Here are some common problems that our compounding department regularly address with clients and their physicians. They wanted to share some common problems and some solutions to these issues which are becoming more common. Please feel free to contact the compounding department 781-893-3870 ext.1 for more information. They will be glad to discuss formulations with 
you and your physician.
Erectile dysfunction:
Erectile dysfunction is the difficulty obtaining or keeping an erection long enough for sexual intercourse. Two compounded injectable medications for the treatment of erectile dysfunction include Bi-Mix and Tri-Mix formulation. Bi-Mix consists of papaverine and phentolamine, while Tri-Mix consists of papaverine, phentolamine, and alprostadil. Papaverine and phentolamine causes widening in the vessels of the penis resulting in increased blood flow to the penis which produces an erection. Alprostadil works by relaxing the smooth muscles and arteries of the penis which results in an elongated and rigid penis. Studies have shown that Bi-Mix may be just as effective as and also less painful than alprostadil injection alone. Studies have revealed that more patients had a successful response to Tri-Mix than compared to Bi-Mix, however Tri-Mix may have an increased chance of prolonged erections.
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Pelvic Floor Dysfunction:
Pelvic floor dysfunction is the inability to control a group of muscles in the pelvic area which results in poor bowel and bladder movements. Pelvic floor dysfunction usually results in pain to the pelvic area. Compounded diazepam intra-vaginal suppositories can be useful as muscle relaxants for controlling pain associated with Pelvic floor dysfunction. Diazepam suppository formulations are advantageous over oral diazepam formulations because they can are associated with less body-wide adverse effects such as dizziness and drowsiness since the drug will mainly work locally at the pelvic area. Intra-vaginal diazepam suppositories dosage can range from 5-20mg. In addition, diazepam suppositories can be combined with baclofen (a muscle relaxant), lidocaine (a local anesthetic), or both. Some formulations include diazepam 10mg/ baclofen 10mg and diazepam 10mg/baclofen 10mg /lidocaine 2%mg suppositories.
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Vulvodynia/Vaginal Atrophy:
Vulvodynia is chronic pain around the area of the opening of the vagina that has no identifiable cause which last for more than three months. The vaginal pain is often described as irritating, burning, and stinging. Vaginal atrophy is when the vagina wall becomes thin, dry, and inflamed due to low amounts of estrogen hormones. Intra-vaginal diazepam suppositories can be used as muscle relaxants for controlling the pain associated with vulvodynia. Intra-vaginal diazepam suppositories dosage can range from 5-20mg. In addition studies have shown that amitriptyline 2% cream and amitriptyline 2%/baclofen 2% can also be used to help control the pain associated with vulvodynia. Amitriptyline produce pain suppression effects at low doses. Diazepam suppository and amitriptyline/baclofen cream formulations are advantageous over oral formulations of these medications because they can are associated with less body-wide adverse effects such as dizziness and drowsiness since the drug will mainly work locally at the vagina.
Low doses of hormones such as estradiol, estriol, and hyaluronic acid vaginal creams/gels can be used intra-vaginally or topically to help control the symptoms of irritating, burning, and stinging. Low doses of estrogen hormones will increase increase blood flow locally to the vaginal area and also help thicken it. Studies have shown that hormone-free hyaluronic acid gel is quite effective in controlling symptoms of vaginal dryness and irritation seen in vulvodynia and vaginal atrophy. Hyaluronic acid gel will help heal the tissue around the vaginal wall.
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Please stop in or call the compounding department and one of our compounding pharmacist will be happy to answer your questions. 781-893-3870 ext. 1
