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Abstract
Published information on alternative ways to administer commercial dosage forms may not always be the best option for patients and the hospital staff. There are resources available to research information about drugs and excipients. A compounding pharmacist can review the information and, based on training and experience in compounding, develop a formulation to meet the individual needs of a patient. The tretinoin oral suspension formulation included with this article is an example of how to develop a formulation without a published stability study by utilizing various compounding references and databases.
Tretinoin (Vesanoid), commonly known as Rcuji-A or Renova, is used topically for the treatment of acne vulgaris or photodamaged skin and palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin as part of a comprehensive skin care program. When taken orally, tretinoin is an antineoplastic agent used alone or in combination with the following antineoplastic agents for remission induction in acute promyelocyte leukemia (APL):
* Arsenic trioxide
* Arsenic trioxide-gemtuzumab
* Daunorubicin
* Daunorubicin-cytarabine
* Idarubicin
Tretinoin is also being investigated for post consolidation and maintenance therapy in API. and for use in combination therapy with arsenic trioxide for remission induction in APL.
Tretinoin is only commercially available as a ??-mg liquid-filled capsule. It is a category X drug and hazardous precautions must be used by the nursing and medical staff when administering the drug. Although this drug is primarily administered to adult patients, not all patients are able to swallow the capsules. There are cases in institutional settings where patients requiring tretinoin therapy cannot take medications orally (NPO) because they are intubated. These cases present a difficult rrearmenr challenge for the hematology/onco logy staff.
Treatment Options
Although the manufacturer does not recommend using the contents of rhe tretinoin capsules to extemporaneously prepare a tretinoin oral suspension, there are limited case reports on altering the commercial dosage form to treat NPO patients. In a patient with a nasogastric (NG) tube, the tretinoin capsules were cut open and the contents were partially aspirated into a glass syringe. The residual contents of the capsule were mixed with soybean oil, aspirated into the same syringe, and administered to the patient.1 Another reported option was to mix the tretinoin capsules with sterile water,...