Pharmaceutical Preparations 2003
Drug Information Center Ministry Of Health-Khartoum Health-Khartoum State Directorate of Pharmacy
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DRUG INFORMATION CENTER MINISTRY OF HEALTH KHARTOUM STATE DIRECTORATE OF PHARMACY
TEL: 00249-11-793200 00249-11-793201 FAX: 00249-11-793200 EMAIL:
[email protected] WEBSITE: www.dickhartoum.com
Printed by Sudan currency printing press
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CONTENTS
Preface Introduction General Notices Creams Ear drops Lotions Ointments Paints Pastes Solutions References Subject Index
1 2 3 9 13 14 18 25 27 30 34 35
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Preface It was apparent at the time that opportunities for pharmacists in primary care to promote the rational use of medicines were occurring with increasing frequency, a trend that has continued unabated. More pharmacists are working as medical practioners in hospitals, running specific pharmacies, or rationalizing the range of medicines prescribed by the practice, and striving to improve the repeat prescribing process. Against this background , the administration of pharmacy in the ministry of health – Khartoum state has continued to advocate that pharmacist should be a more integral part of the primary care team and become fully utilized as a source of advice to all members of the health care team and patients. This booklet will continue to be a source of information for those pharmacists undertaking these developing rules. Our thanks go to Hassan Ali Hassan (B. Pharm ) for helping us bring information and sharing with us his expertise . Hashim Ibrahim Awad BSc.Pharm Drug Information Center Ministry Of Health Khartoum State
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Introduction Over the last 50 years pharmaceutical manufacturers have played a significant role in advancing health care. Although the mass-marketed and mass-produced drugs meet the needs of most patients, there are still a number of patients who require pharmacists to customize medication to meet their unique medical needs. This practice of individualizing or customizing medication is called "compounding". Many pharmacists and physicians are rediscovering the benefits of compounding to improve patient care. The practice of preparing medications dates back to the origins of pharmacy, yet the pharmacy profession has changed over the years. As late as the 1930's, approximately half of all medications were compounded. During the 1950's and 60's, with the advent of the pharmaceutical manufacturers, the practice of compounding greatly declined. Industrialization had an impact on every aspect of the activity of the pharmacist. First, it led to the creation of new drugs, drugs that the individual pharmacist’s own resources could not produce. Second, many drugs that the individual pharmacist was able to produce could be manufactured more economically, and in superior quality, by industry. Third, industry assumed responsibility traditionally vested in the pharmacist for the quality of the medication. However, today there is still a compelling and vital need for compounded medications. Many of prescribed proprietary drugs do not meet the true medical needs of the patient, and that a compounded medication may be more appropriate. One of the most important reasons to use a compounded medication is patient non-tolerance of a manufacture product. Many patients are allergic to preservatives or dyes, or are sensitive to standard drug therapies. Physicians also prescribe compounded medications to change the strength, alter its form to make it easier for the patient to use, and/or to changed the flavor to make it more palatable. The pharmacist can also prepare the medication using several unique delivery systems, such as a sublingual lozenge, a lollipop, or transdermal gel. Thus compounding can substantially improve patient compliance by allowing the physician to prescribe a custom-tailored medication to meet the patient's need.
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General Notices
Rules for prescribing drugs for skin diseases
The prescriber should remember that drugs that act on the skin consist of a vehicle, which is sometimes chemically inert, and active ingredients. The vehicle To obtain the best results from active ingredients much attention should be given to the choice of vehicle. Skin preparations are supplied in powder, watery, or greasy forms. The greasy form is the one most commonly used. In general when choosing a vehicle the following dermatological and pharmaceutical factors should be considered. Absorption and penetration (a) Paraffin's do not readily penetrate the skin. (b) Animal and vegetable fats and oils do penetrate the skin. (c) Wool fats (lanolin) do penetrate the skin. (d) Absorption is required of the active ingredient. (e) Substance soluble both in oil and in water are most readily absorbed. (f) Water soluble substances are most readily absorbed when in aqueous bases. (g) Oil in water emulsions bases release their active ingredients more readily than greasy bases or water in oil emulsion bases. Effect on skin function:
When a cooling effect is required oil in water emulsion or other water miscible bases are preferable, as these mixes readily with aqueous skin secretions, whereas greasy bases do not. Miscibility with skin secretion and serum:
Oil in water emulsions mix readily with both aqueous and fatty secretions of the skin, so the active ingredients are more rapidly and completely released, which reduces the amount of medicament needed. Natural bases should be used to avoid incompatibilities wi th active ingredients and skin secretion. The vehicle should be also be free from irritant or sensitizing effects; it should have emulsion properties; and it should be easy and convenient to apply as well as easy to remove. As well the dermatological factors, the pharmaceutical factors to be considered are: Stability: The hydrocarbon bases (paraffins) are the most stable vehicles. Animal fat bases become rancid on exposure to moisture, light, and air. Wool fat bases and wool alcohol bases do not turn rancid, but emulsions made with
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them are liable to surface discoloration. The hot climate in the Sudan tends to break emulsions down and cause discoloration. Ointments of emulsion type should be freshly prepared and long storage avoided. The consistency of ointments in foreign pharmacopoeias is intended for cooler climate, so in the Sudan it is advisable to increase the amount of hard paraffin or beeswax to harden the ointment. Other factors influencing the choice of vehicle are its solvent properties, emulsifying properties, and site of intended application. Local availability of vehicles and the cost may well be included as important factors. INGREDIENTS USED FOR TOPICAL APPLICATIONS Aluminium
Aluminium powder alone and in paste form with zinc oxide has been used as a dressing. Aluminium acetate
Used in dermatology as astringent lotions for irritating skin conditions. Ammoniated mercury
Used topically in the treatment of skin infections and psoriasis but the use of such mercurial preparations is generally deprecated. Frequent or prolonged application to large areas or to broken skin or mucous membranes can cause mercury poisoning and use on infants has produced acrodynia. Benzoic acid (Benzoate):
Benzoate has antibacterial and anti fungal properties. Their antimicrobial activity is due to undissociated benzoic acid and is therefore pH dependent. They are relatively Inactive above a pH of about 5. Benzyl benzoate
Is an acaricide used in the treatment of scabies. Boric acid
Boric acid possesses weak bacteriostatic and fungistatic properties. Brilliant green Is a triphenylmethane antiseptic dye with actions similar to those of crystal violet. Its activity is greatly reduced in the presence of serum.
