Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
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Stevens Pharmacy and Compounding Pharmacy Center
Located in Costa Mesa, Orange County, California
www.stevensrx.com
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
Charles Bonner of Stevens Pharmacy talks about Profound and Profound Lite Dental Gels
Profound Dental gel is an topical anesthetic gel made from a powerful combination of tetracaine, lidocaine, and prilocaine. It actually allows for gingival (gum) recontouring and other soft tissue procedures with little or no need for local anesthesia.
If, after application of Profound Dental Gel, a patient were to be given local anesthesia via injection, the patient would experience no burn or sting. With our many years in the compounding pharmacy business, Profound Dental Gel, you can nearly eliminate the need for lower blocks and achieve instant pulpal (gum) anesthesia without any tongue or cheek numbness.
As a long time established compounding pharmacy, we also compound Profound Light dental gel, which is half the strength and provides good anesthesia for deep cleanings and other work the dental hygienist might do. Please visit our Stevens Compounding Pharmacy video selection and our website for more information about our various compounding pharmacy dental gels.
Stevens Pharmacy and Compounding Pharmacy Center
Located in Costa Mesa in Orange County, California (The OC)
www.stevensrx.com
Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
As a service to our ever growing dentist customer base, we are reprinting an article by Dr. Michael DiTolla called The Return of Dyclone!
The Return of Dyclone!
Michael DiTolla
Dr. Michael DiTolla talks about Stevens compounding Pharmacy custom compounded dental gels
“Every once in awhile a product just seems to disappear from the dental marketplace with little or no warning. Typically, it is difficult to even find information on why the product was discontinued, or if anyone else is making a similar product. I remember after graduating from dental school that I began using a temporary material called Scutan. I loved the handling characteristics of this material, and used it on every temporary. Then, one day, it was unavailable from any dental dealer. Our rep said the material was made from a certain tree, and that the raw material was no longer available. It sounded like a fishy explanation, but the bottom line was the material was gone.
Earlier this year, the long-lasting local anesthetic Marcaine disappeared suddenly. Since Duranest disappeared, Marcaine was essentially the only long-lasting local anesthetic available in carpules for dentistry. The Internet has made it easier to investigate these issues, and – when Kodak changed etidocaine suppliers – new FDA clearances had to be filed and approved before Marcaine could be sold again. Meanwhile, dentists were left without an anesthetic that could provide four to six hours of pulpal anesthesia. Thus, patients had to be reinjected on longer cases.
But the most complaints I have heard from hygienists deal with the disappearance of Dyclone. My hygienists mourned its loss, and I have received inquiries from hygienists around the country about what happened to it. Dyclone was a topical anesthetic in a liquid form that patients could swish with for one minute to anesthetize gingival and palatal tissues. It is fantastic for hygiene patients who need some anesthesia but donāt want local infiltrations or blocks. It also worked well for needle-phobic, sensitive hygiene patients, and for patients who gag during impressions. I searched the FDA database and found that the company decided to stop producing the product for its own reasons. The FDA verified that it had nothing to do with the safety or efficacy of the product.
During a chance conversation with an individual from a local compounding pharmacy, I was shocked to learn that the pharmacy compounded Dyclone, and has been doing so for years! This person said the pharmacy does the compounding for many medical professionals but not dentists. Needless to say, I ordered several bottles of the product. When I gave the bottles to my hygienists, they acted as if they were popping corks on champagne bottles!
The product is available from Stevenās Pharmacy at (800) 352-3784 or (714) 540-8911.The pharmacist I deal with at Stevenās is Charles Bonner. The pharmacy labels the solution Cyclone. It is available in the original strength that my practice once used, 0.5 percent. It also is available in a double-strength 1.0 percent solution called Cyclone DS. My practice has settled on Cyclone DS. We have noticed no difference between the two solutions except that Cyclone DS works better on most patients. Unlike the original Dyclone, which had an unpleasant taste, Cyclone is available in both tangerine and lime. These flavors make the product palatable for more patients.
