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Compounded ophthalmic-formulations for veterinary patients are used more often than ever before. Prepared in a dedicated cleanroom according to strict regulations for sterile compounds, their ingredients, strength, and dosage form can be individualized to treat the diseased or injured eye. Common ocular-diseases treated with compounded medications include:
Although most compounds used to treat ophthalmic disease in veterinary patients are applied topically, compounded oral medications also are prescribed.
When to Prescribe Compounded Ophthalmic Medications
Veterinary practitioners diagnose and treat numerous ophthalmic conditions. More difficult cases usually are referred to a veterinary ophthalmologist for treatment. Most veterinary ophthalmologists are members of the American College of Veterinary Ophthalmologists or the American Society of Veterinary Ophthalmologists.
Compounded medications are prescribed when:
The most-common dosage forms for topical veterinary ophthalmic medications are solutions, suspensions, ointments, and gels. These dosage-forms are all within the capability of a knowledgeable compounding pharmacist with the appropriate equipment (discussed under Choosing a Compounding Pharmacy). Each dosage-form has unique formulation considerations.
Ophthalmic solutions are one of the most frequently used dosage-forms. Considerations when formulating a solution include solubility of the formula ingredients, clarity, tonicity, buffers, pH, sterility, and appropriate selection of preservatives when indicated. The most-common vehicle for solutions is water; however, there are oil solutions of select chemicals.
Ophthalmic suspensions generally are prescribed for medications that are not water-soluble. They usually are aqueous suspensions of the active ingredient. Particle size and the selection of a suspending agent are important when compounding an ophthalmic suspension. The particles in the suspensions must be small and uniformly suspended after shaking. Additional considerations are pH, sterility, and preservatives.
Ophthalmic ointments and gels are solid dosage-forms using either the more-common white-petrolatum vehicle or the newer aqueous methylcellulose gel. Compounding considerations for gels include ensuring a small, uniform particle size for a non-gritty, non-irritating product. Additionally, sterility and the selection of a preservative, if needed, must be considered.
All dosage-forms then must be packaged in an appropriate container. The packaging of veterinary ophthalmics must be sterile, protect the active drug, and facilitate administration. There are a number of options available including amber glass dropper-bottles or an opaque plastic drop-container to dispense solutions, and suspensions and tubes with ophthalmic applicator tips for ointments and gels.
Due Diligence Considerations
Not every pharmacy has the equipment, qualified staff, or facilities necessary to perform sterile compounding. The veterinarian who prescribes any preparation bears responsibility for the outcome of treatment and must exercise due diligence in selecting a compounding pharmacy. At a minimum, the pharmacy should have a Class 1000 cleanroom with a Class 100 Laminar Air Floor Hood or a Glovebox/Isolator to provide a sterile environment. This equipment should be certified independently biannually. Additional equipment such as sterilization filters, pH meters, micronizers, autoclaves, and ointment mills also are used by the pharmacist to prepare quality pharmaceutical-preparations. Pharmacists should be familiar with veterinary compounding in general and veterinary ophthalmic compounding in particular. Compounding personnel should be trained and validated in aseptic technique according to USP guidelines. Quality-control evaluations that include weight, volume, pH, visual inspection, post-filtration integrity testing, and sterility testing should be performed on all batches of ophthalmic preparations. Documentation should be extensive and allow for the tracing of any dispensed medication back to the formulation worksheet and ingredient lot number. After the above criteria are met, other factors such as turnaround time and quality customer service, membership in professional organizations such as the American College of Veterinary Pharmacists and attendance at veterinary ophthalmology meetings also should be considered when a compounding pharmacy is selected to prepare ophthalmic preparations.
Compounded medications offer an excellent alternative for many ophthalmic patients.
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This content is intended for counseling purposes only. This content is informational/educational and is not intended to treat or diagnose any disease or patient. No claims are made as to the safety or efficacy of mentioned preparations. The compounded medications featured in this content have been prescribed and/or administered by prescribers who work with Wedgewood Pharmacy. You are encouraged to speak with your prescriber as to the appropriate use of any medication. Wedgewood Pharmacy’s compounded veterinary preparations are not intended for use in food and food-producing animals. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them.