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Calamine
Calamine has mild astringent and antipruritic actions and is used as a dusting powder, cream, lotion, or ointment in a variety of skin conditions. Cajuput oil
Has been applied externally as stimulant and mild rubefacient in rheumatism. It is also used with other volatile agents in preparations for the relief of respiratory congestion. Capsicum oleoresin
Has a carminative action used as a counterirritant . Also used in topical preparations in the treatment of painful skin conditions. Cetrimide
Cetrimide is a quaternary ammonium antiseptic with actions and uses typical of cationic surfactants. Have bactericidal activity against Gram-positive and at higher concentration, against some Gram-negative. Chlorhexidine
Chlorhexidine is abisbiguanide antiseptic and disinfectant . Chlorhexidine inhibits some viruses and is active against some fungi. Use for cleansing skin and wounds, and as oral gels and mouthwashes for mouth infections including candidiasis and to reduce dental plaque accumulation. Coconut oil
Coconut oil forms a readily absorbable ointment basis. Copper sulphate Have an astringent action on mucous surfaces and in strong solutions they are corrosive. Corticosteroid and antibiotic preparations
Mixtures with gentamicin, choramphenicol, chlortetracycline, oxytetracycline, gramicidin, polymixin B, neomycin, and framycetin are marketed. The last two are especially likely to cause sensitivity.
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Dithranol
Dithranol is used in the treatment of sub acute and chronic psoriasis. Eucalyptus oil
Has been taken by mouth for catarrh and coughs. Has been applied as a rubefacient and is used as a flavour. Hydrogen peroxide:
It's an oxidizing agent used as an antiseptic, disinfectant and deodorant. It owes its antiseptic action to its ready release of oxygen when applied to tissues, but the effect lasts only as long as the oxygen is being released and is of short duration, in addition the anti microbial effect of the liberated oxygen is reduced in the presence of organic matter. Its solutions are used to clean wounds and ulcers in concentrations of up to 6%, a cream containing 1-5%. Gentian violet
In 1 or 2 per cent aqueous solution this is an inexpensive antibacterial, fungicidal, and antimonilial preparation. Iodine
Iodine has a powerful bactericidal action. It is also active against fungi, viruses, protozoa, cysts, and spores. Iodine is used as an antiseptic and disinfectant. Lactic acid:
Its action similar to those of acetic acid and has been used similarly in the treatment of infective skin. It is used as an antifungal and antiprotozoal in vaginal gel and douches, irrigations, and topical preparations for the skin and nails. Magnesium sulphate
Used an application to inflammatory skin conditions such as boils and carbuncles. Menthol
Menthol is chiefly used to relieve symptoms of bronchitis, sinusitis, and similar conditions. When applied to the skin menthol dilates the blood vessels, causing a sensation of coldness followed by an analgesic effect. It relieves itching and is used in creams, lotions, or ointments in pruritis and urticaria . In small doses by mouth menthol has a carminative action. 6
Methyl salicylate
Is a salicylic acid derivative that is irritant to the skin and is used topically in rubefacient preparations for the relief of pain in musculoskeletal, joint, and soft tissue disorders. Nicotinic acid:
Topical nicotinamide may be used in the treatment of inflammatory acne. Panthinol:
Has been used topically as an ointment , cream or solution usually in strength of 2% for the treatment of various minor skin disorders ( to relive itching and to aid healing. Phenol
Phenol is an antiseptic and disinfectant effective against vegetative Gram positive and Gram-negative bacteria, mycobacteria and some fungi . It is also active against certin viruses. Potassium permanganate:
It posses oxidizing properties explain their disinfectant properties. Its also an astringent. Solutions are used as cleansing applications to wounds, ulcers or abscesses and as wet dressing and in baths in eczematous conditions and acute dermatomes especially where there is secondary infection. It is often prepared as 0.1% solution in water. Solutions have also been used in bromhydrosis in mycotic infections such as athletes' foot, and in poison ivy dermatitis.
Resorcinol
Resorcinol has keratolytic properties and has been used in topical preparations for the treatment of acne and seborrhoeic skin Sodium thiosulphate
Has been used for its antifungal properties. Salicylic Acid
Has keratolytic properties and is applied topically in the treatment of hyperkeratotic and scalling skin conditions such as dandruff and seborrhoeic dermatitis, ichthyosis, psoriasis and acne. Initially a concentration of about 2% is used, increased to about 6% if necessary, through a wider range of
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concentration has been used. It is often used in conjunction with other drugs, notably coal tar. Preparations containing up to 60% salicylic acid have been used as a caustic for the removal of plantar warts, corns, or calluses. It also possesses fungicidal properties and is used topically in t he treatment of dermatophytes skin infections. Sodium bicarbonate
Can be administered as ear drops to soften and remove ear wax. Sulphur
This is a keratolytic, a mild antiseptic, a mild antifungal, and parasticide. Use in treatment of acne, dandruff, seborrhoeic conditions, scabies, and superficial fungal infections. Tannic acid
Has been used as an astringent for the mucous membranes of the mouth and throat. Formers uses of tannic acid include its application to burns. Tar
Coal tar preparations are used for their keratogenic properties and antipruritic effect in atopic dermatitis, chronic eczema, and psoriasis.. The keratogenic action can be augmented by combination with salicylic acid. Urea:
Emollient; it is an osmotic agent. It is mainly applied topically in the treatment of ichthyosis and hyper keratotic skin disorders it has hydrating and keratolytic properties. It is applied in cream or lotions containing 10- 25 % urea .A preparation of 40% may be used for nail destruction. Zinc oxide
This Is midly astringent and is used topically as asoothing and protective application in eczema and slight excoriations, in wounds, and for haemorrhoids. Zinc oxide reflects ultraviolet Zinc sulphate
Is used topically in a variety of skin conditions mainly for its astringent properties.
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Zinc undecenoate
Zinc undecenoate applied topically in the prophylaxis and treatment of superficial dermatophytoses, particularly tinea pedis. Topical corticosteroids There is Avery wide range of products; some consist of corticosteroids alone, some of corticosteroids with antibiotics or chemotherapeutic or other agents. The choice of ointment base is important. Sensitivity to added ingredients can occur. The various chemical formulations include: (a) hydrocortisone and hydrocortisone acetate; (b) intermediate corticosteroids, such as prednisolone; (c) dexamethasone and betamethasone and methyl- prednisolone; (d) fluorinated compounds. Creams, ointments, lotions, or sprays can be made up, the choice depending on the site and nature of the lesion. For prolonged use over large areas or in children a corticosteroid preparation must be diluted or weakened.