We use Cyclone DS on patients who are worried about having impressions taken, whether for Invisalign, bleaching trays, or even just study models. We use it on full-arch crown and bridge impressions, as well as on patients who may gag while we try to capture the detail of multiple preps. We even use it prior to taking digital X-rays. On the hygiene side, we use it for periodontal probing for patients with inflammation, as well as gross-debridement patients who have sensitivity. We see many patients who are overdue for hygiene but do not need scaling and root planing. Since we typically only use local anesthetic for root planing patients, Cyclone helps fill the gap since it is an easy-to-use topical that helps to provide peace of mind for the patients.
We offer Cyclone to almost any patient receiving treatment who doesnāt get local anesthesia. My practice does not charge for this service, although there are dentists who have told me that they charge a small fee (typically $5), and that patients are happy to pay the fee. We also donāt charge for local anesthetic, and think that providing Cyclone falls into the same category.”
Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several clinical programs available on DVD through Glidewell. For more information on this article, or to receive a free copy of one of Dr. DiTollaās clinical DVDs, e-mail him at mcditolla@mac.com.
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
Bio-Identical verses Non-Bio-Identical Hormones
As a compounding pharmacy, we frequently hear many types of questions about bio-identical hormones. We hope the following explanation is helpful. For more information, feel free to visit the Stevens Pharmacy website.
Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The term “bio-identical” does not indicate the source of the hormone, but rather refers to the chemical structure. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. Bio-identical hormones are able to follow normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy.
There are significant differences between hormones that are natural to humans (bio-identical) and non-bio-identical (including horse) preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer. A patented drug can be profitable to mass produce, and therefore a drug company can afford to fund research as to the medication’s use and effectiveness. However, bio-identical substances can not be patented, so scientific studies are less numerous on natural hormones, because medical research is usually funded by drug companies. Structural differences that exist between bio-identical human, and non-bio-identical synthetic and animal hormones may be responsible for side effects that are experienced when non-bio-identical hormones are used for replacement therapy.
Bio-identical hormones include estrone (E1), estradiol (E2), estriol (E3), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone. Our compounding specialists work together with patients and prescribers to provide customized bio-identical hormone replacement therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman’s specific needs. Hormone replacement therapy should be initiated carefully after a woman’s medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and medication adjustments are essential.
More information is available here.
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
Blood Sugar & Diabetes Care
As an added service to customers who have been diagnosed with diabetes, or who have symptoms of diabetes but have not yet had their blood sugar levels tested, the pharmacists at Steven’s are able to provide on-site tests designed to monitor glucose levels, which indicates average blood sugar level over the previous 3-4 months (the average life span of a red blood cell). These tests include a glucoprotein test which indicates blood sugar levels for the previous two to three weeks, and the HbA1c, or glycosylated hemaglobin test which indicates the blood sugar range over the previous three-month period. In addition, Steven’s offers Lipid Panels, a test which indicates cholesterol levels for HDL, often referred to as “good cholesterol”, LDL, often referred to as “bad cholesterol”, triglycerides and total cholesterol.
Monitoring of blood sugar levels and cholesterol is essential for diabetes patients, as is nutrition education to assist diabetes patients in controlling the progression of their disease. It is estimated that diabetes occurs in approximately 4.5% of the population in the United States. Monitoring and controlling blood sugar levels is critical to the prevention of complications such as eye disease, hardening of the arteries, kidney disease, nerve damage and foot ulcers. This is true for all diabetics, including Type II diabetics who are not insulin-dependent. In fact, Medicare expanded its coverage (in 1998) for Type II diabetes so that strips and lancets they use with their monitoring glucometers will now be reimbursable.
Glycosylated Hemoglobin [HbAlc]
Indicates blood sugar levels for previous 3 week to tell you where it’s headed.
Body Fat Analysis
Doctors, personal trainers, and nutritionists recommend the periodic measurement of body fat for maintaining proper health status.
Blood Pressure
Blood pressure is the force exerted by circulating blood on the walls of blood vessels and constitutes one of the principal vital signs. Persistent hypertension, or hypertension, is one of the risk factors for strokes, heart attacks, heart failure, arterial aneurysms, and is the leading cause of chronic renal failure. Low blood pressure, or hypotension, may be a sign of severe disease and requires urgent medical attention.
