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Formulas

Clonidine HCl 2.2 mg/mL/Gabapentin 60 mg/mL/Ketamine HCl 115 mg/mL/Lidocaine 20 mg/mL Topical Gel

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

This compounded topical gel combines Clonidine HCl, Gabapentin, Ketamine HCl, and Lidocaine to provide targeted relief for neuropathic pain and musculoskeletal pain. The semisolid formulation is dispensed through a pump mechanism, ensuring easy and precise application on the skin. The gel-like consistency allows for effective absorption of active ingredients, offering a convenient treatment option for patients suffering from these conditions.

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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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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.

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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.
Clonidine Hydrochloride
Gabapentin
Ketamine Hydrochloride
Lidocaine Hydrochloride
Topical Gel

Formula Information

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This topical gel formulation combines Clonidine HCl 2.2 mg/mL, Gabapentin 60 mg/mL, Ketamine HCl 115 mg/mL, and Lidocaine 20 mg/mL to offer a comprehensive approach to pain management, particularly for neuropathic pain conditions. Dispensed through a convenient pump mechanism, it allows for easy and precise application directly onto the skin, ensuring targeted treatment and optimal absorption of the active ingredients.

Clonidine HCl functions as an alpha-2 adrenergic agonist, which helps modulate pain by inhibiting the release of norepinephrine and reducing sympathetic nerve activity. This action can alleviate hyperalgesia and neuropathic pain symptoms by dampening overactive pain signals in the nervous system.

Gabapentin is a gamma-aminobutyric acid (GABA) analog that effectively manages neuropathic pain by binding to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system. This binding reduces the release of excitatory neurotransmitters, thereby diminishing pain signal transmission.

Ketamine HCl acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. By blocking NMDA receptors, ketamine interrupts the pain wind-up phenomenon and central sensitization often associated with chronic pain conditions. This can result in significant pain relief, especially in cases where other treatments have failed.

Lidocaine is a well-known local anesthetic that provides immediate topical analgesia. It works by blocking sodium channels in neuronal cell membranes, preventing the initiation and conduction of nerve impulses. This results in temporary numbness in the treated area, offering prompt relief from pain.

The combination of these active ingredients in a gel base allows for localized delivery of medications with minimal systemic absorption. This targeted approach not only enhances the efficacy of pain relief but also reduces the risk of systemic side effects commonly associated with oral medications.

This formulation is particularly useful in treating conditions such as diabetic neuropathy, post-herpetic neuralgia, complex regional pain syndrome (CRPS), and other chronic neuropathic pain syndromes. By addressing multiple pain pathways simultaneously, it provides a multi-modal analgesic effect that can improve patient outcomes.

For prescribers, this compounded topical gel offers a customizable treatment option for patients who may not respond adequately to standard therapies or who experience intolerable side effects from systemic medications. The pump mechanism ensures accurate dosing and ease of use, which can enhance patient compliance.

Patients using this topical gel should apply it exactly as prescribed, typically to clean, intact skin over the affected area. It is important to avoid applying the gel to broken or irritated skin. After application, hands should be washed thoroughly to prevent unintentional absorption or contact with mucous membranes.

As with any medication, there may be potential side effects, including skin irritation at the application site or systemic effects if absorbed in large quantities. Patients should be advised to report any adverse reactions to their healthcare provider promptly.

If you have any questions about this topical gel formulation or its suitability for your condition, please reach out to us.

Drug Interactions

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This compounded topical gel formulation contains Clonidine HCl, Gabapentin, Ketamine HCl, and Lidocaine, each of which has its own potential for drug interactions. It is crucial for both patients and prescribers to be aware of these interactions to ensure safe and appropriate use of the medication.

Clonidine HCl, an alpha-2 adrenergic agonist, can interact with other medications that affect blood pressure. Concurrent use with antihypertensive drugs, such as beta-blockers or calcium channel blockers, may result in additive hypotensive effects, potentially leading to dizziness or fainting. Additionally, Clonidine may enhance the CNS depressive effects of alcohol, sedatives, and other CNS depressants, increasing the risk of sedation and respiratory depression.

