Treatment of palmar-plantar erythrodysesthesia (PPE) with topical sildenafil: a pilot study.

Purpose: Palmar-plantar erythrodysesthesia (PPE) is a common chemotherapy and anti-VEGF multi-kinase inhibitor class-related toxicity that often results in debilitating skin changes and often limits the use of active anti-cancer regimens. Mechanistic and anecdotal clinical evidence suggested that topical application of sildenafil cream may help reduce the severity of PPE. Therefore, we conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the feasibility, safety and efficacy of topical sildenafil cream for the treatment of PPE.

Quality-control analytical methods: aqua pura: water purification systems and United States pharmacopeia waters for the compounding pharmacy, part 1.

The types of water used most often in a compounding pharmacy are potable water, purified water, and sterile water (water for injection or irrigation). Of those three types, purified water is most frequently used; it is essential as a clean glassware rinse and is used in the compounding and reconstitution of frequently prescribed no sterile compounds, such as antibiotic suspensions. Using the appropriate water is absolutely essential to good compounding practice.

Automated endotoxin testing program for high-risk-level compounded sterile preparations at an institutional compounding pharmacy.

Purpose: An endotoxin testing program for high-risk-level compounded sterile preparations (CSPs) was verified for compliance with finished-preparation release test requirements of United States Pharmacopeia chapter 797 and implemented at an institutional compounding pharmacy.

Summary: An efficient bacterial endotoxins test (BET) was sought for finished-preparation testing of high-risk-level CSPs prepared in batches of > or =25 units. An automated photometric BET was selected that utilized dried, pre-calibrated Limulus amebocyte lysate cartridges rather than liquid reagents and standards.

Contract sterilization and validation companies offer new options for sterile compounded preparations.

To ensure patient safety, adhere to good compounding practices, and safeguard against professional liability, the sterility of some compounded preparations must be assured. When in-house sterilization capabilities do not suffice, the intervention of a contract sterilization and/or validation company can assist in establishing the sterility, purity, and potency of the pharmaceuticals used in compounded preparations. In this article, three contract steriliziation companies and two contract validation firms are profiled, methods that compounders can use to best interface with those companies are presented, and sterilization and validation processes are explained and compared.

Microbial air-sampling equipment, part 2: experiences of compounding pharmacists.

The most recent changes to Chapter 797 of the United States Pharmacopeia-National Formulary initiated an intense controversy about the frequency of cleanroom air sampling that is required to prevent the contamination of sterile preparations. For compounders who must purchase an air sampler to use in the cleanroom, choices abound. This article summarizes discussions from compounding pharmacists and their experiences with air sampling devices.

APS position statement on the use of placebos in pain management.

In the spring of 2003, the board of directors of the American Pain Society asked the APS Ethics Committee to formulate a position statement for the Society concerning the use of placebos in clinical practice (cf, reference ). A subset of the Ethics Committee under my direction composed such a statement based on the available scientific and ethical literature. We then sought feedback from the entire ethics committee as well as numerous prominent voices in the literature and presented the statement to the membership for discussion at the 2004 annual APS meeting in Vancouver, British Columbia, at both a symposium and an ethics special interest group meeting.

Extemporaneous compounding of pain and symptom control medications.

This paper introduces a new series in the Journal on extemporaneously compounded dosage forms for symptom control. Some advantages and limitations of compounded medications are described and issues that clinicians should consider are mentioned. Topics that will be discussed in future papers in this series are described.

Meperidine: a critical review.

Meperidine was initially synthesized as an anticholinergic agent but was soon discovered to have analgesic properties. Although meperidine's anticholinergic effects were demonstrated in vivo, the anticholinergic effects on the biliary and renal tracts have not been demonstrated in vivo. Studies have clearly demonstrated that meperidine is no more efficacious in treating biliary or renal tract spasm than comparative mu opioids.