Peak Flow Analysis for Asthmatics
We can measure your peak expiratory flow, a number that tells you how fast you can blow out air after a maximum inhalation. It may be helpful for you and your doctor to use peak flows numbers for your treatment “zones”. Zones will help you decide what to do when you have changes with your asthma.
Lipid Panels Including Cholesterol and High & Low Density Proteins
A lipid panel is a blood test that usually measures 3 kinds of lipids in the blood. The lipids are related to cholesterol, a fatty substance also in the blood. The 3 kinds of lipids measured in a lipid panel are: LDL cholesterol (low-density lipoprotein), HDL cholesterol (high-density lipoprotein), and triglycerides. The lipid panel also measures total cholesterol, which is the sum of all the types of cholesterol in your blood.
Triglycerides
Blood tests for triglycerides are usually part of a lipid profile used to identify the risk of developing heart disease. If you are diabetic, it is especially important to have triglycerides measured as part of any lipid testing since triglycerides increase significantly when blood sugar is out of control.
Low Density Lipoproteins (LDL)
Indicates your “bad” cholestrol.
High Density Lipoproteins (HDL)
Indicates your “good” cholestrol.
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
From Charles T. Bonner, Rph., lead pharmacist and owner of Stevens Pharmacy, your neighborhood compounding pharmacy and compounding pharmacy to the world. “It is an extraordinary thing to see the change in a persons life when a medical condition is properly diagnosed and the correct treatment implemented.” Feel free to contact us at 714.540.8911. Our fax is 714.435.0261
Adrenal Fatigue
The adrenal glands secrete hormones such as cortisol, estrogen, and testosterone that are essential to health and vitality and significantly affect total body function. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women. Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or chronic illness can lead to Adrenal Fatigue, which is an important contributing factor in health conditions ranging from allergies to obesity.
Anti-inflammatory and anti-oxidant adrenal hormones like cortisol help to minimize allergic and negative reactions, such as cancer and autoimmune disorders. These hormones closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, and cardiovascular and gastrointestinal function. Proper adrenal support is essential to complete the hormonal pathway to optimal health, and includes proper nutrition, getting plenty of sleep, regular moderate exercise, stress management, slowing down to regain a proper perspective on life, and replacement of deficient hormones.
Thyroid Hormone for Low Thyroid and Thyroid Problems
Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.
Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). Some hypothyroid patients remain symptomatic (still have symptoms), and T3 may also be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 is synthetic liothyronine sodium in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body. Excess dosages may trigger serious side effects, including heart palpitations. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects.
A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.
For more information about patient-specific Bio-identical Hormone Replacement Therapy, please contact our compounding pharmacist.
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
Compounding is fundamental to the profession of pharmacy and was a standard means of providing prescription medications before drugs began to be produced in mass quantities by pharmaceutical manufacturers.
The demand for professional compounding has increased as healthcare professionals and patients realize that the limited number of strengths and dosage forms that are commercially available do not meet the needs of many patients, and that these patients often have a better response to a customized dosage form that is “just what the doctor ordered”.
Our compounding professionals can prepare:
Unique dosage forms containing the best dose of medication for each individual.
medications in dosage forms that are not commercially available, such as transdermal
gels, troches, “chewies”, and lollipops.
Medications free of problem-causing excipients such as dyes, sugar, lactose, or alcohol.
combinations of various compatible medications into a single dosage form for easier administration and improved compliance.
Medications that are not commercially available.
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Compounding Pharmacy lead pharmacist Charles Bonner of Stevens Pharmacy answers your questions
Our compounding professionals can prepare individualized therapies for a myriad of dermatologic problems. Compounding pharmacists continue to improve both the aesthetic and therapeutic aspects of customized medications, offering alternatives and advantages for dermatology.
We can compound medications into cosmetically appealing creams, topical sprays and powders, as well as create customized oral dosage forms (such as flavored troches or lollipops) and various preparations for other routes of administration.
