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Question

Posted on: April 8 2014

Cetomacrogol cream becomes quite liquid when the nystatin is added. What could be a solution?

Triamcinolone acetonide 0.1% Zinc Oxide 10% Chlorhexidine GL 0.5% Nystatin 100 000 E/G Cetomacrogol Cream TMF The cream was originally prescribed with an image base, which is not compatible with the chlorhexidine.

Answer

First some important dates:  

Triamcinolone acetonide   maximum stability at pH   =. 3.4   above pH   = 5.5 rapid degradation.

Nystatin   pKa = 3.62

whether there is an image-based or cetomacrogol cream will not bring drastic improvements to the common main problems:

-interaction ZnO with Nystatin  

-Problem of stability of triamcinolonacetonide  

If we check what happens when spécialité   with the prescribed products, the combination of Triamcinolone-nystatin exists as cream but without ZnO and the combination ZnO with Nystatin is found in a base consisting of petroleum jelly.  

So it seems appropriate to fall back on a water-free basis like e.g. the water-free emulsifying ointment TMF, of which I cannot guarantee that it exhibits enough flexibility to be able to be evenly spread. But a change in the ratio of Vaseline-liquid paraffin can remedy this.  

The added solution Chlorhexidinedigluc.   can be rubbed on the trituration of Triamcinolonacetonide.