Gabapentin, an anticonvulsant, can interact with antacids containing aluminum or magnesium, which may reduce its absorption and efficacy. It is advisable to separate the administration of gabapentin and antacids by at least two hours. Gabapentin may also potentiate the effects of other CNS depressants, such as opioids, benzodiazepines, and alcohol, leading to increased sedation and risk of respiratory depression.

Ketamine HCl, an NMDA receptor antagonist, is known for its dissociative anesthetic properties. It can interact with other CNS depressants, including alcohol, benzodiazepines, and opioids, potentially leading to enhanced sedative effects and respiratory depression. Ketamine may also interact with medications that affect the cytochrome P450 enzyme system, such as CYP3A4 inhibitors or inducers, which can alter its metabolism and effects.

Lidocaine, a local anesthetic, can interact with other antiarrhythmic drugs, such as amiodarone or mexiletine, potentially leading to additive cardiac effects, including bradycardia or heart block. Caution is advised when used with other medications that affect cardiac conduction. Additionally, lidocaine may enhance the effects of other local anesthetics or medications that cause methemoglobinemia, such as nitrates or sulfonamides.

Given the potential for interactions, it is essential for prescribers to review the patient's current medication regimen, including over-the-counter drugs and supplements, before prescribing this topical gel. Patients should be advised to inform their healthcare provider of all medications they are taking and to report any unusual symptoms or side effects promptly. If you have any questions or concerns about drug interactions with this formulation, please reach out to us for further assistance.

How Does it Work

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This compounded topical gel formulation combines Clonidine HCl, Gabapentin, Ketamine HCl, and Lidocaine to provide a multifaceted approach to pain management. Each active ingredient plays a distinct role in alleviating pain, and their synergistic effects can offer significant relief for patients suffering from various pain-related conditions. The semisolid gel is dispensed through a pump mechanism, ensuring precise dosing and easy application directly to the affected area, which enhances the targeted treatment and absorption of the active ingredients.

Clonidine HCl is an alpha-2 adrenergic agonist that works by decreasing the release of norepinephrine, which in turn reduces the transmission of pain signals in the nervous system. By modulating the sympathetic nervous system, Clonidine can help alleviate neuropathic pain and improve overall pain control. Its inclusion in the gel allows for localized action, minimizing systemic side effects often associated with oral administration.

Gabapentin is an anticonvulsant that is commonly used to treat neuropathic pain. It works by inhibiting voltage-gated calcium channels, which reduces the release of excitatory neurotransmitters and dampens the pain signaling pathways. When applied topically, Gabapentin can provide direct relief to the affected area, offering an alternative for patients who may not tolerate oral Gabapentin due to side effects or who require additional localized pain control.

Ketamine HCl is an NMDA receptor antagonist that provides analgesic effects by blocking the transmission of pain signals in the central nervous system. The topical application of Ketamine allows for targeted pain relief with reduced risk of systemic side effects, making it a valuable component of this formulation.

Lidocaine is a local anesthetic that works by blocking sodium channels, thereby preventing the initiation and conduction of nerve impulses. This results in a numbing effect on the skin and underlying tissues, providing immediate relief from pain. The inclusion of Lidocaine in the gel formulation ensures rapid onset of action, which can be particularly beneficial for acute pain episodes or breakthrough pain.

The gel-like consistency of this formulation allows for easy application and absorption through the skin, providing a non-invasive option for pain management. The pump mechanism ensures that patients receive a consistent and accurate dose with each application, enhancing the safety and efficacy of the treatment. This formulation is particularly useful for patients who require localized pain relief and may not be suitable candidates for systemic medications due to contraindications or side effects.

For prescribers, this compounded gel offers a customizable approach to pain management, allowing for adjustments in the concentration of each active ingredient based on the patient's specific needs and response to treatment. It is important to consider the patient's overall medical condition, potential drug interactions, and previous response to pain medications when prescribing this formulation.

If you have any questions or need further information about this formulation, please reach out to us at Bayview Pharmacy. Our team of compounding pharmacists is here to assist you with any inquiries or concerns you may have regarding the use of this topical gel for pain management.