Compatible drugs can be combined into a single dosage form to simplify a medication administration schedule and improve compliance. USP approved chemicals can be utilized to enhance the absorption of topically applied medications.
We commonly prepare unique formulations that physicians develop to meet specific needs of their patient population, or “tried and true” formulas acquired during medical training.
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Stevens Pharmacy is a premier world class compounding pharmacy nestled in the bedroom community of Costa Mesa, in the heart of the OC or Orange County, California.
We produce custom compounded medications for the special needs of patients and physicians.
Customer satisfaction is our number 1 goal and our medications are used all over the globe.
Our website is here and we welcome your questions and business!
Charles Bonner Lead Pharmacist Stevens Pharmacy
compounding pharmacy videos
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Charles Bonner Lead Pharmacist Stevens Pharmacy
Upon a prescription order, we can compound:
lip balms for viral lesions
topical muscle relaxants/analgesics
topical anesthetics
non-staining antibacterial rinses
oral sedation in lollipops and freezer pops
lollipops for oral thrush
mouth rinses for aphthous ulcers or chemotherapy-induced stomatitis
mouth rinse to stop oral bleeding during dental procedures for patients who take anticoagulants
dry socket preparations
“mucosal bandages” to cover ulcerated, infected, or tender mucosa
lozenges that help to prevent gagging
and many more unique preparations and novel delivery systems.
Medications are manufactured in a limited number of strengths and dosage forms that will satisfy the needs of most patients due to stability concerns, and the cost of stocking and distributing numerous formulations of each drug.
Using pharmaceutical grade chemicals and specialized equipment not found in most pharmacies, we can compound medications in doses and dosage forms that are not commercially available. We want to optimize the care of every patient. Just let us know what you need!
Charles T. Bonner, Rph.
Compounding
What is compounding?
Compounding Problem Solving
Adrenal Fatigue/Thyroid Hormones
Overview
Andropause
Overview
Testosterone
Steven’s Dentistry Compounds
Here are some of our compounded products that are popular for use in the office by dentists and dental hygienists.
Profound Gel and Profound Lite Gel
Profound Gel is an topical anesthetic gel made from a powerful combination of tetracaine, lidocaine, and prilocaine.
It allows for gingival recontouring and other soft tissue procedures with little or no need for local anesthesia. If a patient were to be given local anesthesia via injection, the patient would experience no burn or sting.
With Profound, you can nearly eliminate the need for lower blocks, which are not patient-friendly, and achieve instant pulpal anesthesia without any tongue or cheek numbness. We also compound Profound Light, which is half the strength and provides good anesthesia for deep cleanings and other work the dental hygienist might do but has less risk of sloughing. It is dispensed in 30g and 45g tubes.
Info & Articles PDF (3 MB)
Safety Data PDF (4.6 MB)
Click to access profound_cyclone_order.pdf
Profound Light Applications
” I now use the (Profound) Light exclusively for pre-injection numbing. It is plenty strong to numb tissue prior to a needle puncture. For everything else I use the regular Profound Gel. For example, I use Profound for all palatal anesthesia. Palatal (roof of the mouth) anesthesia hurts like hell!! SO whether I am packing retraction cord, extracting a tooth, or doing laser recontouring of the palatal tissue, its all with (Profound) Regular.”
Profound Gel is a great gel that provides pulpal anesthesia. The gel contains prilocaine, lidocaine and tetracaine (10%/10%/4%) in a loose running mint flavored green gel.
We compound Profound gel in 30g or 45g quantities. The gel should be applied for no longer than 3 minutes to prevent possibility of sloughing- leave on the site for about 2 &1/2 minutes, then rinse thoroughly. We also compound Profound Light which is half the strength and provides good anesthesia for deep cleanings and other work the dental hygienist might do but has less risk of sloughing.
Profound Gel / Profound Light
We ship nationwide via UPS or FedEx
Profpet
Profpet is similar to Profound gel, but contains thickener and 2% phenylephrine to prevent bleeding. It is dispensed in 30g and 45g tubes.
Depblu
Depblu is similar to Profound gel, but contains sweetener, thickener, and 2% phenylephrine to prevent bleeding. It is dispensed in 30g and 45g tubes.