CREAMS Creams are viscous emulsions of semi – solid consistency , which may be of an oil – in – water type (aqueous creams) or water - in – oil type (oily creams). In pharmaceutical practice the term (cream) should be restrictor to preparations for external use. Emulsifying agents for aqueous creams include emulsifying anionic , cationic and non- - ionic waxes , polysorbates and sodium , potassium , ammonium and triethanolamine soaps ; oily creams are normally prepar0ed with emulsifying agents such as wool fat , wool alcohols , beeswax , calcium soaps and certain sorbitan esters. The possibility of incompatibility between the emulsifying agent and the other ingredients or preservatives must be considered when choosing the emulsifying agent for a particular preparation. Incompatibilities may also arise if two creams are mixed. Moulds or micro – organisms may grow, particularly in aqueous creams , if no preservative is include . Even if a preservative is present, care must be taken to avoid contamination by observing the highest standards of cleanliness during preparation and by selecting a suitable final container. If heavy microbial contamination develops in a cream, it may cause either deterioration of the preparation or, if the cream is applied to broken or inflamed skin , an infection in the patient. In order to reduce the risk of such infections, the number of micro – organisms in anti – inflammatory creams and creams likely to be applied to broken skin or burns should be reduced to the lowest possible level. Preparation of creams. The apparatus used in the preparation of creams and the final containers should, before use, be thoroughly cleansed, then rinsed with purified water which has freshly boiled and cooled, and finally dried. Freshly 9
boiled and cooled purified water should be used in the preparation of all creams, and hygienic precautions should be taken throughout the preparation and subsequent filling into containers. Dilution of creams. For certain specified creams, when a cream of strength lower than any available from a manufacturer is prescribed, a stronger cream should be diluted to the required strength with the diluent(s) suggested in the individual monograph. Hygienic precautions must again be taken, and the diluted cream must be freshly prepared. It is inadvisable to dilute creams for which information on a suitable diluent is not available. Containers and storage. Creams should be stored and supplied in well – closed containers which prevent evaporation and contamination , and kept in a cool place . Collapsible tubes of metal or suitable plastics should be used whenever possible . If aluminum tubes are used, a phosphate buffer such as that provided by a mixture of 0.1 per cent of disodium hydrogen phosphate (anhydrous) and 0.02 per cent of sodium dihydrogen phosphate (dihydrate) may be included , if this is specified in the individual monograph , in order to inhibit corrosion of the aluminum and reduce the possibility of evolution of hydrogen gas. Aluminum tubes are not suitable for creams preserved with an organic mercury compound. Labelling. The container should be labelled ( For external use only). The label on the container of a diluted cream should also state that the contents should not be used later than one month after issue for use. (1) AQUEOUS CREAM
Emulsifying Ointment Phenoxyethanol Purified Water, freshly boiled and cooled, sufficient to produce
300 g 10 g 1000 g
Method:
Aqueous Cream may be prepared in the following manner. Dissolve the Phenoxyethanol in sufficient Purified Water at about 60° to produce a total weight of about 700 g. Melt the Emulsifying Ointment, add the phenoxyethanol solution when both are at about 60° and mix. Stir gently until cool, add sufficient of the Purified Water to produce 1000 g and mix. (2) BETAMETHASONE VALERATE CREAM, betamethasone valerate with chlorocresol in a water – miscible base.
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(3) BUFFERED CREAM
Purified Water , freshly boiled and cooled Emulsifying Ointment Sodium phosphate Citric Acid Chlorocresol
669g 300g 25g 5g 1g
Method: Melt the emulsifying ointment with the aid of gentle heat , add the sodium phosphate , the citric acid and the chlorocresol , previously dissolved in the water at the same temperature , and stir gently until cold. (4) CALAMINE CREAM, AQUEOUS Formula A Purified water , freshly boiled and cooled Arachis Oil Emulsifying Wax Calamine Zinc Oxide
570g 300g 60g 40g 30g
Method: Melt the emulsifying wax with the aid of gentle heat, add the arachis oil, and warm; add 400 g of the water at the same temperature, and stir until cold. Triturate the calamine and the zinc oxide with the remainder of the water, and incorporate in the cream. (5) CETOMACROGOL CREAM
Cetomacrogol Cream may be prepared according to one of the following formulate , for use as a diluent as specified in the individual monographs: Formula A Cetomacrogol Emulsifying Ointment Chlorocresol Purified Water , freshly boiled and cooled
300g 1g 699g
Formula B Cetomacrogol Emulsifying Ointment Methyl Hydroxybenzoate Propyl Hydroxybenzoate Thiomersal Purified Water , freshly boiled and cooled
300 g 1.5g 0.8g 0.02g 697.68 g
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Method: Dissolve the preservatives in the water with the aid of gentle heat ; melt the cetomacrogol emulsifying ointment on a water – bath , add the solution containing the preservatives at the same temperature , and stir until cold. It must be freshly prepared . (6) CETRIMIDE CREAM
Liquid Paraffin Purified Water , freshly boiled and cooled Cetostearyl Alcohol Cetrimide
500g 445g 50g 5g
Method: Melt the cetostearyl alcohol with the aid of gentle heat, add the liquid paraffin, and warm ; dissolve the cetrimide in the water at the same temperature , and add to the warm mixture , stirring gently until cold.
(7) CHLORHEXIDINE CREAM
Cetomacrogol Emulsifying Wax Liquid Paraffin Chorhexidine Gluconate Solution Purified Water, freshly boiled and cooled to
250 g 100 g 50 ml 1000 g
Method: Melt the cetomacrogol emulsifying wax in the liquid paraffin at 60, and add, with rapid stirring, to the chlorhexidine gluconate solution, previously diluted to 500 ml with the water, at the same temperature. Cool, add sufficient of the water to produce the required weight, and mix.
(8) OILY CREAM (Hydrous Ointment)
Wool alcohol ointment Purified water
50 g 50 g
(9) SALICYLIC ACID AND SULPHUR CREAM
Salicylic acid , finely sifted Precipitated sulphur , finely sifted Aqueous cream
2g 2g 96 g
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(10) ZINC CREAM
Zinc oxide Oleic acid Arachis oil (or any locally available vegetable oil) Wool fat Calcium hydroxide Water to
32 g 0.5 ml 32 g 8g 45 mg 100 g
(11) ZINC AND ICHTHAMMOL CREAM
Ichthammol Cetostearyl Alcohol Wool Fat Zinc Cream sufficient to produce
50 g 30 g 100 g 1000 g
Method: Melt together the Wool Fat and the Cetostearyl Alcohol with the aid of gentle heat, triturate the mixture with 800 g of Zinc Cream until smooth, incorporate the Ichthammol, add sufficient Zinc Cream to produce 1000 g and mix. EAR-DROPS
Ear-drops are solutions or suspensions of medicaments in water , glycerin , diluted alcohol , propylene glycol or other suitable solvent , and are intended for instillation into the ear. Containers. Ear – drops should be dispensed in coloured fluted bottles with a dropper or in suitable plastics containers. Labelling. The container should be labelled (for external use only ).
