Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Dichloroacetic Acid Oral Solution   100 mg/mL
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    dichloroacetic acid, USP    PWD   
    sodium chloride  0.9%  INJ  qs to 
Recipe Total Quantity:
Final Quantity Desired: mL

Directions: 1. In a glass beaker, dissolve powder in required amount of sodium chloride 0.9% solution.
2. Draw up solution into a syringe and filter through 0.22-micron filter into final container.

Notes Prepare in a biological safety cabinet (BSA).

Follow MSDS data sheet for hazardous precautions and handling information.

Packaging:  Amber Glass Bottle

Auxiliary Labels: DO NOT FREEZE

Storage/Expiry:Refrigerator: expires 2 months after manufacturing or 7 days after opening, whichever is sooner

Last Date Revised: 29-Jun-18

References: Verbal communication with Script Pharmacy Calgary, Alberta - Jan 2018

Dichloroacetic acid powder MSDS data sheet.

Personal communication with TCI America, May 13 1999. ACH Drug Information Pharmacy.

The Hospital for Sick Children, Dichloroacetic Acid Sodium Salt 100 mg/mL oral soluton recipe, faxed May 12, 2011 to Alberta Children's Hospital Pharmacy.

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist

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