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Dr. Davis, your opinion on my compounded gel for TTS?

Posted by Matt L. on 9/14/01 at 08:19 (060291)

I have been using the following custom compounded gel for the past several months: Ketamine 15%, Gabapentin 6%, Clonidine 0.2%, Amitriptylene 2%, EMLA 7%, Ketaprofen 5%. Does this strike you as appropriate fot tts pain? Anything you would add, increase,or change? I would characterize its effectiveness in my case to be modest at best. Thank you for any input you can offer.

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Ed Davis, DPM on 9/14/01 at 11:39 (060315)

Matt:

Sounds like a good compound, but the percentage of Ketamine is quite high. Okay if you are not getting side effects such as drowsiness. The only change I would consider, provided that you are tolerating the ketamine, is to increase the percentage of Ketoprofen to 20%. That may help but perhaps not in a dramatic way. How often do you apply the compound? Only a certain fixed amount will be absorbed with each application so increasing the frequency of application may also have a beneficial effect.
Ed

Re: Dr. Davis (and others)

elliott on 9/14/01 at 13:38 (060334)

Dr. Davis, how 'bout mine? I've been using something called neuropathy gel, from the same lab as Matt's, on my left foot, which has tingling and nerve irritation. The listed main ingredients are ketoprofen (2%), carbamazepine (2%) and amitriptyline (2%). It does knock down my tingling pain down by around 30-40% for around three or four hours, but is of limited value, since if I don't wear shoes but only sandals or boots, I don't need it at all or only occasionally, and if I do wear shoes, 30-40% off unbearable is still unbearable. The main discomfort is apparently along a more minor nerve branch just under the ankle and a bit more forward; I put the gel on there as well as along the tarsal tunnel incision area. Is it possible that by changing the concentration I would get more relief? BTW, why are the concentrations of the key ingredients in all these topical drugs so wimpy? I mean, if, say, those 2%'s were increased to 20%, might that not give 100% relief (and a high :-))?

To the others, it may help to state your symptoms when asking Dr. Davis about topical formulas. I was given three to try: the neuropathy gel as described above which is meant for tingling; the one Matt has that is meant for shooting pain; and another (ibuprofen 20%, dexamethasone 0.4%, lidocaine 0.5% and ketamine 1%) meant for burning and numbness. Matt's didn't do a thing at all for me, the other may have done a wee little bit for my left foot with mainly some pain and weakness currently but burning and numbness pre-surgery. But the one meant for tingling really does do something for tingling.

Re: oops! mixed up my feet in last paragraph; "left" s/b "right" (nm)

elliott on 9/14/01 at 13:42 (060337)

.

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Matt L on 9/14/01 at 15:12 (060344)

I've been applying about 2x daily although the prescription calls for 3-4x in part due to the expense (insurance so far is balking).

Re: Dr. Davis (and others)

Ed Davis, DPM on 9/16/01 at 03:23 (060550)

Elliott:

I would probably leave the percentage of carbamazepine and amitryptalline alone but I think it is worth a try to up the ketoprofen to 20%. The addition of ketamine 1% could be tried ( I realize that it did not work in the other formula but the other ingredients were not targeted for nerve pain).

Remember that we are talking about the active ingredients but don't forget about the inactive ingredient, the vehicle or carrier that the active ingredients are dissolved in. Vehicles which are more lipid (fat) soluble appear to have better tissue penetration---my preference is pluronic lecithin organogel.
Ed

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Ed Davis, DPM on 9/16/01 at 03:25 (060551)

Matt:

Try to go to 4 times a day just for a few days just to see if it helps. If it does, call up the medical director for your health insurance plan to appeal the coverage issue.
Ed

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Ed Davis, DPM on 9/14/01 at 11:39 (060315)

Matt:

Sounds like a good compound, but the percentage of Ketamine is quite high. Okay if you are not getting side effects such as drowsiness. The only change I would consider, provided that you are tolerating the ketamine, is to increase the percentage of Ketoprofen to 20%. That may help but perhaps not in a dramatic way. How often do you apply the compound? Only a certain fixed amount will be absorbed with each application so increasing the frequency of application may also have a beneficial effect.
Ed

Re: Dr. Davis (and others)

elliott on 9/14/01 at 13:38 (060334)

Dr. Davis, how 'bout mine? I've been using something called neuropathy gel, from the same lab as Matt's, on my left foot, which has tingling and nerve irritation. The listed main ingredients are ketoprofen (2%), carbamazepine (2%) and amitriptyline (2%). It does knock down my tingling pain down by around 30-40% for around three or four hours, but is of limited value, since if I don't wear shoes but only sandals or boots, I don't need it at all or only occasionally, and if I do wear shoes, 30-40% off unbearable is still unbearable. The main discomfort is apparently along a more minor nerve branch just under the ankle and a bit more forward; I put the gel on there as well as along the tarsal tunnel incision area. Is it possible that by changing the concentration I would get more relief? BTW, why are the concentrations of the key ingredients in all these topical drugs so wimpy? I mean, if, say, those 2%'s were increased to 20%, might that not give 100% relief (and a high :-))?

To the others, it may help to state your symptoms when asking Dr. Davis about topical formulas. I was given three to try: the neuropathy gel as described above which is meant for tingling; the one Matt has that is meant for shooting pain; and another (ibuprofen 20%, dexamethasone 0.4%, lidocaine 0.5% and ketamine 1%) meant for burning and numbness. Matt's didn't do a thing at all for me, the other may have done a wee little bit for my left foot with mainly some pain and weakness currently but burning and numbness pre-surgery. But the one meant for tingling really does do something for tingling.

Re: oops! mixed up my feet in last paragraph; "left" s/b "right" (nm)

elliott on 9/14/01 at 13:42 (060337)

.

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Matt L on 9/14/01 at 15:12 (060344)

I've been applying about 2x daily although the prescription calls for 3-4x in part due to the expense (insurance so far is balking).

Re: Dr. Davis (and others)

Ed Davis, DPM on 9/16/01 at 03:23 (060550)

Elliott:

I would probably leave the percentage of carbamazepine and amitryptalline alone but I think it is worth a try to up the ketoprofen to 20%. The addition of ketamine 1% could be tried ( I realize that it did not work in the other formula but the other ingredients were not targeted for nerve pain).

Remember that we are talking about the active ingredients but don't forget about the inactive ingredient, the vehicle or carrier that the active ingredients are dissolved in. Vehicles which are more lipid (fat) soluble appear to have better tissue penetration---my preference is pluronic lecithin organogel.
Ed

Re: Dr. Davis, your opinion on my compounded gel for TTS?

Ed Davis, DPM on 9/16/01 at 03:25 (060551)

Matt:

Try to go to 4 times a day just for a few days just to see if it helps. If it does, call up the medical director for your health insurance plan to appeal the coverage issue.
Ed