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Compounded Drugs of Value in Outpatient Hospice and Palliative Care Practice

Author(s):  McNulty John P, Muller George

Issue:  May/Jun 2014 - Volume 18, Number 3
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Note:  Electronic version includes supplemental material.

Abstract:  A compounded preparation is needed when no commercially manufactured medication is available to adequately address a patient’s medical needs. Among the greatest therapeutic challenges faced by both patients and caregivers is the treatment required by individuals who have a terminal condition. It is difficult to find evidence-based studies on the management of end-of-life situations because each patient’s medical case is unique. In addition, maintaining a controlled environment for such patients is difficult. End-of-life care is multifaceted; it does not lend itself to “cookbook medicine,” and people with a terminal illness are among the most vulnerable patients in need of effective and compassionate care. When those patients suffer in spite of commercially available therapies, the innovation and experience of clinicians and compounding pharmacists can often yield a solution to the most challenging treatment problems. In this article, we discuss some of the most often prescribed compounds used in outpatient hospice and palliative care to treat common conditions (wounds, pain and dyspnea, intractable cough, nausea and vomiting, depression, bladder infections caused by an indwelling catheter, rectal pain). The effectiveness of the preparations we describe is substantiated in the medical literature and by our personal experience, which together encompasses nearly 100 years of clinical practice. The medications described in this report have been shown over time to be effective. Formulations for the preparations presented in this article are provided on the International Journal of Pharmaceutical Compounding website at

Related Keywords: John P. McNulty, MD, FACP, FAAHPH, George Muller, RPh, hospice, palliative care, death and dying, terminal illness, end of life care, compassion, formulations, decubitus ulcers, bedsores, wound care, phenytoin paste, morphine cream, Stanford #5 oral liquid, topical preparations, pain relief, pain control, analgesia, analgesic, chloramphenicol, metronidazole, thrombin, Monsel's solution, ferric subsalicylate, dyspnea, morphine, methadone, levorphanol, oxycodone, hydromorphone, neuropathic pain, ketamine, transdermal absorption, depression, neuropathy, cough, nausea, vomiting, haloperidol, lorazepam, diphenhydramine, metoclopramide, secretions, HABR, indwelling urinary catheter, acetic acid solution, potassium permanganate, bladder infection, dexamethasone, rectal pain, rectal rocket, suppository, ketamine gel


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