(1) HYDROGEN PEROXIDE EAR- DROPS
Hydrogen Peroxide Solution Water
25 ml to 100 ml
(2) PHENOL EAR-DROPS
Phenol Glycerin Glycerin
40 ml to 100 ml
Caution. Dilution with water renders phenol Ear – drops caustic; the preparation may be diluted with glycerin, if desired. 13
(3) SODIUM BICARBONATE EAR – DROPS
Sodium Bicarbonate Glycerin Purified Water
5g 30 ml to 100 ml
Method:
Dissolve the sodium bicarbonate in about 60 ml of the water , add the glycerin and sufficient of the water to produce the required volume , and mix. The ear – drops should be recently prepared.
(4) SPIRIT EAR – DROPS
Alcohol (95 per cent) Water
50 ml to 100 ml
In making this preparation the alcohol (95 per cent) may be replaced by Industrial Methylated Spirit, provided that the law and the statutory regulations governing the use of industrial methylated spirit are observed.
LOTIONS Lotions are liquid or semi-liquid preparations containing one or more active ingredients in suitable vehicles. They are intended to be applied to the unbroken skin without friction. Lotions may contain suitable antimicrobial preservatives, unless the active ingredients or vehicles have sufficient intrinsic antibacterial and antifungal activity. They may contain other suitable auxiliary substances such as stabilizers. Storage Lotions should be kept in well-closed containers. Labelling: The label states (1) the names and concentrations of the active ingredients; (2) that the lotion is intended for external use only; (3) that the contents should be shaken before use ; (4) the date after which the Lotion is not intended to be used ; (5) the conditions under which the lotion should be stored. (1) ALUMINIUM ACETATE LOTION
Aluminum acetate solution Purified water to It must be freshly prepared and used undiluted.
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5 ml 100 ml
(2) ALUMINIUM CHLORIDE 10 per cent solution in water. (3 ) BENZYL BENZOATE LOTION
Benzyl benzoate Triethanolamine Oleic acid Purified water
250 ml 5g 20 g 750 ml
Method: Mix the Triethanolamine with the Oleic acid, add the Benzyl benzoate, and mix. Transfer the mixture to a suitable container of about 2000 ml capacity, add 250 ml of purified water, and shake the mixture thoroughly. Finally add the remaining purified water, and again shake thoroughly. (4) CALAMINE COMPOUND LOTION
Prepared calamine Strong solution of lead acetate Glycerin Lime water (0.1 per cent solution)
10 g 1 ml 5 ml 100 ml
(5) CALAMINE AND SULPHUR LOTION
Precipitated sulphur Calamine Lotion
4g 100 g
to
(6) CALAMINE LOTION
Calamine Zinc Oxide Bentonite Sodium Citrate Liquefied Phenol Glycerol Purified Water, freshly boiled and cooled Sufficient to produce
150 g 50 g 30 g 5g 5 ml 50 ml 1000 ml
Method: Triturate the Calamine, the Zinc Oxide and the Bentonite with a solution of the Sodium Citrate in about 700 ml of the Purified Water and add the Liquefied Phenol, the Glycerol and sufficient Purified Water to produce 1000 ml.
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(7) CALAMINE LOTION OILY (Liniment of calamine)
Calamine Wool fat Oleic acid Arachis oil (or any locally Available vegetable oil) Calcium hydroxide solution to
5g 1g 0.5 ml 50 ml 100 ml
(8) CHLORINATED LIME WITH BORIC ACID LOTION (Eusol)
Chlorinated lime Boric acid Purified water to
1.25 g 1.25 g 100 ml
(9) COPPER AND ZINC SULPHATE LOTION
Copper sulphate Zinc sulphate Camphor water
10 g 15 g 1000 ml
to
(10 ) HYDROCORTISONE LOTION
Self-emulsifying Monostearin Hydrocortisone in ultra-fine powder Chlorocresol Glycerin Purified water, freshly boiled and cooled to
40 g 10 g 0.5 g 63 g 1000 g
Method:
Dissolve the Chlorocresol in 850 ml of the water with the aid of gentle heat, add the self-emulsifying monostearin, heat to 60, and stir until completely dispersed. Triturate the hydrocortisone with the glycerin, incorporate , with constant stirring , in the warm basis, allow to cool slowly, stirring until cold, and sufficient of the water to produce the required weight, and mix. Hydrocortisone Lotion may be prepared using any other suitable basis. (11) SALICYLIC ACID LOTION
Salicylic acid Castor oil Alcohol (95 %)
20 g 10 ml 1000 ml
to
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Method:
Dissolve the salicylic acid in a portion of the alcohol , add the castor oil and sufficient of the alcohol to produce the required volume, and mix. (12) SULPHUR COMPOUND LOTION
Precipitated sulphur Alcohol (95 %) Glycerin Quillaia tincture Calcium hydroxide solution
40 g 60 ml 20 ml 5 ml 1000 ml
to
Method:
Disperse the precipitated sulphur in the alcohol and the glycerin previously mixed, add the quillaia tincture and sufficient of the calcium hydroxide solution to produce the required volume, and mix. (13) SCALP LOTION
Resorcinol Salicylic acid Sodium metabisulphite Glycerin Alcohol 50% to
2g 2g 0.01 g 2g 100 ml
NOTE: resorcinol is likely to change the colour of the hair temporarily (14) SODIUM THIOSULPHATE 20 per cent solution in water. (15) TRIAMCINOLONE LOTION
Triamcinolone Lotion is a dispersion of Triamcinolone Acetonide in a suitable lotion basis. (16) ZINC SULPHATE LOTION Formula A
Zinc sulphate Amaranth solution Purified water to Formula B Zinc sulphate Compound tincture of lavender Purified water to
10 g 10 ml 1000 ml 0.5 g 2 ml 100 ml
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(17) WHITE LOTION
Zinc sulphate Talc powder Glycerin Lime water to
25 g 25 g 25 g 100 ml
OINTMENTS
Ointments are semisolid preparations consisting usually of a medicament or mixture of medicaments dissolved or dispersed in a suitable basis which nowadays is often anhydrous. They are used as emollients, as protective preparations on the skin or as a means for the local application of medicaments. Emollient and protective ointments may contain vegetable oils, synthetic esters of fatty acids or wool fat, together with inert bases such as soft paraffin. A mildly antiseptic or astringent powder such as zinc oxide may be added. Suitable preservatives may be including when permitted in the monographs. Oil – in – water emulsifying agents such as Emulsifying Wax, Cetrimide Emulsifying Wax or Cetomacrogol Emulsifying Wax may be incorporated into anhydrous bases in order to render them miscible with exudates and more easily removable from the skin by washing. Water – miscible ointments may be prepared with a basis consisting of a mixture of macrogols. Such preparations are particularly suitable for application to the scalp. The proportions of paraffins, oils, fats and waxes may be varied in ointments intended to be used in tropical or subtropical climates to meet extremes of temperature, but the amounts of active ingredients must in all cases be maintained. Dilution of ointments. For certain specific ointments, when strength of ointment not available from a manufacturer is prescribed, a stronger ointment should be diluted to the required strength with the suggested in the individual monograph. Containers and storage: Ointments should be stored and supplied in containers made of materials which do not allow absorption or diffusion of the contents. In addition, ointments containing water or other volatile ingredients should be stored and supplied in well – closed containers which prevent evaporation. Containers made of certain plastics, particularly polystyrene, are unsuitable for ointments containing methyl salicylate, phthalate esters and similar substances. Ointments should be stored in a cool place. Labeling: When a preservative is included, the label on the container, except one issued on a medical prescription for an individual patient, should state the name and concentration of the preservative present.
