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Question

Posted on: January 8 2016

What do I do with a prescription for a penetrating ointment, which contains ketamine 10%, clonidine 0.3% and diclofenac 5%

Ketamine HCl is available in bulk product, but the purchase price for a 10g jar is €90. The cost price for the patient is very high. The doctor asked whether we could possibly assume Ketalar amp, which is a lot cheaper in cost price. Can this be used in this formulation? I found on the question box KU Leuven the use of D PLO Gel: Is it available in Belgium as a finished product? Can you give me the supplier? Ketalar ampoules contain only 50mg ketamineHCl per ml, and is available in 10ml ampoules. So, in order to reach a concentration of 10%, I will need too much volume, I fear to process this in the cream base. Presumably the only option is to go out of the raw material ketamine HCl which has a cost price of €90. The purchase price of Pentravan cream is €32.46 which in proportion is still best...

Answer

You give me happi a lot of information, which avoids having to write back and forth.  

Let me start by notifying you that the PLO gel as well as its components are no longer supplied by Bassron, which offers in the place Pentravan crème. Both for the ketamine raw material and for the Pentravan cream we have to do with expensive raw materials, of which one does not like to remain with a surplus.  

If we take the starting point that the customer should not be offered too expensive account then there must be the assumption of Ketalar Ampules. The large amount of water, which you obtain after opening the many ampoules, we can use as a water phase for a cream. So I would suggest to the doctor a simple cream, of which an exceptionally penetrating ability is not guaranteed. This is the downside of the medal for the fact that we take into account the cost of the preparation.  

I cannot assure that the one O/W cream base will have a greater penetrating ability as the other and for that reason I would choose a simple composition like image base. In order to favour the absorption of the ketamine, I would partially convert the hydrochloride to the base using a 5% NaHCO3 solution, which we drop into the cream by drops to pH = +/-  6à 6.5.

I hope that the patient can be helped with this proposal, which we must admit is not optimal.