Compounding ophthalmics

Several guidelines are available in the literature for the pharmacist who must extemporaneously prepare an ophthalmic solution. The USP contains a section on ophthalmic solutions, as do other compendia and several standard textbooks. Since the pharmacist does not have the facilities to test the product, he or she should dispense only small quantities, with an expiration date of no more than 30 days. Refrigeration of the product should also be required as a precautionary measure. To reduce the largest potential source of microbial contamination, only sterile purified water should be used in compounding ophthalmic solutions. Sterile water for injection, USP, from unopened IV bottles or vials is the highest-quality water available to the pharmacist. Prepackaged sterile water with bacteriostatic agents should not be used. 

Goldstein SW. Antibacterial agents in compounded ophthalmic solutions. ] Am Pharm Assoc Pract Pharm) 1953 14 498-524. 

Anaizi NH, Swenson CF, Dentinger PJ (1997) Stability of acetylcysteine in an extemporaneously compounded ophthalmic solution. Am J Health Syst Pharm 54 549-553... 

A number of articles considered the association of chitosan with polylactic acid or similar compounds [47-49] another group of articles presented new data on highly cationic chitosans [ 50 - 55]. More data have also been made available on the delivery of growth factors [56] and ophthalmic drugs [57,58], on the activation of the complement, macrophages [59-61] and fibroblasts [62], on mucoadhesion [63] and functionalization of chitin [64]. The development of new carriers for the delivery of drugs, and the interactions of chitosans with living tissues seem therefore to be major topics in the current research on chitosan. Therefore, this chapter will place emphasis on these aspects. 

The USP has numerous requirements, e.g., ophthalmic solutions [need be] essentially free from foreign particles, suitably compounded and packaged for instillation into the eye, or ophthalmic suspensions [need contain] solid particles dispersed in liquid vehicle intended for application to the eye [1]. Ophthalmic suspensions are required to be made with the insoluble drug in a micronized form to prevent irritation or scratching of the cornea. A finished ophthalmic ointment must be free from large particles and must meet the requirements for leakage and for metal particles under ophthalmic ointments . These and other requirements will be discussed further in subsequent sections. 

This preservative is comparatively new to ophthalmic preparations and is a polymeric quaternary ammonium germicide. Its advantage over other quaternary ammonium seems to be its inability to penetrate ocular tissues, especially the cornea. It has been used at concentrations of 0.001-0.01% in contact lens solutions as well as dry eye products. At clinically effective levels of preservative, POLYQUAD is approximately 10 times less toxic than benzalkonium chloride [87,137], Various in vitro tests and in vivo evaluations substantiate the safety of this compound [137,141,142], This preservative has been extremely useful for soft contact lens solutions because it has the least propensity to adsorb onto or absorb into these lenses, and it has a practically nonexistent potential for sensitization. Its ad-sorption/absorption with high water and high ionic lenses can be resolved by carefully balancing formulation components [143],... 

This preservative is also comparatively new to ophthalmic formulations and has been used as a disinfectant in contact lens solutions. Polyaminopropyl biguanide (polyhexamethyl biguanide) also is a polymeric compound that has a low toxicity potential at the concentrations generally used in these solutions [141, 149, 150]. 

When an ophthalmic ointment is manufactured, all raw material components must be rendered sterile before compounding unless the ointment contains an aqueous fraction that can be sterilized by heat, filtration, or ionizing radiation. The ointment base is sterilized by heat and appropriately filtered while molten to remove extraneous foreign particulate matter. It is then placed into a sterile steam-jacketed kettle to maintain the ointment in a molten state under aseptic conditions, and the previously sterilized active ingredients) and excipients are added aseptically. While still molten, the entire ointment may be passed through a previously sterilized colloid mill for adequate dispersion of the insoluble components. 

Stablizers. Stabilizers are ingredients added to a formula to decrease the rate of decomposition of the active ingredients. Antioxidants are the principal stabilizers added to some ophthalmic solutions, primarily those containing epinephrine and other oxidizable drugs. Sodium bisulfite or metabisulfite are used in concentration up to 0.3% in epinephrine hydrochloride and bitartrate solutions. Epinephrine borate solutions have a pH range of 5.5 7.5 and offer a more difficult challenge to formulators who seek to prevent oxidation. Several patented antioxidant systems have been developed specifically for this compound. These consist of ascorbic acid and acetylcysteine, and sodium bisulfite and 8-hydroxyquinoline. Isoascorbic acid is also an effective antioxidant for this drug. Sodium thiosulfate is used with sodium sulfacetamide solutions. 

When oils are used as vehicles in ophthalmic fluids, they must be of the highest purity. Vegetable oils such as olive oil, castor oil, and sesame oil have been used for extemporaneous compounding. These oils are subject to rancidity and, therefore, must be used carefully. Some commercial oils, such as peanut oil, contain stabilizers that could be irritating. The purest grade of oil, such as that used for parenteral products, would be advisable for ophthalmics. 

Narducy KW, Duzman E, Carney JM, Wilcox AL. Ophthalmic Pharmaceutical Compositions Comprising Nitrone Compound and Methods for Treating Ocular Inflammation Using Such Compositions, US Patent No. 5972977, October 26, 1999. 

How many grams of 2% ophthalmic hydrocortisone acetate ointment and how many grams of ophthalmic base (diluent) should be used in compounding the prescription ... 

In birds, the trigeminal nerve appears to play a role in food selection. Starlings more easily accepted commercial feed treated with otherwise avoided coniferyl benzoate after bilateral section of the ophthalmic branch of the trigeminal nerve. Therefore, the trigeminal nerve may help to protect the animal by detecting plant defense compounds. Many of these compounds are astringent or irritating (Jakubas and Mason, 1991). 

The different PFCLs used as interoperative tools can be categorised as a group of compounds with more or less uniform behaviour. On the contrary, the partially fluorinated species have to be regarded as individuals each. This is due to the hybrid character of these compounds, which combine the behaviours of alkanes and perfluoroalkanes. Especially, the toxicological behaviour cannot be optimised by simple modifications of the degree of fluorination. If the two molecule parts are combined in the right balance, the cytotoxic behaviour of the alkyl chain can be overcompensated by the inert perfluorinated part of the compound. But each compound should be tested individually to ensure its suitability as a candidate for ophthalmic use. 

The free world market for cerium-oxide based polishing compounds is not large—approximately 4400 metric tons per year—, and we do not see a substantial growth potential despite the 11% annual growth in sales of spectacle lenses. The reason is twofold first, faster more efficient polishing compounds are available which can be used in slurry concentrations one-half that of a few years ago second, fully half the market for ophthalmic glass lenses has been captured by plastic lenses of CR-39 polymer. Cerium oxide is ineffective in polishing this material specially treated alumina or stannic oxide are used. 

Ophthalmic, transmucosal, and transdermal products will be the most sensitive to the strength of binding. These routes of administration experience minimal dilution. However, this may not be a signiLcant concern because the drug typically can also be displaced from the CD cavity at the delivery site by competing lipophiles at the delivery site, such as triglycerides, cholesterol, bile salts, and other hydrophobic compounds, which are often in much higher concentrations (Thompson, 1997). 

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