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(1)AMMONIATED MERCURY OINTMENT
Ammoniated Mercury Ointment Simple ointment
2.5 g 97.5 g
(2)AMMONIATED MERCURY AND COAL TAR OINTMENT
Yellow Soft Paraffin 950 g Ammoniated Mercury 25 g Strong Coal tar Solution 25 g Method: Triturate the ammoniated mercury with a portion of the yellow soft paraffin until smooth, mix with the remainder of the yellow soft paraffin, and incorporate the strong coal tar solution. (3)AMMONIATED MERCURY, COAL TAR AND SALICYLIC ACID OINTMENT
Ammoniated Mercury and Coal Tar Ointment Salicylic Acid, in fine powder
980 g 20 g
Method: Triturate the salicylic acid with a portion of the ammoniated mercury and coal tar ointment until smooth, and gradually incorporate the remainder Of the ointment. (4) BENZOIC ACID OINTMENT, COMPOUND (Whitfield's Ointment)
Emulsifying ointment Benzoic acid, in fine powder Salicylic Acid, in fine powder
910 g 60 g 30 g
Method: Triturate the benzoic acid and the salicylic acid with a portion of the emulsifying ointment until smooth, and gradually incorporate the remainder of the ointment. (5) CALAMINE OINTMENT
WHITE Soft Paraffin Calamine, finely sifted
850 g 150 g
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Method: Triturate the calamine with a portion of the white soft paraffin until smooth, and gradually incorporate the remainder of the paraffin. (6) CALAMINE AND COAL TAR OINTMENT
White Soft Paraffin Hydrous Wool Fat Calamine ,finely sifted Zinc Oxide, finely sifted Strong Coal tar Solution
475 g 250 g 125 g 125 g 25 g
Method: Melt together the hydrous wool fat and the white soft paraffin, incorporate the calamine, the zinc oxide and the strong coal tar solution ,and stir until cold. (7) CAPSICUM OINTMENT Simple Ointment 935 g Emulsifying Wax 50 g Capsicum Oleoresin 15 g Method: Melt together the simple ointment and the emulsifying wax, incorporate the capsicum oleoresin, and stir until cold. (8)CETOMACROGOL EMULSIFIYIG OINTMENT
White Soft Paraffin Cetomacrogol Emulsifying Wax Liquid Paraffin
500 g 300 g 200 g
Method:
Melt together and stir until cold.
( 9 )CETRIMIDE EMULSIFYING OINTMENT
White Soft Paraffin Cetostearyl Alcohol Liquid Paraffin Cetrimide
500 g 270 g 200 g 30 g
Method : Melt together the White Soft Paraffin, Cetostearyl Alcohol and Liquid Paraffin, add the Cetrimide and stir until cold.
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(10)COAL TAR AND SALICYLIC ACID OINTMENT
Coconut Oil Emulsifying Wax Hard Paraffin Yellow Soft Paraffin Strong Coal Tar Solution Salicylic Acid
500 g 180 g 100 g 100 g 100 g 20 g
Method: Melt together the hard paraffin, the emulsifying wax, the yellow soft paraffin and the coconut oil, and dissolve the salicylic acid in the melted basis. Cool to about 40° , and the strong coal tar solution ,and stir until cold. It should be recently prepared. (11)COAL TAR AND ZINC OINTMENT
Yellow Soft Paraffin Zinc Oxide, finely sifted Strong Coal tar Solution
600 g 300 g 100 g
Method: Mix the zinc oxide with the strong coal tar solution ; triturate with a portion of the yellow soft paraffin until smooth , and gradually incorporate the remainder of the paraffin . (12) EMULSIFYING OINTMENT
Emulsifying wax White Soft Paraffin Liquid Paraffin
300 g 500 g 200 g
Method: Melt together and stir until cold. (13) HYDROUS WOOL FAT OINTMENT
Hydrous Wool Fat Yellow soft Paraffin
500 g 500 g
Method: Melt together and stir until cold. (14) HYDROUS OINTMENT (Oily Cream)
Wool Alcohols ointment Phenoxymethanol
500 g 10 g
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Dried Magnesium Sulphate Purified Water, freshly boiled and cooled
5g 485 g
Method: Dissolve the Phenoxymethanol and the Dried Magnesium Sulphate in the Purified Water with the aid of gentle heat. Melt the Wool Alcohols ointment , add the aqueous solution gradually while still warm , stirring constantly ,mix vigorously until smooth cream is obtained and stir until cold. (15) ICHTHAMMOL OINTMENT Wool Fat Yellow Soft Paraffin Ichthammol
450 g 450 g 100 g
Method: Melt together the wool fat and the yellow soft paraffin, incorporate the ichthammol, and stir until cold. (16) IODINE OINTMENT, NON-STAINING
Iodine Arachis oil Yellow soft Paraffin
50 g 150 ml a sufficient quantity
Method: Shake the iodine with the arachis oil at room temperature until dissolved, and maintain the solution at 50°, with occasional stirring, until the brown colour disappears. Determine the concentration of iodine present in the solution by the method given below ,using about 0.1 g, accurately weighed; to the remainder of the solution add sufficient of the yellow soft paraffin ,previously heated to 40° ,to produce an ointment of the required strength, and mix. (17) IODINE OINTMENT, NON-STAINING, WITH METHYL SALICYLATE
Methyl Salicylate Non- staining Iodine Ointment to
50 ml 1000 g
Method: Melt the non-staining iodine ointment at a low temperature, add the methyl salicylate, and stir until cold. (18) METHYL SALICYLATE OINTMENT Methyl Salicylate 500 g White Beeswax 250 g Hydrous Wool Fat 250 g
22
Method: Melt together the beeswax and the hydrous wool fat, add the methyl salicylate, and stir until cold.
