: 30g Sig: Apply TID

Topical Compound Notes

Terms

Compounding is putting together things not normally together, they create products that otherwise are not available.

The Depot Effect refers to that reapplying a medication builds it up in the applied area.  So over time there is a higher residual concentration (i.e. build up).

DMSO is an agent to help penetrate the skin deeper.

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. (1)

Notes

Drugs are foreign chemicals and have side effects. Topical compounds remove the potential abuse issue.

Neuropathic pain is difficult to treat:

• Topical compounds may have as many as 4-5 meds in a cream for maximum relief. An example of one of these medications is Ketamine which works well for neuropathy topically and there are no side effects
• Recommends Krisgel 100 for a DMSO as it penetrates deeply

Advantages of transdermal:

• Different skin has different abilities, for example, the skin on the feet is thick and requires a penetration enhancer. TIP: you can also cover it. (i.e.  Leave over night covered with saran wrap and a sock).
• Re applying over and over helps with the depot effect providing more consistent relief.
• TIP: After 10 minutes the medication has penetrated as much as it will so wipe it off with a warm cloth so the skin isn’t irritated.

Dermatomes to boost relief:

• Dermatomes equate to the nerve path from the spine to the parts of the body where the nerve ‘ends’.
• By applying to where in the spine the nerve is that is sending the pain signals, as well as at the sight pain, relief may improve.

Below is a graphic showing where the nerve exiting each vertebrae leads to in the body. Internet searches for “Dermatomes images” will provide many versions of this diagram.

References

(1) https://www.medicalnewstoday.com/articles/what-are-dermatomes