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Formulas

Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel

FDA-approved generic
Dose form
Topical Gel
Active ingredients
Amitriptyline Hydrochloride
Clonidine Hydrochloride
Gabapentin

Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel is a semisolid formulation designed for easy and precise application on the skin through a pump mechanism. This gel-like consistency ensures targeted treatment and absorption of active ingredients.

This formulation is used to treat neuropathic pain, fibromyalgia, and localized pain syndromes, providing relief by delivering a combination of medications directly to the affected area.

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For prescribers
Prescription details
RxThis formula
Dose formSee below
Quantity____
SigAs directed by prescriber
Refills____
PharmacyBayview Pharmacy, Warwick RI, NCPDP 4106882
Copy prescription detailsOrder form
Controlled substance: e-prescribe (EPCS) from your EHR. Faxed and phoned prescriptions cannot be accepted for this preparation.
Send it from your EHR, or fax to (401) 284-4506. How to e-prescribe this formula
Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.
To prescribe, you must be a verified prescriber.
To prescribe, you must be in a state where we hold an active out-of-state pharmacy license.
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This medication requires a prescription from your doctor
Ships within 1 to 2 business days after pharmacist verification
HSA and FSA eligible
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Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.

For prescribersSign in for prescription details and order forms.
Compounded preparations are prepared by Bayview pursuant to a prescription for an individual patient. They are not FDA-approved and have not been evaluated by FDA for safety or effectiveness.
Amitriptyline Hydrochloride
Clonidine Hydrochloride
Gabapentin
Topical Gel
Service area

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Bayview fills prescriptions for patients in Connecticut, Florida, Maine, Massachusetts, New Hampshire, New Jersey, Pennsylvania and Rhode Island. New York patients are served on a limited basis while nonresident pharmacy registration is pending.

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Formula Information

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Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel is a compounded medication formulated to provide targeted relief for neuropathic and chronic pain conditions. By combining these three active ingredients into a gel applied directly to the skin, the medication aims to alleviate pain at the source while minimizing systemic side effects associated with oral medications.

Amitriptyline HCl is a tricyclic antidepressant that, when used topically, may help reduce nerve pain by inhibiting the reuptake of neurotransmitters like serotonin and norepinephrine, which are involved in pain signaling pathways. Clonidine HCl, an alpha-2 adrenergic agonist, can decrease pain transmission by reducing the release of norepinephrine, potentially diminishing sympathetic nervous system responses associated with pain. Gabapentin, known for its efficacy in treating neuropathic pain, works by modulating calcium channels on nerve cells, thus reducing neuronal excitability and pain sensations.

The topical gel formulation allows for localized delivery of these medications, enhancing their therapeutic effects on affected areas such as joints, muscles, or specific nerve regions. The semisolid gel is dispensed through a pump mechanism, ensuring precise dosing and easy application. This targeted approach can lead to improved pain control and patient comfort, especially for those who may not tolerate systemic medications well.

Patients experiencing conditions like diabetic peripheral neuropathy, post-herpetic neuralgia, complex regional pain syndrome, or other forms of localized neuropathic pain may benefit from this compounded gel. Applying the medication directly to the painful area can provide relief by addressing multiple pain pathways simultaneously through the combined actions of the active ingredients.

For prescribers, customizing the concentrations of each active ingredient allows for individualized therapy tailored to the patient's specific pain profile and tolerance levels. Monitoring patient response is crucial to optimize treatment outcomes and adjust the formulation as needed. The compounded nature of this medication necessitates collaboration with a compounding pharmacy experienced in preparing such specialized formulations.

Patients should use this medication exactly as prescribed, applying it to clean, intact skin over the affected area. They should wash their hands before and after application and avoid contact with eyes, mouth, or broken skin. Potential side effects may include local skin irritation or systemic effects if absorbed in significant amounts; therefore, any unexpected symptoms should be reported to a healthcare provider promptly.

If you have any questions, reach out to us.

Drug Interactions

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The combination of Amitriptyline HCl, Clonidine HCl, and Gabapentin in a topical gel formulation is designed to provide targeted relief for conditions such as neuropathic pain, chronic pain syndromes, and localized pain disorders. While this formulation offers the advantage of localized application, minimizing systemic exposure, it is important to consider potential drug interactions that may arise from the active ingredients, especially in patients who are concurrently using other medications.

Amitriptyline, a tricyclic antidepressant, can interact with a variety of medications. Systemically, it is known to interact with monoamine oxidase inhibitors (MAOIs), SSRIs, and other antidepressants, potentially leading to serotonin syndrome. Although the topical application reduces systemic absorption, caution is advised when patients are on these medications. Additionally, amitriptyline may enhance the sedative effects of CNS depressants such as alcohol, benzodiazepines, and opioids, which could be a consideration even with topical use if systemic absorption occurs.

Clonidine, an alpha-2 adrenergic agonist, can interact with other antihypertensive agents, potentially leading to additive hypotensive effects. Patients using oral clonidine or other blood pressure medications should be monitored for signs of hypotension, even though the topical application is less likely to cause systemic effects. Clonidine may also interact with tricyclic antidepressants, potentially reducing the antihypertensive effect of clonidine, which is an important consideration for prescribers.