(19) METHYL SALICYLATE OINTMENT ,COMPOUD
Methyl Salicylate White Beeswax Wool Fat Menthol Water Cajuput oil Eucalyptol
500 g 200 g 105 g 100 g 45 g 25 g 25 g
Method: Melt together the beeswax and the wool fat, and add the menthol previously dissolved in the methyl salicylate , the eucalyptol and the cajuput oil. Incorporate the water at the same temperature, and stir until cold. (20) PARAFFIN OINTMENT
White Beeswax Hard Paraffin Cestostearyl alcohol White soft Paraffin
20 g 30 g 50 g 900 g
Method: Mix the ingredients, heat gently with stirring until homogenous and stir until cold. (21) SALICYLIC ACID OINTMENT
Salicylic Acid, finely sifted Wool Alcohols ointment
20 g 980 g
Method: Melt the Wool Alcohols Ointment, gradually add the salicylic Acid and stir until cold. (22) SALICYLIC ACID AND SULPHUR OINTMENT
Oily Cream Salicylic acid, finely sifted Precipitated sulphur, finely sifted
940 g 30 g 30 g
23
Method: Triturate the salicylic acid and the precipitated sulphur with a portion of the oily cream until smooth, and gradually incorporate the remainder of the cream. (23)SIMPLE OINTMENT
Wool Fat 50 g Hard Paraffin 50 g Cetostearyl Alcohol 50 g White Soft Paraffin or Yellow Soft Paraffin 850 g Method: Mix the ingredients, heat gently with stirring until homogenous and stir until cold. (24)SULPHUR OINTMENT
Precipitated sulphur Simple ointment prepared with white Soft paraffin
10 g 90 g
(25) ZINC OINTMENT
Zinc oxide Simple ointment
15 g 85 g
Method: Triturate the Zinc Oxide with a portion of the Simple ointment until smooth, gradually add the remainder of the simple ointment and mix thoroughly. (26)ZINC UNDECENOATE OINTMENT
Zinc undecenoate Emulsifying ointment Undecenoic acid
20 g 75 g 5g
(27)ZINC AND CASTOR OIL OINTMENT ( zinc and castor oil cream) Zinc Oxide, finely sifted 75 g Castor Oil 500 g Cetostearyl Alcohol 20 g White Beeswax 100 g Arachis Oil 305 g
24
Method : Triturate the Zinc Oxide with a portion of the Castor Oil until smooth and add the mixture to the remainder of the ingredients previously melted together. Stir while cooling until the temperature is about 40°. (28)WOOL ALCOHOL OINTMENT
Wool Alcohols 60 g Hard Paraffin 240 g White Soft Paraffin or Yellow Soft Paraffin 100 g Liquid Paraffin 600 g In preparing Wool Alcohols Ointment, the proportions of Hard Paraffin, Soft Paraffin and Liquid Paraffin may be varied to produce Wool Alcohols Ointment having suitable properties. When Wool Alcohols Ointment is used in a white ointment, it should be prepared with White Soft Paraffin; when used in a coloured ointment it should be prepared with Yellow Soft Paraffin. Method : Melt together with the aid of gentle heat and stir until cold.
PAINTS Paints are liquid preparations intended for application to the skin or mucous surfaces. They are usually medicated with substances possessing antiseptic, astringent, caustic or analgesic properties. Resinous substances such as benzoin, prepared storax or tolu balsam in ethereal solution are employed as bases of medicated varnishes. Containers. They should be dispensed in coloured fluted bottles. (1) BRILLIANT GREEN PAINT
Brilliant green Alcohol ( 70 %)
to
1g 100 ml
(2) BRILLIANT GREEN AND CRYSTAL VIOLET PAINT
Brilliant green Crystal violet (gentian violet ) Alcohol (90% ) Water to
0.5 g 0.5 g 50 ml 100 ml
25
Method:
Dissolve the brilliant green and the crystal violet in the alcohol, and add sufficient water to produce the required volume.
(3) GENTIAN VIOLET PAINT Formula A
Gentian Violet Water
5g 1000 ml
to
Formula B
Gentian Violet Water
1g 100 ml
to
(4)ICHTHAMMOL GLYCERIN
Glycerin Ichthammol
900 g 100 g
(5) MAGENTA PAINT (Castellant's paint)
Magenta Phenol Boric acid Acetone Resorcinol Industrial methylated spirit or alcohol (90 %) Water
0.4 g 4g 0.8 g 4 ml 8g 8.5 ml to
100 ml
Method:
Dissolve the magenta in the alcohol and the acetone, previously mixed. Dissolve the boric acid in a portion of water; dissolve the phenol and the resorcinol in this solution , add the alcoholic magenta solution and sufficient water to produce the required volume, and mix. (6)PHENOL GLYCERIN
Glycerin Phenol
840 g 160 g
26
Method:
Dissolve the phenol in the glycerin, with the aid of gentle heat if necessary. (7) TANNIC ACID GLYCERIN
Glycerin Tannic acid
850 g 150 g
Method:
Triturate the tannic acid with the glycerin, and warm gently until solution is effected.
PASTES Pastes are semisolid preparations intended for external application. They usually consist of a high proportion of finely powdered medicaments mixed with soft or liquid paraffin or with a non-greasy basis made with glycerin. mucilage or soap. They are used principally as antiseptic, protective or soothing dressings which are often spread on lint before being applied. Containers and storage: Pastes should be stored and supplied in containers made of materials which do not allow absorption or diffusion of the contents. In addition , pastes containing water or other volatile ingredients should be stored and supplied in well closed containers which prevent evaporation.
(1) COMPOUND ALUMINIUM PASTE(Baltimore paste)
Aluminum Powder Zinc Oxide Liquid Paraffin
200 g 400 g 400 g
Method: Mix the Aluminum Powder and the Zinc Oxide with the Liquid Paraffin until smooth. (2) COAL TAR PASTE
Strong Coal Tar Solution Compound Zinc Paste
75 g 925 g
27
Method: Triturate the Strong Coal Tar Solution with a portion of the Compound Zinc Paste until smooth and gradually incorporate the remainder of the Compound Zinc Paste. (3) COMPOUND ZINC PASTE
Zinc Oxide, finely sifted Starch, finely sifted White Soft Paraffin
250 g 250 g 500 g
Method: Melt the White Soft Paraffin, incorporate the Zinc Oxide and the Starch and stir until cold.
(4) DITHRANOL PASTE
Dithranol Zinc and Salicylic Acid Paste
1 g, or a sufficient quantity
sufficient to produce 1000 g
Method: Mix the Dithranol with a portion of the Zinc and Salicylic Acid Paste until a smooth, even dispersion is obtained and gradually incorporates the remainder of the Zinc and Salicylic Acid Paste. (5) MAGNESIUM SULPHATE PASTE(Morison's paste)
Dried Magnesium Sulphate Phenol Glycerol, previously heated at 120° for 1 hour and cooled
a sufficient quantity 0.5 g 55 g
Method: Dry about 70 g of Dried Magnesium Sulphate at 150° for 1.5 hours or at 130° for 4 hours and allow to cool in a desiccators. Mix 45 g of the dried material in a warm mortar with the Phenol dissolved in the Glycerol.