Other Uses

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The Clonidine HCl 2.2 mg/mL/Gabapentin 60 mg/mL/Ketamine HCl 115 mg/mL/Lidocaine 20 mg/mL Topical Gel is a versatile formulation that, beyond its primary indications, may offer potential benefits for a variety of other conditions. This compounded gel, with its unique combination of active ingredients, is primarily used for pain management, particularly in neuropathic pain conditions. However, its components suggest potential utility in other therapeutic areas. Clonidine, an alpha-2 adrenergic agonist, may aid in reducing symptoms of hyperhidrosis (excessive sweating) when applied topically, as it can modulate sympathetic nervous system activity. Gabapentin, known for its anticonvulsant properties, might be beneficial in alleviating symptoms of restless leg syndrome or certain types of chronic itch, given its ability to modulate nerve activity. Ketamine, an NMDA receptor antagonist, has been explored for its rapid-acting antidepressant effects, and while systemic use is more common, topical application could potentially provide localized relief for depressive symptoms associated with chronic pain conditions. Lidocaine, a local anesthetic, is often used to relieve itching, burning, and pain from skin inflammations, and its inclusion in this gel could extend its use to conditions like post-herpetic neuralgia or localized pain from minor injuries.

For prescribers considering this formulation, it is important to evaluate the potential off-label uses based on the individual patient's condition and response to treatment. The synergistic effects of these active ingredients may offer a multifaceted approach to symptom management, particularly in patients who have not responded adequately to conventional therapies. Patients should be informed about the potential benefits and risks associated with the use of this compounded gel for conditions beyond its primary indications. As with any compounded medication, the efficacy and safety profile may vary, and close monitoring is recommended to ensure optimal outcomes. If you have any questions or need further information about this formulation, please reach out to us at Bayview Pharmacy. We are here to assist both patients and healthcare providers in making informed decisions about their treatment options.

Frequently Asked Questions

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What is the purpose of this compounded topical gel formulation?

This compounded topical gel is designed for targeted treatment or absorption of active ingredients through the skin. It combines Clonidine HCl, Gabapentin, Ketamine HCl, and Lidocaine to potentially address pain and discomfort in a localized area.

How should I apply the gel?

The gel should be dispensed through the pump mechanism and applied directly to the affected area of the skin. Ensure the area is clean and dry before application for optimal absorption.

How often can I use this topical gel?

The frequency of application should be determined by your healthcare provider based on your specific condition and needs. Follow their instructions carefully to avoid overuse.

Can I use this gel on broken or irritated skin?

It is generally advised not to apply the gel on broken or irritated skin unless directed by a healthcare professional, as it may cause further irritation or adverse effects.

What should I do if I experience side effects?

If you experience any side effects, such as skin irritation, redness, or an allergic reaction, discontinue use immediately and consult your healthcare provider for further guidance.

Is this topical gel safe for use in children?

Consult a healthcare provider before using it on children.

How should I store the gel?

Store the gel at room temperature, away from direct sunlight and moisture. Keep it out of reach of children and pets to prevent accidental ingestion or misuse.

Can I use this gel with other medications?

Before using this gel with other medications, consult your healthcare provider to avoid potential interactions. They can provide guidance based on your current medication regimen.

What should I do if I miss a dose?

If you miss a dose, apply it as soon as you remember. If it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not double the dose to catch up.

How long does it take for the gel to work?

The onset of action can vary depending on the individual and the condition being treated. Some users may experience relief shortly after application, while others may require consistent use over time. Consult your healthcare provider for more information on what to expect.

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.

This preparation is a controlled substance. Additional prescribing, refill, and shipping restrictions apply, and the states Bayview can dispense it to are narrower than for non-controlled preparations.

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.

Clonidine HCl 2.2 mg/mL/Gabapentin 60 mg/mL/Ketamine HCl 115 mg/mL/Lidocaine 20 mg/mL Topical Gel
Topical Gel
60 g
controlled

Apply topically to affected area(s)