Cyclone
Cyclone is a topical anesthetic in the form of a rinse that patients can swish around for one minute to anesthetize gingival and palatal tissues. It is fantastic for hygiene patients who needs some anesthesia but don’t want local infiltrations or blocks. It also works well for needle-phobic, sensitive hygiene patients, and for patients who gag during impressions. It is dispensed in 480mL and 960mL bottles.
Topical Therapy for Pain and Infection
The options to help patients with oral and perioral pain problems such as neuropathies, burning mouth syndrome, neuromas and neuralgias. Vehicle-carrier agents and bases have been developed that can penetrate the mucosa and cutaneous tissues and transport the active medication to the treatment site. Dentists have been using topical agents with increasing frequency as part of the therapeutic protocol for orofacial painful neuropathy.
Several topical intraoral medications are used in the treatment of oral ulcerations and infections, including antifungals; nonsteroidal anti-inflammatory drugs (NSAIDs); and corticosteroids.
Because of their rapid onset and low side-effect profile, topical medications offer a distinct advantage over systemic administration for orofacial disorders.
Medicated lollipops, lozenges, and adhering powders are ideal for keeping an antibiotic or antifungal in contact with an infected area in the mouth.
Topical AnestheticsāCombinations of your Choice
Update on Burning Mouth Syndrome
Burning mouth syndrome (BMS), also referred to as glossopyrosis or glossodynia (when the burning occurs on the tongue only) is usually described as oral burning pain, sometimes with dysesthetic qualities similar to those present in other neuropathic pain conditions.
Therapy for Temporo-Mandibular Joint Disorder (TMJ)
Transdermal application of NSAIDs such as ketoprofen results in significantly higher tissue levels beneath the site of application than are achieved with oral administration. Additionally, side effects such as gastrointestinal irritation are avoided.
Transdermal Anti-Emetics
Topical application of anti-emetics in a gel formulation provides a rapid onset and offers an effective alternative to oral administration. Oral surgeons have found this formulation to be particularly useful.
Periodontal Therapy
Compounding allows countless active ingredients to be incorporated into customized mouthwashes, gels, troches, etc.
For example, to treat periodontal disease, antibiotics can be formulated as a mouthwash, or added to an oral adhesive paste or a plasticized gel that will maintain the contact between the tissue and medication for a prolonged period of time.
“Miracle Mouthwashes”
Compounding dental mouthwashes or rinses may offer numerous advantages over commercially available dosage forms.
Elixirs, syrups, and suspensions often contain preservatives such as alcohol which can cause reactions or gastrointestinal irritation, or sugar which makes the preparation undesirable for prolonged use in the mouth or for diabetic patients.
A customized preparation without unnecessary excipients – i.e., a sugar-free, dye-free, lactose-free, and preservative-free dosage form – can eliminate concerns of palatability, alcohol content, and dyes which may stain exposed mucosa.
Various preparations are also available to treat burning mouth syndrome and anesthetic/analgesic and antibiotic/anti-infective mouthwashes are commonly requested.
Examples of Compounded Medications
We are dedicated to meeting the unique needs of dental patients, and we welcome your questions and medication problems. Our compounding professionals are problem-solving specialists!
Examples of Customized Medications for Dental Care
Anti-Viral Lip Balms
Ketamine/Ketoprofen/Gabapentin gel
Ketoprofen/Cyclobenzaprine topical gel
Lidocaine/Prilocaine gel in plasticized base
Mucosal Bandages
Oxytetracycline/Hydrocortisone Suspension
Peruvian Balsam/Eugenol
Sucralfate Oral Adhesive Paste
Tranexamic Acid Mouthwash
Triple-Anesthetic gel – benzocaine/lidocaine/tetracaine (“BLT”)
All formulations are customized per prescription to meet the unique needs of each patient. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.
Submitted by Stevens Pharmacy Compounding Pharmacy To The World
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Stevens Pharmacy
1525 Mesa Verde Drive East # 101
Costa Mesa, CA 92626
714.540.8911
Stevens Compounding Pharmacy 