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(6) ZINC AND COAL TAR PASTE
Emulsifying Wax Coal Tar Zinc Oxide, finely sifted Starch Yellow Soft Paraffin
50 g 60 g 60 g 380 g 450 g
Method: Melt the Emulsifying Wax at 70°, add the Coal Tar and 225 g of the Yellow Soft Paraffin, stir at 70° until completely melted, and add the remainder of the Yellow Soft Paraffin, cool to 30°, add the Zinc Oxide and the Starch, stirring constantly, and stir until cold.
(7) ZINC AND SALICYLIC ACID PASTE
Zinc Oxide, finely sifted Salicylic Acid, finely sifted Starch, finely sifted White Soft Paraffin
240 g 20 g 240 g 500 g
Method: Melt the White Soft Paraffin, incorporate the Zinc Oxide, the Salicylic Acid and the Starch and stir until cold. (8) KAOLIN POULTICE
Heavy Kaolin, finely sifted Boric Acid, finely sifted Methyl Salicylate Thymol Peppermint Oil Glycerol
527 g 45 g 2 ml 500 mg 0.5 ml 425 g
Method:
Mix the Heavy Kaolin, previously dried at 100°, and the Boric Acid with the Glycerol, heat at 120° for 1 hour, stirring occasionally, and allows cooling. Separately, dissolve the Thymol in the Methyl Salicylate, add to the cooled mixture, add the Peppermint Oil and mix thoroughly. The heating step may be omitted if some other satisfactory means of mixing the solid ingredients with the Glycerol is used but in this case Heavy Kaolin that has been sterilized is used.
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SOLUTIONS
Solutions are liquid preparations containing one or more soluble ingredients usually dissolved in water. They are intended for internal or external use or for instillation into body cavities. They are issued sterile or unsterilised, depending on the purpose for which they are intended. Sterile Solutions These include solutions for external application to abraded surfaces, anticoagulant solutions, bladder irrigations, intraperitoneal dialysis solutions, and concentrated solutions for the preparation of injections. Preparation of sterile solutions. The apparatus used in the preparation of sterile solutions and the containers should be thoroughly cleansed before use. The medicament is dissolved in the solvent, and the solution clarified by filtration, transferred to the final co containers, which are then closed, and sterilized by autoclaving or by heating with a bactericide (see Appendix 27 ) . Alternatively, the solution is sterilized by filtration (see Appendix) , and transferred by means of an aseptic technique to the final sterile containers , which are then closed to exclude micro – organisms. Standard Sterility. Sterile solutions comply with the tests for sterility. Containers: Containers should be readily distinguishable from containers used for intravenous fluids and should be closed so as to exclude microorganisms. A readily breakable seal should cover the closure. Labelling: The label on the sealed container states: (1) The name and strength of the solution, (2) The words ( Sterile Solution) and (Not for Injection) and (3) That any portion of the solution not used when the seal is first broken should be discarded. Unsterilised Solutions: These include solutions for internal administration, either alone or as ingredients of other preparations, solutions for external application to non- a braided surfaces, and heamodialysis solutions. Precautions should be taken to minimize any microbial contamination during preparation. (1) BORIC ACID SOLUTION
Dissolve 5 g of boric acid in a mixture of 20 ml of water and 20 ml of absolute ethanol and dilute to 250 ml with absolute ethanol. (2) BENZOIC ACID SOLUTION
Benzoic Acid Propylene Glycol Purified Water, freshly boiled and cooled sufficient to produce
30
50 g 750 ml 1000 ml
Method: Dissolve the Benzoic Acid in the Propylene Glycol and add sufficient Purified Water, in small quantities and with constant stirring, to produce 1000 ml. (3) COAL TAR SOLUTION
Coal Tar Polysorbate 80 Ethanol (96 per cent)
200 g 50 g sufficient to produce 1000 ml
In making Coal Tar Solution, the Ethanol (96 per cent) may be replaced by Industrial Methylated Spirit. Method: Mix the Coal Tar, warmed if necessary to render it fluid, with the Polysorbate 80, pour this mixture in a thin stream into 800 ml of Ethanol (96 per cent) in a closed vessel fitted with an agitator; continue agitation throughout the addition of the mixture and for 1 hour thereafter. Allow the mixture to stand for not less than 24 hours, decant and filter the supernatant liquid, wash the vessel and filter with Ethanol (96 per cent), combine the filtrate and washings and add sufficient Ethanol (96 per cent) to produce 1000 ml. (4) HYDROGEN PEROXIDE TOPICAL SOLUTION USP
Preserve in tight, light – resistant containers at controlled room temperature. Contains, in each 100 ml, not less than 2.5 grams and not more than 3.5 grams of Hydrogen Peroxide. Contains not more than 0.05% of a suitable preservative or preservatives. Meets the requirements for Identification, Acidity, Barium, Heavy metals (not more than 5 ppm) Limit of nonvolatile residue, and Limit of preservative (not more than 0.05%). (5) IODINE TINCTURE USP
Iodine Tincture may be prepared by dissolving 20 grams of iodine and 24 grams of Sodium Iodide in 500 ml of Alcohol and then adding Purified Water to make the product measure 1000 ml. (6) POTASSIUM PERMANGANATE SOLUTION
Potassium permanganate Water
0.1g to 100 ml
31
Method: It must be freshly prepared. The diluted solution contains potassium permanganate about 1/8000 Directions for use, one part to be diluted with seven parts of water or as directed. (7) POTASSIUM PERMANGANATE SOLUTION, STRONG
Potassium permanganate Water
4g to 100 ml
It must be freshly prepared. The diluted solution contains potassium permanganate about 1/2500 Directions for use: 5 ml to be diluted to 600 ml with water or as directed. (8) SODIUM CHLORIDE SOLUTION (Normal Saline)
Sodium Chloride Purified Water
9g to 1000 ml
Method: Dissolve, and filter. (9) STRONG COAL TAR SOLUTION
Coal Tar Polysorbate 80 Ethanol (96 per cent)
400 g 50 g sufficient to produce 1000 ml
In making Strong Coal Tar Solution the Ethanol (96 per cent) may be replaced by Industrial Methylated Spirit1. Method: Mix the Coal Tar, warmed if necessary to render it fluid, with the Polysorbate 80, pour this mixture in a thin stream into 700 ml of Ethanol (96 per cent) in a closed vessel fitted with an agitator; continue agitation throughout the addition of the mixture and for 1 hour thereafter. Allow the mixture to stand for not less than 24 hours, decant and filter the supernatant liquid, wash the vessel and filter with Ethanol (96 per cent), combine the filtrate and washings and add sufficient Ethanol (96 per cent) to produce 1000 ml.
