Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Diazepam Oral Suspension    1 mg/mL
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    diazepam  10 mg  TAB   
    Ethanol (ethyl alcohol)  100%  SOLN   
    Methylcellulose   1500 mPA-s  PWD   
    Parabens   10%  PO SOLN   
    glycerin  100%  PO SOLN   
    Water, sterile       qs to 
Recipe Total Quantity:
Final Quantity Desired: mL

Directions: 1. In a mortar, crush tablets and triturate to a fine powder.
2. Gradually levigate sequentially with ethanol, methylcellulose powder, parabens and lastly, glycerin.
3. Pour into a graduated cylinder.
4. Rinse mortar and qs to final volume with water.
5. Transfer to final container and label.

Notes See recipe for Parabens 10% oral solution.

Modified from original recipe which employed 95% ethanol (ethyl alcohol).

Ethanol-containing extemporaneous preparations are not recommended to be used in the neonatal or pediatric populations; as this formulation contains 5% ethanol, clinical appropriateness for your patient should be reviewed.

Packaging:  Amber Glass Bottle

Auxiliary Labels: Protect From Light
  Shake Well

Storage/Expiry:Refrigerator: 30 days

Last Date Revised: 20-Oct-20

References:Woods D. Formulation in pharmacy practice. 2nd ed. 2001. Dunedin, New Zealand: HealthCare Otago; Available from
Trissel LA. Trissel’s™ Stability of compounded formulations. 4th ed. Washington, DC: American Pharmacists Association; 2009.

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist

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