Customized Medications Solve Problems for Mothers and Babies
Oxytocin nasal spray can be compounded to help women who have problems with milk letdown. Lactation failure may result from insufficient oxytocin. A rise in the concentration of oxytocin causes contraction of cells around the alveoli and milk ducts, in preparation for suckling. Oxytocin nasal solution (Syntocinon®) was formerly commercially available, and indicated for use in stimulating lactation during the first week postpartum (not for continued use). Oxytocin nasal spray is contraindicated during pregnancy since it may provoke a uterotonic effect, precipitating contractions and abortion. The medication is still frequently requested and can be compounded per a prescription order.
“All purpose nipple ointment” (APNO) is a combination of ingredients which seems to relieve many causes of sore nipples during breastfeeding. The presence of Candida albicans can cause nipple soreness and cracking, and cracks and erosions in the nipple harbour bacteria that can cause infection or delay healing, and can cause significant pain. APNO was originally developed by pediatrician Jack Newman, MD, who started the first hospital-based breastfeeding clinic in Canada in 1984. He noted, “It is always good, however, to try to assure the best latch possible, because improving the latch helps with any cause of pain.” Ointments often work better than creams to treat sore nipples, and Dr. Newman recommended a preparation containing mupirocin 2% ointment 15 grams, betamethasone 0.1% ointment 15 grams, with miconazole powder added so that the final concentration is 2% miconazole. Dr. Newman suggested that sometimes it is helpful to add ibuprofen powder as well, so that the final concentration of ibuprofen is 2%. The combination is applied sparingly after each feeding.
Topical application of tretinoin (retinoic acid) has been shown to significantly improve the appearance of pregnancy-related stretch marks. In a double-blind, randomized, vehicle-controlled study, 22 women with early, clinically active stretch marks applied either 0.1% tretinoin or vehicle daily for 6 months to the affected areas. Patients were evaluated by physical exam monthly and by analysis of biopsy specimens of stretch marks obtained before and at the end of therapy in comparison with untreated normal skin. After 2 months, patients treated with tretinoin had significant improvements in severity scores of stretch marks compared with patients who received vehicle. After 6 months, 8 of the 10 tretinoin-treated patients had definite or marked improvement compared with one of the 12 vehicle-treated patients. An open-label, multicenter, prospective study of 20 women found that tretinoin cream 0.1% applied daily for 3 months to pregnancy-related stretch marks in the abdominal area resulted in significantly improved clinical appearance.
Another study reported that elastin content within the reticular and papillary dermis can increase with topical 20% glycolic acid combined with 0.05% tretinoin emollient cream therapy.
This therapy should not be used while pregnant or breastfeeding.
Arch Dermatol. 1996 May;132(5):519-26
Adv Ther. 2001 Jul-Aug;18(4):181-6
Dermatol Surg. 1998 Aug;24(8):849-56
Diaper Rash (Dermatitis)
Approximately two-thirds of infants experience diaper rash. Customized diaper rash preparations -ointments, powders, or creams- tailored to treat each baby’s specific symptoms, can be compounded using ingredients which will protect the skin from additional irritation, soothe and encourage healing, and prevent secondary infections. Skin protectants (zinc oxide, petrolatum) provide a physical barrier against external irritants such as urine or gastrointestinal enzymes in stool. Antifungal creams can be used when a yeast(Candida) infection is suspected. Topical steroids (such as hydrocortisone 1%) should be reserved for severe diaper rash, because a baby’s skin can absorb enough medication to lead to systemic effects.
Decreased gastrointestinal transit time can mean less time for bile acid resorption in the distal ileum, and high concentrations of bile acids in the stool can irritate the anus and buttocks in a manner similar to the skin irritation associated with ostomies. When applied topically, cholestyramine, a bile acid sequestrant, can irreversibly bind the bile and bring relief to the patient. Annals of Pharmacotherapy 30(9):954-956 reported the case study of a two-month old boy with reflux and regurgitation who was treated with a promotility agent. He developed a rash on his buttocks and anal irritation that progressed in severity despite the use of numerous topical products and extended diaper-free periods. A compounded topical cholestyramine ointment was administered and resulted in complete resolution within three days.
Pediatric Dosage Forms
Many medications needed by babies and children are not commercially available in pediatric strengths or dosage forms. We can eliminate the need to break or crush tablets or administer unpleasant drugs intended for adults, by compounding the best dose of the needed medication into a pleasantly-flavored dosage form such as a syrup or suspension, lollipop, or even a gummy bear or freezer pop. Rectal suppositories remain popular for children, and we can prepare suppositories that are not commercially available.
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