Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Akabutu's Mouthwash   .
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    hydrocortisone  10 mg  TAB   
    glycerin  100%  PO SOLN   
    nystatin  100,000 units/mL  SUSP   
    lidocaine HCL, viscous solution  2%     
    sodium chloride  0.9%  INJ  qs to 
Recipe Total Quantity:
Final Quantity Desired: mL

Directions: 1. Triturate the hydrocortisone tablets into a fine powder and levigate with glycerin to form a paste.
2. Add portion of the normal saline, and transfer into appropriate size container.
3. Add viscous lidocaine 2%, nystatin suspension, and QS with remaining normal saline.
4. Shake until mixed well.
5. Transfer to final container and label. Refrigerate final product.

Notes Hydrocortisone USP powder can be used instead of tablets.

Sodium chloride 0.9% for irrigation can be used instead of injection.

Use a glycerin product as close to 100% glycerin as available.

Since no stability data available, assign beyond use date using NAPRA Guidance Document For Pharmacy Compounding Of Non-Sterile Preparations:
For Water Containing Oral Formulations: The BUD is not later than 14 days when stored at controlled cold temperatures.

Per DI Question # 20572, a mouthwash will be considered an oral formulation.

THIS FORMULATION IS NOT BASED ON LITERATURE, but is from unpublished data, historical use, or physician/pharmacy experience.

Packaging:  Amber Plastic Bottle

Auxiliary Labels: Protect From Light
  Refrigerate
  Shake Well

Storage/Expiry:Refrigerator: 14 days

Last Date Revised: 25-Aug-21

References:Dr. Akabutu, UAH; Dr. Yanofsky; Cross Cancer Institute Edmonton Alberta.
  Water-containing oral formulations The BUD is not later than 14 days with storage at controlled cold temperatures.
National Association of Pharmacy Regulatory Authorities (NAPRA). Guidance Document For Pharmacy Compounding Of Non-Sterile Preparations. Ottawa, ON: National Association of Pharmacy Regulatory Authorities (NAPRA); 2018.
Available at: https://napra.ca/sites/default/files/documents/Mdl_Stnds_Pharmacy_Compounding_Nonsterile_Preparations_Guidance_June2018_FINAL.pdf

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist
   6-Dec-2021         


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