Testosterone Therapy for Late-Onset Hypogonadism: A Clinical, Biological, and Analytical Approach Using Compounded Testosterone 0.5-20% Topical Gels.

Testosterone is integral to men's sexual and overall health, but there is a gradual decline in the ageing male. The topical administration of testosterone is a valuable option as a supplement (replacement) therapy to alleviate hypogonadal symptoms. The clinical efficacy of a compounded testosterone 5% topical gel was assessed retrospectively in a male patient in his seventies by evaluating the laboratory testing of the serum total testosterone and the results of a validated androgen deficiency questionnaire. After treatment, the patient's hypogonadal symptoms improved and the serum total testosterone level achieved was considered clinically optimal. The skin permeation of the testosterone topical gel (biological testing) was evaluated in vitro using the Franz finite dose model and human cadaver skin, and it is shown that testosterone can penetrate into and through ex vivo human skin. Testosterone therapy is often prescribed for extended periods, and consequently, it is crucial to determine the beyond-use date of the compounded formulations. The analytical testing involved a valid, stability-indicating assay method for compounded testosterone 0.5% and 20% topical gels. This multidisciplinary study shows evidence supporting topically applied testosterone's clinical efficacy and the compounded formulations' extended stability. Personalized, topical testosterone therapy is a promising alternative in current therapeutics for hypogonadal patients.

Case Study: Personalized Oral Low-dose Naltrexone Titration for Pain Management.

Naltrexone is a competitive opioid receptor antagonist indicated to treat opioid and alcohol dependence. In the U.S., naltrexone is commercially available as 50-mg tablets, and the adult dosage strength typically ranges between 50 mg once daily and 100 mg once daily. However, there is evidence to suggest that naltrexone prescribed in low doses, about 1/10th of the daily standard dosage, may be effective in managing a myriad of chronic conditions, including pain refractory to conventional pharmacological treatments. The U.S. Food and Drug Administration recently granted an orphan drug designation for low-dose naltrexone for the treatment of complex regional pain syndrome. This article provides a case study of a patient who was treated with a low dose of naltrexone for pain associated with the diagnosis of idiopathic hypereosinophilic syndrome.

Vulvovaginal Symptoms in a Postmenopausal Woman: A Case Study.

A postmenopausal female patient was suffering from vulvovaginal symptoms such as dryness and irritation, which were affecting her relationship with her partner and her overall quality of life. The patient was instructed to apply an estriol 0.1% vaginal ointment (PCCA Ellage Anhydrous Vaginal) for a duration of three months. The safety and efficacy of the compounded treatment were evaluated using an online data collection form, which included the validated Vulvovaginal Symptom Questionnaire. Post-treatment results show that the vulvovaginal symptoms were no longer bothersome, and that the patient's relationship was no longer affected. There were no reports of undesirable effects as a result of the compounded treatment. This case study reinforces the benefits and convenience of using topical hormone replacement therapy in postmenopausal women.

The Potential Effects of a Compounded Methylcobalamin Nasal Spray on Short-term Memory Loss After Intracranial Hemorrhage: A Case Report.

Short-term memory loss is a common complication after intracranial hemorrhage or traumatic brain injury. FDA-approved cholinesterase inhibitors for memory symptoms of Alzheimer's disease have not been proven effective for improving memory impairment resulting from a hemorrhagic event. The purpose of this case study was to present the potential effectiveness of a compounded nasal spray containing methylcobalamin in improving short-term memory function in a patient post-intracranial hemorrhage. The patient started to administer the methylcobalamin nasal spray once daily after suffering from short-term memory loss for four years. His verbal memory, visual memory, and quality of life were assessed by the Hopkins Verbal Learning Test-Revised, Benton Visual Retention Test, and the 36-Item Short Form Survey, respectively, at baseline and 30 days after treatment. The delayed recall test was repeated after 60 days. After 30 days of treatment, the patient received improved scores in both verbal and visual memory tests, as well as improved self-reported quality of life. The patient became less dependent on phone reminders in daily life. The improvement in delayed recall remained significant after 60 days of treatment. This case report suggests a potentially safe and effective therapy for attenuating short-term memory impairment after intracranial hemorrhage.

Glycopyrrolate Sorbitol Lollipops for Drooling: Two Case Reports.

Drooling is a pathologic condition that is commonly associated with neurodisability and poor quality of life. An elderly dementia patient and an adult cancer patient suffered from persistent drooling, and they were both prescribed glycopyrrolate 0.5-mg sorbitol lollipops, per recommendation of their local compounding pharmacist. The severity and frequency of drooling decreased substantially in both patients, and there were no reported adverse effects. These two case reports demonstrate the safety and efficacy of glycopyrrolate lollipops in managing excessive salivation, as well as the importance of the triad relationship in addressing the individual patient needs.

