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Doxepin HCl 10%/Ketamine HCl 2%/Pentoxifylline 10%/Tetracaine 8% Transdermal Gel

Find relief with our custom-compounded Doxepin HCl/Ketamine HCl/Pentoxifylline/Tetracaine Transdermal Gel, designed to help manage neuropathic pain and more.
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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.
Doxepin Hydrochloride
Ketamine Hydrochloride
Pentoxifylline Hydrochloride
Tetracaine Hydrochloride
Topical Gel
654e90e1751e9d846dee091e

Formula Information

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Our custom-compounded transdermal gel combines Doxepin HCl, Ketamine HCl, Pentoxifylline, and Tetracaine in a unique formulation designed to address a variety of symptoms and conditions. It may also help alleviate itching associated with certain dermatological conditions. Ketamine HCl, an NMDA receptor antagonist, is included for its potent analgesic effects, especially in chronic pain syndromes that have not responded to conventional treatments. It has been shown to reduce central sensitization, which is a hallmark of neuropathic pain.

Pentoxifylline, a xanthine derivative, is incorporated for its vasodilatory action, which improves blood flow and oxygen delivery to various tissues. This can be beneficial in treating conditions like peripheral artery disease and can aid in the healing of wounds by enhancing microcirculation. Tetracaine, a local anesthetic, provides immediate topical analgesia, numbing the skin and surrounding tissues to provide relief from acute pain or procedural discomfort.

The combination of these four active ingredients in a 10%/2%/10%/8% concentration, respectively, is formulated into a semisolid gel that is dispensed through a pump mechanism. This delivery system allows for easy and precise application, ensuring consistent dosing with each use. The transdermal route of administration ensures that the medication is absorbed directly into the affected area, providing targeted relief with potentially fewer systemic side effects compared to oral medications.

This formulation is particularly suited for patients experiencing localized pain, chronic neuropathic pain, or those requiring improved blood flow to certain areas of the body. It may also be beneficial for individuals who have difficulty swallowing pills or who prefer a non-invasive treatment option. As with any medication, it is important to use this compound under the guidance of a healthcare professional who can tailor the treatment to the individual's specific needs and monitor for efficacy and safety.

If you have any questions about this formulation or how it can be integrated into a treatment plan, please do not hesitate to reach out to us at Bayview Pharmacy. Our team of compounding pharmacists is dedicated to providing personalized care and support to both patients and prescribers.

Drug Interactions

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The transdermal gel formulation containing Doxepin HCl, Ketamine HCl, Pentoxifylline, and Tetracaine is designed for targeted treatment and absorption through the skin. Each of these active ingredients has its own mechanism of action and potential drug interactions that should be considered when prescribing or using this medication.

Doxepin is a tricyclic antidepressant that has antihistaminic and analgesic properties. It is metabolized by the liver enzymes CYP2D6 and CYP2C19. Drugs that inhibit these enzymes, such as fluoxetine and paroxetine, may increase the levels of doxepin and lead to enhanced effects or toxicity. Conversely, inducers of these enzymes, such as rifampin, may decrease doxepin levels and reduce its efficacy. Additionally, because doxepin has CNS depressant effects, it may enhance the sedative effects of other CNS depressants, including alcohol, benzodiazepines, and opioids.

Ketamine is an NMDA receptor antagonist used for its anesthetic and analgesic properties. It is metabolized primarily by CYP3A4, and drugs that inhibit this enzyme, such as ketoconazole, may increase ketamine levels. Similarly, inducers of CYP3A4, such as St. John's Wort, may decrease the effectiveness of ketamine. Ketamine also has CNS depressant effects and may have additive effects with other CNS depressants.

Pentoxifylline is a methylxanthine derivative that improves blood flow and has anti-inflammatory effects. It is metabolized by CYP1A2, and drugs that inhibit this enzyme, such as ciprofloxacin and fluvoxamine, may increase pentoxifylline levels and the risk of adverse effects. Smoking tobacco may induce CYP1A2 and decrease the effectiveness of pentoxifylline. Additionally, pentoxifylline may enhance the effects of antihypertensive agents and anticoagulants, increasing the risk of hypotension and bleeding, respectively.

Tetracaine is a local anesthetic that blocks sodium channels. While systemic interactions are less likely with topical administration, there is still a potential for additive systemic effects if used concomitantly with other local anesthetics or agents that affect cardiac conduction. Caution is advised when using other topical medications that may have similar local anesthetic effects.

When using this transdermal gel, it is important to consider all potential drug interactions with the patient's current medications. The risk of systemic absorption and interactions may be lower with topical administration compared to oral or parenteral routes, but they can still occur, especially with prolonged use or application to large areas of skin. Patients should be advised to inform their healthcare providers of all medications they are taking, including over-the-counter drugs and herbal supplements. Prescribers should monitor for signs of drug interactions and adjust therapy as needed. If you have any questions or concerns about this formulation and its potential interactions, please reach out to us at Bayview Pharmacy for further assistance.

How Does it Work

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The Doxepin HCl 10%/Ketamine HCl 2%/Pentoxifylline 10%/Tetracaine 8% Transdermal Gel is a compounded medication designed to deliver a combination of active ingredients directly through the skin to the affected area. This semisolid formulation is dispensed through a pump mechanism, which allows for easy and precise application. The gel-like consistency ensures that the medication stays in place and facilitates the absorption of the active ingredients into the skin.

Doxepin is a tricyclic antidepressant that also has potent antihistamine and anti-itch properties. When applied topically, Doxepin can help alleviate itching and pain associated with various dermatological conditions. It works by blocking histamine receptors and stabilizing neuronal membranes, which reduces the sensation of itch and discomfort.