Gabapentin, an anticonvulsant and neuropathic pain agent, has a relatively low interaction profile. However, it can potentiate the effects of other CNS depressants, which may be relevant if the patient is using other medications that cause sedation. While the topical formulation minimizes systemic exposure, prescribers should still be aware of the potential for additive CNS depression.

For patients and prescribers, it is crucial to consider the overall medication regimen, including over-the-counter drugs and supplements, to avoid potential interactions. Patients should be advised to report any unusual symptoms or side effects, such as excessive sedation, dizziness, or changes in blood pressure, to their healthcare provider. Prescribers should evaluate the risk-benefit profile of this topical formulation in the context of the patient's complete medication list and health status.

If you have any questions or need further information regarding this formulation and its potential interactions, please reach out to us at Bayview Pharmacy. Our team of compounding pharmacists is here to assist you with any concerns or inquiries you may have.

How Does it Work

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The Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel is a compounded formulation designed to deliver a synergistic combination of active pharmaceutical ingredients directly to the site of discomfort or pain. This semisolid gel is dispensed through a pump mechanism, ensuring easy and precise application, which enhances patient compliance and allows for targeted treatment. The gel-like consistency facilitates the absorption of the active ingredients through the skin, providing localized relief while minimizing systemic exposure and potential side effects.

Amitriptyline HCl, a tricyclic antidepressant, is included in this formulation for its analgesic properties. When applied topically, amitriptyline can help modulate pain by inhibiting the reuptake of norepinephrine and serotonin, neurotransmitters involved in the pain pathway. This action can lead to an increase in the availability of these neurotransmitters in the synaptic cleft, thereby enhancing their analgesic effects and providing relief from chronic pain conditions.

Clonidine HCl, an alpha-2 adrenergic agonist, contributes to the formulation by reducing sympathetic outflow and decreasing the release of norepinephrine. This action can help alleviate pain by modulating the transmission of pain signals in the central nervous system. Topically applied clonidine can also lead to vasodilation, which may improve blood flow to the affected area, further aiding in pain relief and reducing inflammation.

Gabapentin, an anticonvulsant, is included for its ability to modulate the activity of voltage-gated calcium channels, which play a crucial role in the transmission of pain signals. By inhibiting these channels, gabapentin can reduce the excitability of neurons and decrease the release of excitatory neurotransmitters, thereby providing relief from neuropathic pain. The topical application of gabapentin allows for direct action at the site of pain, enhancing its efficacy while minimizing systemic absorption and associated side effects.

This combination of active ingredients in a topical gel formulation is particularly beneficial for patients suffering from localized neuropathic pain, such as that associated with diabetic neuropathy, post-herpetic neuralgia, or other chronic pain conditions. By delivering the medication directly to the site of pain, this formulation can provide targeted relief, improve patient outcomes, and enhance quality of life.

If you have any questions about this formulation or its use, please reach out to us at Bayview Pharmacy. Our team of knowledgeable compounding pharmacists is here to assist you with any inquiries or concerns you may have.

Other Uses

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The Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel is a versatile formulation that, beyond its primary indications, may offer potential benefits for a variety of other conditions due to its unique combination of active ingredients. Amitriptyline, a tricyclic antidepressant, is known for its analgesic properties, which can be beneficial in managing neuropathic pain conditions. Clonidine, an alpha-2 adrenergic agonist, can help in reducing sympathetic outflow, potentially aiding in conditions characterized by excessive sympathetic activity.

For patients experiencing localized pain due to conditions such as post-herpetic neuralgia, diabetic neuropathy, or fibromyalgia, this topical gel may provide targeted relief by delivering the active ingredients directly to the site of discomfort, minimizing systemic side effects. Additionally, the formulation may be considered for use in managing symptoms of complex regional pain syndrome (CRPS) or other chronic pain syndromes where traditional systemic therapies have proven inadequate or have caused undesirable side effects.

Prescribers might find this formulation beneficial for patients who are unable to tolerate oral medications due to gastrointestinal issues or those who are at risk of drug interactions with systemic medications. The topical application allows for localized treatment, which can be particularly advantageous in patients with comorbidities that limit the use of systemic therapies. Furthermore, the gel's pump mechanism ensures precise dosing, enhancing patient compliance and ease of use.

While the primary use of this formulation is for specific pain-related conditions, its components suggest potential off-label applications that could be explored in clinical practice. As always, it is crucial for prescribers to evaluate the individual needs of their patients and consider the risk-benefit profile of using this compounded formulation for other indications. If you have any questions or need further information, please reach out to us at Bayview Pharmacy.

Frequently Asked Questions

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What is Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel used for?

This topical gel is used for targeted treatment of localized pain and neuropathic conditions. It combines the effects of amitriptyline, clonidine, and gabapentin to help alleviate pain and discomfort when applied to the skin.

How should I apply the topical gel?