A topical naltrexone formulation for surgical wound healing: A case report.

BACKGROUND: In current guidelines, there is no specific therapeutic recommendation for promoting surgical wound healing. Proper postsurgical wound care regimen can speed up wound healing and prevent abnormal scarring. AIMS: The purpose of this case study was to evaluate the effectiveness of a compounded topical formulation containing naltrexone in managing surgical wound in a patient after Mohs micrographic surgery (MMS). PATIENTS/METHODS: A patient started to apply the topical naltrexone formulation two days after the MMS on his hand. Images of the wound and a Patient Scar Assessment Questionnaire (PSAQ) were used to evaluate the clinical outcomes. RESULTS: The wound completely healed, and the hand function was fully recovered following application of the formulation for 2 weeks. No abnormal scarring was formed, and the scar was only slightly noticeable after 2 months. CONCLUSION: This case study demonstrated the effectiveness of the topical naltrexone formulation in surgical wound management.

Pitch Ointment: Applications in Scar and Wound Management.

There is a high incidence of household knife-related injuries requiring emergency department treatment in the U.S. The Pitch Ointment, a named formula developed by a compounding pharmacist, was used separately by two patients who suffered a knife injury in a finger and a foot. This formula combines Pinene (L-Alpha) 0.5% and Canada Balsam 5% in PracaSil-Plus, special ingredients with applications in scar and wound healing. The patients' level of satisfaction with the Pitch Ointment was very high since all 4 treatment satisfaction domains by the Treatment Satisfaction Questionnaire for Medication (effectiveness, side effects, convenience, global satisfaction) were rated over 85. These results are consistent with the clinical improvements observed in the before and after treatment photographs. The success of these case reports is evidence to suggest that the Pitch Ointment may be recommended by compounding pharmacists as a viable treatment option in scar and wound management.

Use of a topical anhydrous silicone base containing fatty acids from pracaxi oil in a patient with a diabetic ulcer.

OBJECTIVES: The treatment of diabetic ulceration of the lower extremities is a complicated task due to the nature of the ulcer and potential underlying comorbidities. This report describes the case of a 61-year-old male patient with Type 2 Diabetes who presented with an ulcerative leg wound. The objective of this study was to evaluate the outcome of a topical compounded treatment. METHODS: The patient applied a compounded medicine containing 2% mupirocin in a topical anhydrous silicone base containing fatty acids from pracaxi oil directly to the ulcer for 63 days, 3 times daily. This regimen was supplemented with exercise and an additional compounded medicine applied to the wound margins in order to increase circulation. RESULTS: By the end of the application period, the patient's ulcer was fully closed. CONCLUSION: A topical anhydrous silicone compounding base containing fatty acids from pracaxi oil may be useful in the treatment of patients with diabetic ulcers.

Case series: the effectiveness of Fatty acids from pracaxi oil in a topical silicone base for scar and wound therapy.

INTRODUCTION: Wounding affects the integrity of the skin and can ultimately result in skin scarring. Current therapeutic goals of wound treatment focus on the reduction of scar formation and severity. However, scar formation itself varies not only between individuals based on factors such as ethnicity, but also within an individual based on the location of the wound. Therefore, the preparation of customized treatments for individual patients represents an important therapeutic goal in the fields of dermatology and wound healing. The objective of this study was to evaluate the usefulness of fatty acids found in pracaxi oil in a compounded topical anhydrous silicone base for wound and scar therapy. METHODS: Initially, 21 patients with various surgical, traumatic, or burn wounds and scars were enrolled into this case series. Patients applied a compounded topical anhydrous silicone base containing pracaxi oil with or without additional active ingredients, including pentoxifylline, caffeine, tranilast, and mupirocin. Wound/scar photographs taken before and after application of the compounded pracaxi oil topical formulation (with/without additional ingredients) were reviewed and adjudicated by a blinded dermatology reviewer. Improvements in wound size, coloration, and overall appearance before and after treatment were determined. Patient satisfaction was assessed after application of compounded topical formulation using a self-report questionnaire distributed at the time of dispensing. RESULTS: A total of seven patients were considered available for analysis and were included in the study. In all seven cases, patients reported improvement in scar and wound attributes, including scar and wound size, severity, color, and pain associated with the scar or wound after application of the compounded medicine. On average, patients rated their satisfaction with treatment highly, with a mean score of 10 on a rating scale of 1-10. Retrospective review of wound/scar photographs demonstrated clinically relevant improvements in wound attributes as assessed by a dermatologist. Six of the seven wounds examined were considered "much improved" from baseline. CONCLUSIONS: Application of a compounded anhydrous silicone base containing pracaxi oil alone or in combination with other active substances led to considerable improvements in wound healing and scar attributes and is a potentially useful option in the treatment of surgical, traumatic, or burn wounds and scars.