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(10) STRONG IODINE TINCTURE USP
May be prepared by dissolving 50 grams of Potassium Iodide in 50 ml of Purified Water , adding 70 grams of Iodine , and agitating until solution is effected , and then adding Alcohol to make the product measure 1000 ml. (11) TOLU-FLAVOUR SOLUTION
Cinnamic Acid Benzoic Acid Ethyl Cinnamate Vanillin Cinnamon Oil Sucrose Ethanol (96 per cent) Water sufficient to produce
5.0 g 2.5 g 0.3 g 0.1 g 0.02 ml 500 g 350 ml 1000 ml
Method: Dissolve the Sucrose in 320 ml of Water. Add 250 ml of the Ethanol (96 per cent), with mixing. Dissolve the Cinnamic Acid, Benzoic Acid, Ethyl Cinnamate, Vanillin and Cinnamon Oil in the remaining 100 ml of Ethanol (96 per cent), add this solution to the sucrose solution with mixing, dilute to 1000 ml with Water and mix. Allow to stand for a few hours before use.
(12) WEAK IODINE SOLUTION (Iodine Tincture) B.p
Iodine Potassium Iodide Purified water Ethanol (90 per cent) Sufficient to produce
25 g 25 g 25 ml 1000 ml
Method: Dissolve the Potassium Iodide and the iodine in the purified water and add sufficient Ethanol 990 per cent) to produce 1000 ml.
33
References 1. British Pharmacopoeia 1988 volume 1. 2. British Pharmacopoeia 1988 volume 2. 3. British Pharmacopoeia 2000 CD 4. Approved Drug Products and Legal Requirements, 2000, 20 th edition, volume 3. 5. British Pharmaceutical Codex 1968. 6. Sudan National Formular0y 1979.
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Subject Index
ALUMINIUM ACETATE LOTION, 14 ALUMINIUM CHLORIDE, 15 AMMONIATED MERCURY AND COAL TAR OINTMENT, 19 AMMONIATED MERCURY OINTMENT, 19 AMMONIATED MERCURY, COAL TAR AND SALICYLIC ACID OINTMENT, 19 AQUEOUS CREAM, 10 BENZOIC ACID OINTMENT, COMPOUND(Whitfield's Ointment), 19 BENZOIC ACID SOLUTION, 30 BENZYL BENZOATE LOTION, 15 BETAMETHASONE VALERATE CREAM, 10 BORIC ACID SOLUTION, 30 BRILLIANT GREEN AND CRYSTAL VIOLET PAINT, 25 BRILLIANT GREEN PAINT, 25 BUFFERED CREAM, 11 CALAMINE AND COAL TAR OINTMENT, 20 CALAMINE AND SULPHUR LOTION, 15 CALAMINE COMPOUND LOTION, 15 CALAMINE CREAM, AQUEOUS, 11 CALAMINE LOTION OILY, 16 CALAMINE LOTION, 15 CALAMINE OINTMENT, 19 CAPSICUM OINTMENT, 20 CETOMACROGOL CREAM, 11 CETOMACROGOL EMULSIFIYIG OINTMENT, 20 CETRIMIDE CREAM, 12 CETRIMIDE EMULSIFYING OINTMENT, 20 CHLORHEXIDINE CREAM, 12 CHLORINATED LIME WITH BORIC ACID LOTION (Eusol), 16 COAL TAR AND SALICYLIC ACID OINTMENT, 21 COAL TAR AND ZINC OINTMENT, 21 COAL TAR PASTE, 27 COAL TAR SOLUTION, 31 COMPOUND ALUMINIUM PASTE (Baltimore paste), 27 COMPOUND ZINC PASTE, 28 COPPER AND ZINC SULPHATE LOTION, 16 DITHRANOL PASTE, 28 EMULSIFYING OINTMENT, 21 GENTIAN VIOLET PAINT, 26 HYDROCORTISONE LOTION, 16 HYDROGEN PEROXIDE EAR- DROPS, 13 HYDROGEN PEROXIDE TOPICAL SOLUTION USP, 31
35
HYDROUS OINTMENT (Oily Cream), 21 HYDROUS WOOL FAT OINTMENT, 21 ICHTHAMMOL GLYCERIN, 26 ICHTHAMMOL OINTMENT, 22 IODINE OINTMENT, NON-STAINING, 22 IODINE OINTMENT, NON-STAINING,WITH METHYL SALICYLATE, 22 IODINE TINCTURE USP, 31 KAOLIN POULTICE, 29 MAGENTA PAINT, 26 MAGNESIUM SULPHATE PASTE (Morison's paste), 28 METHYL SALICYLATE OINTMENT, 22 METHYL SALICYLATE OINTMENT, COMPOUD, 23 OILY CREAM, 12 PARAFFIN OINTMENT, 23 PHENOL EAR-DROPS, 13 PHENOL GLYCERIN, 26 POTASSIUM PERMANGANATE SOLUTION, 31 POTASSIUM PERMANGANATE SOLUTION, STRONG, 32 SALICYLIC ACID AND SULPHUR CREAM, 12
SALICYLIC ACID AND SULPHUR OINTMENT, 23 SALICYLIC ACID LOTION, 16 SALICYLIC ACID OINTMENT, 23 SCALP LOTION, 17 SIMPLE OINTMENT, 24 SODIUM BICARBONATE EAR – DROPS, 14 SODIUM CHLORIDE SOLUTION (Normal Saline), 32 SODIUM THIOSULPHATE, 17 SPIRIT EAR – DROPS, 14 STRONG COAL TAR SOLUTION, 32 STRONG IODINE TINCTURE USP, 33 SULPHUR COMPOUND LOTION, 17 SULPHUR OINTMENT, 24 TANNIC ACID GLYCERIN, 27 TOLU-FLAVOUR SOLUTION, 33 TRIAMCINOLONE LOTION, 17 WEAK IODINE SOLUTION (Iodine Tincture), 33 WHITE LOTION, 18 WOOL ALCOHOL OINTMENT, 25 ZINC AND CASTOR OIL OINTMENT, 24 ZINC AND COAL TAR PASTE, 29 ZINC AND ICHTHAMMOL CREAM, 13 ZINC AND SALICYLIC ACID PASTE, 29 ZINC CREAM, 13 ZINC OINTMENT, 24 ZINC SULPHATE LOTION, 17 ZINC UNDECENOATE OINTMENT, 24
36
