Compounded Cream
 

I read a lot of posts in the past that discussed about compounded cream for the PN. I never had the chance to try it because in most of my readings it seems that it does not help.

I went to my rheumatologist (for the osteoarthritis), she recommended the pain cream. She said it wont hurt me if I try....so I said okay....

I tried it and I think its giving me some relief from burning. Due to the duration and extent of my pain, just a relief even for a couple of days is a big deal. I am so happy for the last 2 days that I cant wait to share my very, very tolerable pain.

I am not sure if it'll work for a longer time but I am enjoying my tolerable pain, FOR NOW. I have not felt this for years. It feels so pleasantly strange without the pain I live with since 2011. I really, really hope that my honeymoon with this cream would last at least even until the holidays. Yay!!!!!!

The compounded pain cream is consist of the following:

Ketamine-5%; Baclofen-2%; Gabapentin-10%; Clonidine-0.2%.

Hi Idiopathic PN
 

Yes, keep spreading good news like that when it happens. I too use that compounded cream and find a measure of relief. So glad to hear that it works a bit for you. ginnie:grouphug:

Hi Rosie
 

No, most medicare part D programs will not cover it. I did two things, wrote to the drug company, got a reduction in price, and the next time my son paid for it. I would use it more if it were covered. ginnie

Theilled you are getting some relief!!!

I use a compounded cream on my face for nerve damage with fairly good success, but it is expensive.

I have neuropathy in my left foot and use OTC Kerasal Neurocream with good results. I've gotten coupons from their website and also wait for my CVS coupons (20% of entire purchase, for ex) and buy two at a time. Only the new Neurocream helps. I put it on twice a day. I'm not trying to exercise yet...that seems to cause flairs. But for every day stuff, I'm getting relief.

Hope to try a little exercise relatively soon. Fingers crossed.

Apparently my insurance covered for the cream as i only received a bill for my co-pay.

The only problem with this cream--- it has very short shelf life. It shows on the label that it is valid only for a month.

Does anyone here using the compounded cream use it beyond the expiry date?

Thank you.

Mary

I think you should call the pharmacy and ask them.

Some drugs are not stable in solution, or mixed with water, or some of the compounding gels.

Gabapentin liquid formulations are always kept in the frig, because they are not stable at room temp for example.

The compounding pharmacies have references specific to the stability of the products they make. So asking them is the best way to get an accurate answer.

The drugs (gabapentin and nortryptiline) have been of little help for the "folded sock" pain which I experience in both feet, in the skin folds directly behind the toes.

I started out with Capsazin (lower dose), out of caution, as some complained of intense burning. I went on to the Neuro Cream just over a week ago, and most of the folded sock pain is well relieved. A couple of days ago, the arches in my feet started feeling on fire, perhaps due to my insoles rubbing against them, but now am spreading the Neuro Cream onto my arches & will see if it helps.

I'm using it 3 times a day, but read where one fellow was able to cut down to once daily. How long have you been using it, and about how long do you think it was before you "got the most" out of it?

Hello Groucho:

Fortunately, that Kerasal Neurocream started working on my foot almost immediately. I would say by the second day, the pain was 90% better.i also use an OTC orthotic in my shoe for that foot. I suspect, my foot neuropathy isn't as bad as what others have described here....but some days have been very rough....one day it was tough to walk. I use it usually twice a day...sometimes only one time. I am glad someone took notice...was shocked that no one else seemed to want to try it. It is working VERY well for me...thank goodness! Few things in my medical world have been this simple...and I pray it keeps up. Also, I have been able to get the cream at a discount almost ecpvery time...as I mentioned above.

I also have been careful to keep my B 12 and D3 levels up.


The pain in my face, was caused after some peculiar dental work. Since, I had no idea what was going on, I went to several dental professionals, who likely only worsened the problem. One even pulled my tooth. The trigeminal nerve is likely involved. The pain was through the roof. I use a compounded cream for this mess...that cream has Gabapentin in it and next time I see the neuro I might talk about reducing the dosage (a trial) as this med concerns me.

Anyway, I hope the Neurocream continues to work for you, including the other areas of your feet that are causing you such terrible pain.

Please post an update.

Hi Vowel Lady,

I took Gabapentin, and every few weeks, I had to up my dose, as the "folded sock" pain would return. By the time I decided I'd turned enough into a zombie, bumping into things, I was at 600mg x 4 daily. I'm more or less limited to 30mg once daily of the Nortriptyline, as anything higher gives me tremors & elevated anxiety. 30mg, however is enough to pretty much control the pins and needles, tingling, cramps, and the like. It too, quit working on the folded sock pain after a short time.

