Recommendations for providing basic compounded creams and ointments for Healthcare providers working in non-pharmacy settings.

Compound Creams & Ointments

( — May 16, 2016) — When providing basic compounded creams and ointments is not possible through a pharmacy, front line healthcare providers may be called upon to compound topical preparations directly. 

Here are some basic recommendations and safety guidelines to ensure the patient receives the right dosage concentration and limits the risk of contamination of the product.

1. Creaming

When adding an ointment to a cream, it is important to “cream” the ointment in order to ensure that the items blend together well.  Creaming is completed by repeatedly folding and blending the ointment by itself until it becomes very smooth and pliable.  Ointments may also become “whitish” in color once they are creamed.

2. Cleanliness

Never stick a used spatula into the next jar without thoroughly wiping off the utensil first with a clean dry tissue. If the tools are dirty, wash with hot water and soap and dry thoroughly.

3. Expiry date

The expiry date for a compounded cream or ointment is always the earliest expiry date found on any of the jars used.

4. Referral to a pharmacist

Due to the inherent danger of cross contamination, reduced measurable accuracy, and lack of information regarding stability and/or preservative requirements, it is essential that any chronic compounded prescriptions be written as a prescription and filled by a licensed pharmacist where possible.

5. Tools

Recommended non-sterile product compounding equipment is as follows:

     a)      Spatulas

     b)      Disposable ointment pads or clean, flat washable surface

If a scale is not available for measuring

Collect all the tools required to make the compound:

     1. Disposable ointment pad or other mixing surface and spatula

     2. All necessary ingredients

     3. Kleenex

     4. Clean and empty ointment jar(s)

One solution:

Use ointment jars to select the quantity of each product to be mixed together. CLEAN SPATULA WITH A TISSUE BEFORE USING IT TO SELECT EACH PRODUCT.  This prevents contamination of product from one stock drug to the other.  (Wash spatula if dirty- with hot water and soap- dry thoroughly).

Example:  If a prescription calls for Glaxal base and Vaseline to be mixed on a 1:1 ratio for a total of 50 grams, take two 25gram jars and fill one with Glaxal base, clean the spatula then fill the other  with Vaseline.  Then transfer the contents of each to separate sides of the mixing surface.  DO NOT place one quantity on top of the other because uneven mixing could occur. 

After creaming the Vaseline, take equal parts of each product and mix together, slowly adding more and more from each side as the product gets mixed.  Once the two separate ingredients are completely mixed, mix for one or two minutes more and transfer the whole amount to a 50 gram jar. 

Label as follows:              Glaxal base/Vaseline 1:1 50 gm

Ratio examples are as follows:

1:1 = equal parts of two products i.e. 50g:50g = 100g                                                                 

1:1:1 =equal parts of three products 33g:33g:33g=100g                                                               

1:2 = 1 part to 2 parts ie. 33g:66g = 100g                                                                                   

1:2:1 = ie 25g:50g:25g = 100g

The equation is as follows:

Add up the total numbers in the ratio i.e. 1:1:1 = 3 or 1:2:1 = 4 then divide into the total quantity i.e.(125grams)  to determine the amount of each part:

Example 1.     If the total quantity requested is 125g at a ratio of 1:1:1 then we would divide 125 by 3 = 41.7g :41.7:41.7(always round up).

Example 2.    If the total quantity requested is 125g at a ratio of 1:2:1 then we would divide 125 by 4 and double the middle quantity = 31.3:62.6:31.3

6. Clean up

Clean the utensils with tissue and remove the top page of the ointment pad and discard or if using a reusable surface wash with hot soapy water.  Store compounding tools in a cupboard until next use to avoid any risk of contamination from other activities using the same area.