BackgroundThe term chondrosarcoma is used to describe a heterogeneous group of tumours which have in common the production of a cartilaginous matrix, which represent 20% of malignant primary bone tumours. The most common, grade 1 chondrosarcoma (CS1), is a slow growing tumour considered refractory to radiotherapy and chemotherapy for which treatment is based on surgery. Adjuvant treatment with phenol after curettage may be effective in preventing local tumour recurrence.PurposeThe objective was to develop an adequate phenol formulation to be used in the operating room after curettage and evaluate its safety and effectiveness in a report of one case.Material and methodsSurgeons asked our pharmacy department to prepare an 85% phenol formulation. We made a bibliographic research on excipients potentially suitable on Martindale, Micromedex and Pubmed and finally ethanol was chosen because phenol solubility in ethanol is very high and it would not crystalise. Traumatology surgeons used the phenol formulation after curettage in 3 patients. Its effectiveness was assessed measuring the time until tumour recurrence based on imaging and analytical parameters.ResultsAll of the process was developed in a horizontal laminar flow cabinet and we started heating crystalised pure phenol (ACOFARMA) in a circulator at 60°C until it melted, which took about 1 hour. Next, using a 20 mL Luer-Lock syringe, we took 17 mL of liquefied phenol and added it to 3 mL of absolute ethanol (Farmacia Carreras) at 60°C, and invert the syringe several times until they mixed. Then, we filtered the solution using a 0.22 µm sterilising filter to a new syringe, fitted a plug and packed it into a photoresist bag, with 7 days of stability at 25°C.Phenolisation after curettage was practiced in 1 patient, a 34-year-old man with a free survival until image progression of 20 months.ConclusionThis formulation of phenol 85% in ethanol appears to be a well tolerated adjuvant treatment after curettage in chondrosarcoma surgery. Further studies are needed to discern where to use it, and to assess its efficacy.References and/or acknowledgementsQuint U, Vanhöfer U, Harstrick A, Müller RT. Cytotoxicity of phenol to musculoskeletal tumours. J Bone Joint Surg [Br]1996;78-B:984–5.No conflict of interest

BackgroundPsychiatric patients are generally thought of as having low rates of treatment adherence. Simplification of treatment regimen often improves compliance.PurposeTo report a case of major depressive disorder in maintenance treatment with imipramine during a shortage of imipramine tablets.Material and methodsWe report the case of an 82-year-old woman diagnosed with major depressive disorder with psychotic features since 2005. Current treatment: imipramine 150 mg/day, quetiapine 150 mg/day, clonazepam drops (0–5–10), valproic acid 200 mg/day, trazodone 100 mg/day, lorazepam 2 mg/day, candesartan/hydrochlorothiazide 32/12.5 mg/day, atorvastatin 20 mg/day.In October 2013, the supplier of imipramine 50 mg tablets announced a shortage of the drug. Our national Drug Agency began to import tablets of Imipramine chlorhydrate 10 mg. Our patient was told to take 15 tablets a day.Two months later the psychiatrist observed that the patient was suffering delusions again. The principal caregiver informed them that her mother had abandoned treatment 2 weeks ago because of the number of tablets.The psychiatrist contacted the Pharmacy Service to evaluate another alternative. We suggested compounding an oral solution of imipramine 25 mg/ml to simplify the treatment regimen (6 ml/day).MaterialsImipramine chlorhydrate: 2.5 g; sodium methylparaben 99%: 100 mg; simple syrup: 30 ml; saccharin solution: 0.5 ml; orange oil: 0.05 ml; distilled water (DW) q.s 100 ml; Method of preparation: Dissolve the methylparaben with 70 ml of DW. Add the imipramine and mix well. Incorporate the saccharin and orange oil. Mix. Add the simple syrup and DW to final volume.ResultsTen days later, we measured plasma levels of imipramine to check the adherence. Results: Imipramine: 72 ng/ml, desipramine: 31 ng/ml, imipramine + desipramine: 103 ng/ml; (Therapeutic range: 150–250 ng/ml).At the next consultation, 50 days later, the psychiatrist observed a significant clinical improvement in our patient.ConclusionDrug shortages are an increasing problem that is forcing both physicians and pharmacists to seek therapeutic alternatives. Pharmaceutical compounding can be a valuable option when changes of drug or dosage form are not desirable.References and/or AcknowledgementsNo conflict of interest.