Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Polymyxin-Gramicidin / Nystatin / Barrier Cream   1:1:1
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    polymyxin b sulfate - gramicidin  10,000 units - 0.25 mg/g  CRM   
    nystatin  100,000 units/g  CRM   
    silicone  20%  CRM   
Recipe Total Quantity:
Final Quantity Desired: g

Directions: 1. Levigate creams together until a uniform mixture is obtained.
2. Transfer to ointment jar and label.

Notes Assign expiry date using USP 795 Guidelines, since no stability data available:
USP 795 guidelines - For Water-Containing Topical/Dermal and Mucosal Liquid Semisolid Formulations - "The BUD is not later than 30 days."

THIS FORMULATION IS NOT BASED ON LITERATURE, but is from unpublished data, historical use or physician/pharmacy experience

Packaging:  Ointment Jar

Auxiliary Labels: For External Use Only
  Store at Room Temperature

Storage/Expiry:Room Temperature: 30 days

Last Date Revised: 27-Jun-19

References:USP 34 NF 29, 2nd Volume 1. Chapter 795: Pharmaceutical compounding Nonsterile preparations. Rockville, MD, USA: United States Pharmacopeial Convention; 2010

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist

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