Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
HSC Mouthwash Solution   .
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    sugar-free Kool-Aid crystals    PKT   
    Water, sterile        
    lidocaine viscous  2%  PO SOLN   
    Kool-Aid solution sugar free    PO SOLN  qs to 
Recipe Total Quantity:
Final Quantity Desired: mL

Directions: 1. Prepare Kool-Aid solution by dissolving one packet (4.5 g) of Kool-Aid powder in 1500 mL of water.
2. Measure required volume of viscous lidocaine in a graduated cylinder and qs with Kool-Aid solution to required total volume.
3. Transfer solution to appropriate size bottles for dispensing and label.


Auxiliary Labels: Store at Room Temperature

Storage/Expiry:Room Temperature: 2 months

Last Date Revised: 29-Mar-17

SickKids Compounding Service [online recipes]. Toronto, ON: The Hospital for Sick Children. c1999 [current date]. Available from:

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist

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