Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Diclofenac in PLO Gel   5% *Note Strength*
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    diclofenac sodium, USP    PWD   
    PLO gel (Pluronic Lecithin Organogel)  20%  GEL   
    isopropyl alcohol  70%  TOP SOLN  to wet 
Recipe Total Quantity:
Final Quantity Desired: g

Directions: 1. Weigh diclofenac powder and PLO gel.
2. Dissolve diclofenac powder in alcohol.
3. Gradually add small amounts of PLO gel to diclofenac powder and levigate until completely mixed.
4. Transfer to final container and label.

Notes Diclofenac compounded topical products are Non-Formulary with a Therapeutic Interchange.
Refer to Diclofenac topical gel in AHS Provincial Formulary.

Use gloves and mask when preparing.

THIS FORMULATION IS NOT BASED ON LITERATURE, but is from unpublished data, historical use or physician/pharmacy experience.

Packaging: 100 mL Ointment Jar

Auxiliary Labels: For External Use Only
  Note Strength
  Store at Room Temperature

Storage/Expiry:Room Temperature: 6 months

Last Date Revised: 30-Jan-20

References:Maxima Pharmaceuticals Inc. URL:

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist

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