I tried the New Balance Pressure Relief insoles with metatarsal ridge, which helped some, then stopped helping. Everything seems to stop working right after the I tell Neurologist what's helping me. Maybe I should keep my mouth shut. LOL

Anyway, the Neurologist told me this cream was helping a lady & he was passing that info on to me, if I wanted to give it a shot. I wasn't crazy about the inconvenience of putting a cream on, etc., but since it was helping this lady, I'd try it (You would have to live in central NY state to be the lady in question, by the way) I thought I noticed a slight difference after a couple of weeks on the weaker stuff, so was willing to go the expense (I know of the $2 coupon, though, as it's just under $16 for a 2 oz tube at WalMart) So far, it's definitely been worth the hassle. Just hope it doesn't give out like everything else has for me. It's not perfect relief, but I will be reasonably happy if it continues at its present level.

I also have learned of New Balance Shoes on this, and found you can't cheap out when you buy them. They get better & more comfy as the price goes up & am pretty pleased with the $99 retail 959 model.

So, any of you out there wants to try it, its Kerasal Neuro Cream we've been talking about. Just be careful, it's capsicain hot pepper cream & would be painful in the eyes, etc. If you use it and it works for you, there are plenty who'd want to know. Will get back to you on the burning arches, but think they may be starting to clear up already. They say it can take a week to a month to get full results from capsicain.

Question about the compound cream use...
 

I have a rx for a compound cream for my small fiber neuropathy which contains Ketoprofen/Lidocaine/Gabapentin/Amitriptyline. I'm curious how often this can be safely used. The rx says to use one or two times daily, but I get the impression from a brief conversation with the pharmacist and reading a little about it that you can use it pretty liberally. Does anyone know?

The question should be directed to the pharmacist who made it.

The cream itself is a special formulation called "transdermal" meaning it carries the drugs thru the skin easily and into the blood eventually. The amount absorbed will be proportional to the area applied. Usually these topicals are dispensed in small containers.

We used a transdermal gel, to dose our cat with cancer recently. She fought us for any oral administration, so I ground up her dose of prednisolone and mixed it into the transdermal gel I bought from the pharmacy, and we applied it to the tip of her inner ear.
This dose was all absorbed, as she went into remission.

So I would think the drugs in the cream would be well absorbed.

Drugs given orally you know are metabolized by the liver before they get to the rest of the body. This is called first pass. So oral drugs tend to be high in dose to account for the loss in concentration during first pass. When you inhale in the nose, or apply to the skin or under the tongue, there is no first pass, so the dose is much lower. Gabapentin is poorly orally absorbed, in the first place, and NOT metabolized so first pass is not there for it.

Amitriptyline has to be metabolized to an active form (metabolite) to even work and this is done by the liver. The lidocaine would exert most of its effects where applied, and some then into the circulation.

If you have the % of drug content...you can figure some of it out yourself. Say10% of one of the drugs, out of the total weight of the jar... would give the total amount of drug present in the jar. Say, 120 gm jar, 10% ketoprofen...would be 12 grams of it in the whole jar. Divide that by the # of doses used would give the amount of drug in each application. Ketoprofen in topical products, typically is 2.5% in the commercial products. Ketoprofen orally comes in 50, 75, 100, 150, and 200 mg capsules. Amitriptyline is typically 10mg orally to start.

The problem with estimating how much gets into your blood stream of each, really has not been published. I can't find it.
So these creams are made based on trial and error. The ketoprofen and amitriptyline are the most potent drugs in there.
And long term use of ketoprofen and diclofenac (both lipophilic NSAIDs) have shown some liver toxicity over time when applied topically.
This link gives warnings on diclofenac (which is more common in commerically made gels for arthritis relief)...
http://www.rxlist.com/voltaren-gel-d...de-effects.htm

So I don't think you should slather this on... but you can use it in
targeted areas that are small, a bit more often. I'd keep a log as to duration of action and size of the area applied. Any side effects should be logged too. Then when you finish the jar, count the days, and see how much per day you used. Then work back using the % to see how many milligrams you used that day, and then compare it to the oral dose. If it is HIGHER than a daily oral dose, I would be concerned. The ketoprofen and amitriptyline are the most critical and potentially toxic over time compared to the other two ingredients.

For example, the Kirkman cream of magnesium comes with a little scoop that measures 1 gram. They formulate their product commercially to have 100mg of elemental magnesium/scoop. This product originally was made for autistic children, but it illustrates, the problem, and dosing for magnesium. The doctor then decides how many mg of magnesium to apply to the child. It comes in a 4oz jar, or 120grams total. So 1 gram scoop would last 120 days.