Ketamine, a well-known anesthetic, provides analgesic effects when used in a transdermal formulation. It acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, which plays a role in pain modulation. By blocking these receptors, Ketamine can help reduce chronic pain and has been used in the management of neuropathic pain conditions.

Pentoxifylline is a xanthine derivative that improves blood flow and has anti-inflammatory properties. It works by inhibiting phosphodiesterase, leading to an increase in cyclic AMP levels, which results in vasodilation and improved microcirculation. This can be particularly beneficial in treating conditions like stasis dermatitis or other circulatory disorders affecting the skin.

Tetracaine is a local anesthetic that provides temporary relief from pain by blocking sodium channels on neuronal membranes, which prevents the initiation and conduction of nerve impulses. When included in a transdermal gel, Tetracaine can help numb the area of application, providing relief from pain and discomfort.

This unique combination of medications in a transdermal gel form is used to treat a variety of conditions, including chronic pain, neuropathic pain, and skin conditions with an inflammatory or circulatory component. The transdermal route allows for localized treatment, which can reduce systemic side effects and provide targeted relief. It is important for patients and prescribers to understand that this is a specialized medication prepared by compounding pharmacists to meet specific patient needs. If you have any questions or require further information about this formulation and its use in treating specific disease states, please reach out to us at Bayview Pharmacy.

Other Uses

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The compounded transdermal gel combining Doxepin HCl, Ketamine HCl, Pentoxifylline, and Tetracaine is specifically formulated to target certain chronic pain and inflammation states. Beyond the primary indications, this uniquely blended preparation may also have additional uses due to the pharmacological actions of its individual components. Doxepin, an antidepressant with potent antihistamine properties, may provide some relief in pruritic conditions or aid in cases of neuropathic itching. Ketamine, known for its NMDA antagonist effects, may not only be beneficial for pain but could also potentially be used off-label for the management of certain mood disorders when other treatments have failed, although such use would be experimental and involve close psychiatric supervision.

Pentoxifylline, a xanthine derivative known to improve blood flow and reduce viscosity, may be beneficial in peripheral vascular diseases or in conditions requiring improved microcirculation, such as diabetic neuropathy or Raynaud's phenomenon. Tetracaine is a potent local anesthetic that could aid in temporary relief of localized pain such as from minor skin irritations or procedures. This multi-faceted gel is thus potentially beneficial for various pathologies involving pain, inflammation, circulatory disturbances, or skin irritations, although its use should be careful and precise as per the guidelines for compounded medications.

It is important to note that while the compounded transdermal gel may present these additional uses, its application should be strictly according to a physician's prescription, and any off-label use should be approached with caution and under strict medical supervision. Patients interested in exploring these other potential uses for the gel should consult with their healthcare provider. Similarly, prescribers considering this formulation for alternative uses should rely on clinical judgment and available medical literature. Safety, efficacy, and dosage for uses outside of the primary indications are not guaranteed and should be evaluated on a case-by-case basis. If any questions arise regarding the potential for other uses of this transdermal gel formulation, please feel free to reach out to Bayview Pharmacy for more information.

Frequently Asked Questions

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What is this transdermal gel used for?

This compounded transdermal gel is formulated for targeted treatment of various conditions, potentially including neuropathic pain, chronic pain syndromes, and localized inflammation. Each active ingredient serves a unique purpose, contributing to the overall therapeutic effect.

How do I use this transdermal gel?

Apply the gel as prescribed by your healthcare provider. The pump mechanism is designed to deliver a consistent dose each time. Simply press the pump to dispense the medication and gently apply a thin layer of the gel to the affected area of the skin.

What are the active ingredients in this gel?

The gel contains four active ingredients: Doxepin HCl at a 10% concentration, Ketamine HCl at 2%, Pentoxifylline at 10%, and Tetracaine at 8%. Each plays a role in managing pain or inflammation.

Can I use this gel on any part of my body?

You should use this gel only on areas specified by your healthcare provider. Avoid sensitive areas such as eyes, mouth, and mucous membranes unless otherwise directed by your physician.

How often should I apply this medication?

The frequency of application will be determined by your healthcare provider based on your condition and response to treatment. Follow the prescribed regimen and do not apply more often than recommended.

Are there any side effects associated with this transdermal gel?

As with any medication, side effects are possible. Common side effects might include local skin irritation, redness, or itching. If you experience any severe reactions or signs of an allergic reaction, contact your healthcare provider immediately.

What should I do if I miss a dose?

If you miss a dose, apply the gel as soon as you remember. If it is almost time for your next dose, skip the missed dose and proceed with your regular dosing schedule. Do not apply extra gel to make up for a missed dose.

Can I cover the treated area with a bandage?

Do not cover the treated area with a bandage or occlusive dressing unless advised by your healthcare provider, as this may alter the absorption of the medication.

How should I store this transdermal gel?

Store the gel at room temperature, away from heat and direct light. Do not freeze the gel. Keep the container tightly closed. Make sure to keep this medication out of reach of children and pets.

Can I shower or swim after applying the gel?

After applying the gel, it's important to allow it to absorb fully into the skin before getting the treated area wet. Your healthcare provider can give you specific guidance on how long to wait before bathing or swimming.

Is this gel suitable for everyone?

This gel is a prescription medication and may not be suitable for everyone. Certain medical conditions or other medications can interact with the ingredients in this gel. Discuss your medical history with your healthcare provider to ensure it's safe for your use.

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.

Related Formulas

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, NY, NJ, NH, FL, and ME. 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.

Doxepin HCl 10%/Ketamine HCl 2%/Pentoxifylline 10%/Tetracaine 8% Transdermal Gel
Topical Gel
60 g
controlled

Apply topically to affected area(s)