Magistral formulations and pruritus therapy – What is established, what is confirmed, what is new?

Abstract

SummaryPruritus is a common symptom encountered by many different specialties. One must clinically differentiate between pruritus associated with skin disease or inflammation and pruritus with normal skin. Searching for possible underlying diseases is indispensable, because pruritus can be very chronic and has multiple pathogenetic mechanisms. Therapy -especially topical therapy -is difficult and often not successful. Very often systemic treatment has to be combined with topical approaches, considering both the active ingredients and appropriate vehicles. There are still open therapeutic gaps in the pharmaceutical product market, which can partially be resolved by using standard prescriptions for formulations. Due to the new pharmacy practice order, standardized compounded formulations should be given preference, since individual formulations often do not pass the plausibility check of the compounding pharmacist. Also the use of cosmetic ingredients (by example, commercial cold creams) is no longer permitted, since only ingredients with pharmaceutical quality can be used in compounding. We will show -based on practical cases -different therapeutic options for treatment with standardized magistral formulations from the NRF (New German Pharmacopoeia for compounded medications). Systemic and topical therapeutic agents complement each other in their efficacy. Causal and symptomatic therapies result in the most diverse therapeutic options since pruritus has so many causes. In many scenarios, novel therapeutic approaches or special vehicles require magistral formulas [4,5]. The new Pharmacy Practice Act requires a plausibility check of each prescription since 2012, so that frequently individual formulations are scrutinized, so that therapeutic alternatives in the form of magistral formulas are very welcome. We will present only established magistral formulas of the NRF that have already undergone a plausibility check [6,7]. Petra

Extemporaneous formulations in Germany – relevance for everyday clinical practice

“…There are only few publications that investigate issues or offer suggestions regarding the choice of adequate extemporaneous formulations. In recent years, there have been no publications on the frequency of prescriptions or the cost associated therewith . A 1997 publication analyzed the prescription frequency of extemporaneous formulations by office‐based dermatologists in the state of North Rhine‐Westphalia (NRW) for the month of January 1995.…”

Punica granatum L. Hydrogel for Wound Care Treatment: From Case Study to Phytomedicine Standardization

“…In daily care related to the treatment of wounds there is a great concern about the techniques used for the removal of bandages and medicines applied to the lesion and, consequently, its sanitation. This process can be very painful for the patient, which means that special attention is necessarily given in the development of formulations exhibiting characteristics that make this process easier, minimizing patient discomfort and allowing the ready examination of the lesions [22]. According to USP regulations on semisolid formulations, the product quality attributes should include, but are not limited to the following: description, assay, uniformity, physicochemical properties and apparent viscosity.…”

Dermatologische Rezepturen in Deutschland – Relevanz für die Versorgung

“…Es gibt wenige Publikationen, die sich mit Problemen oder Anregungen bezüglich der Wahl einer richtigen Rezeptur beschäftigen. Publikationen über die Verordnungshäufigkeit oder deren Kosten wurden in den letzten Jahren nicht veröffentlicht . Im Jahr 1997 wurden in einer Veröffentlichung die Rezepturverordnungen von niedergelassenen Dermatologen in Nordrhein‐Westfalen (NRW) im Abrechnungszeitraum Januar 1995 analysiert, wobei die Untersuchungskohorte alle Verordnungen für Versicherte der Betriebskrankenkassen nicht national, sondern nur in Nordrhein‐Westfalen zeigte, die zu diesem Zeitpunkt einen Marktanteil von 11 % in NRW hatten.…”