The gel should be dispensed through the pump mechanism and applied directly to the affected area of the skin. Use a small amount and gently rub it in until fully absorbed. Follow your healthcare provider's instructions regarding the frequency and amount of application.

Can I use this gel on broken or irritated skin?

No, you should not apply the gel to broken, irritated, or infected skin. It is intended for use on intact skin only. If you have concerns about your skin condition, consult your healthcare provider before use.

Are there any side effects associated with this topical gel?

Some users may experience mild skin irritation, redness, or itching at the application site. If you experience severe reactions or if irritation persists, discontinue use and consult your healthcare provider.

How does the pump mechanism work?

The pump mechanism is designed to dispense a precise amount of gel with each use, ensuring consistent application. Simply press down on the pump to release the gel onto your hand or directly onto the skin.

Can I use this gel with other topical medications?

Before using this gel with other topical medications, consult your healthcare provider to avoid potential interactions or reduced effectiveness. They can provide guidance on how to safely incorporate it into your treatment regimen.

How should I store the topical gel?

Store the gel at room temperature, away from direct sunlight and moisture. Keep it out of reach of children and pets. Ensure the cap is tightly closed after each use to maintain the gel's efficacy.

Is a prescription required for this topical gel?

Yes, this compounded formulation typically requires a prescription from a healthcare provider. It is tailored to individual needs and should be used under medical supervision.

How long does it take to feel the effects of the gel?

The onset of relief can vary depending on the individual and the condition being treated. Some users may experience relief within a few hours, while others may require several applications over a few days to notice significant improvement.

Can I use this gel if I am pregnant or breastfeeding?

If you are pregnant or breastfeeding, consult your healthcare provider before using this gel. They can assess the potential risks and benefits and determine if it is appropriate for your situation.

About this compounded preparation

This formulation is compounded by Bayview Pharmacy on a prescriber's order for an individual patient. It is not an FDA-approved drug product, and the FDA has not evaluated it for safety, effectiveness, or manufacturing quality.

The conditions listed on this page are indications prescribers have ordered this preparation for. They are not FDA-approved indications, and listing them is not a statement that this preparation is effective for them.

A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice — discuss your situation with a licensed healthcare provider.

Formulas and/or material listed are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment. Every patient is unique, and formulas should be adjusted to meet their individual needs.

No compounded medications are reviewed by the FDA for safety or efficacy.
For prescribers

How to e-prescribe this formula

Controlled substance: e-prescribe only (EPCS). Faxed, phoned, and handwritten prescriptions cannot be filled. Rhode Island law (R.I. Gen. Laws § 21-28-3.18) requires Schedule II to V prescriptions to be transmitted electronically.
1

Find Bayview in your EHR's pharmacy directory

Search by NCPDP 4106882, or by name and ZIP: Bayview Pharmacy, Warwick, RI 02886. Select it as the destination pharmacy and save it as a favorite. Click any value to copy it.

NCPDP4106882NPI1750455143Address3844 Post Rd, Warwick, RI 02886Phone(401) 284-4505Fax(401) 284-4506
2

Enter the formula as a compound

Compounded preparations have no NDC, so this formula will not appear in your EHR's drug search. Use your system's compound, non-formulary, or free-text prescription entry and name the preparation exactly as written in step 3. If your EHR forces you to pick a listed drug, pick the closest entry for the active ingredient and put the full formula in the prescription body (the Sig or directions field), not in Notes to Pharmacy.

Compounded preparations have no NDC and will not appear in your drug search. For EPCS to validate, select a drug entry your EHR recognizes as controlled, usually the bulk powder entry for the active ingredient (for example Ketamine (bulk) powder, not a branded product), then put the full formula from step 3 in the prescription body. A free-text entry that does not validate as controlled will be rejected by your EPCS module.

3

Copy the prescription details

RxFormula name
Dose formDose form
Quantity________
SigAs directed by prescriber
Refills____
PharmacyBayview Pharmacy, Warwick RI, NCPDP 4106882
Copy prescription details

Quantity and directions are starting points for this dose form, not treatment recommendations. Dosing remains the prescriber's responsibility.

4

Send it

Transmit from your EHR. For this non-controlled preparation we also accept fax to (401) 284-4506 and phoned orders at (401) 284-4505. Order forms are on the formulation pages and in the prescriber portal.

Transmit with two-factor authentication through your EPCS-enabled EHR. No order form is offered for this preparation; e-prescribing guides for our controlled preparations are on the formulation pages.

Do not use Notes to Pharmacy for the formula. Some EHRs keep that field internal and never transmit it. A prescription that arrives without the formula is delayed while we call your office.

Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA; New York is served on a limited basis while nonresident registration is pending. Compounded preparations are not FDA-approved. A valid prescription is required. Full guide, including steps by EHR: How to e-prescribe to Bayview. Questions about this formula: call (401) 284-4505.

Amitriptyline HCl 2%/Clonidine HCl 0.22%/Gabapentin 6% Topical Gel
Topical Gel
60 g
controlled

Apply topically to affected area(s)

Three times daily