Our Insights

Executive summary

Compounded medications continue to play an important role in patient care when FDA-approved products are unavailable, contraindicated, or insufficient for individualized needs. Yet variability in quality, oversight, and pricing creates risk for both patients and physicians. In 2025, digital prescribing platforms offer new opportunities for safer, compliant, and transparent access to compounded therapies.

1) What counts as compounding in 2025?

Compounding is defined as the preparation of a medication to meet the unique needs of a patient that cannot be met with an FDA-approved drug. This occurs under two main pathways: 503A traditional compounding pharmacies, which produce patient-specific prescriptions, and 503B outsourcing facilities, which compound in bulk under cGMP standards.

2) Why physicians prescribe compounded drugs

• Patient-specific formulations: Alternative strengths, routes (e.g., rectal suppositories for GI indications), or dosage forms.
• Allergy avoidance: Removal of excipients, dyes, or allergens.
• Therapy gaps: When FDA-approved options are unavailable or discontinued.
• Shortage mitigation: Temporarily filling access gaps.

3) Compliance & liability considerations

Physicians should prescribe only through accredited, reputable pharmacies. PCAB accreditation signals adherence to USP standards. Documentation of medical necessity is recommended, and physicians should avoid writing for compounded versions of drugs with readily available FDA-approved alternatives unless justified.

4) Cost transparency & patient trust

Pricing for compounded medications is notoriously opaque and varies widely by pharmacy. Digital platforms that show comparative pricing at the point of prescribing reduce sticker shock, increase adherence, and enhance patient trust. eNavvi, for example, integrates a compounding network that allows physicians to compare cash prices across PCAB-accredited pharmacies before finalizing the prescription.

5) Case examples

• Dermatology: Customized topical creams (multi-agent formulations not commercially available).
• GI: Rectal mesalamine suppositories for IBD patients intolerant to commercial formulations.
• HRT: Bioidentical hormone replacement, where individualized dosing is required.

6) Streamlined prescribing workflow

Search and select compounded therapy (formulation, dosage form).

Compare accredited pharmacies and cash pricing.

Document indication and rationale (especially when FDA alternatives exist).

Route digitally to the pharmacy, minimizing fax/phone steps.

Track and follow up for adherence, AE reporting, and adjustments.

Key takeaways

• Compounded medications remain clinically essential in select scenarios but pose compliance and liability risks.
• Accreditation and documentation are key to mitigating risk.
• Transparent digital prescribing tools improve trust, adherence, and outcomes.

Unwanted facial hair can be more than a cosmetic nuisance—it can affect confidence, daily routines, and quality of life. Eflornithine HCl 13.9% cream, available for fast digital prescribing through eNavvi, offers a clinically proven, prescription‑strength way to slow hair growth and extend the smooth interval between hair‑removal sessions.

What Is Eflornithine HCl 13.9% Cream?

Eflornithine is a topical medication formulated at 13.9% strength. Unlike depilatories that dissolve hair shafts or lasers that target follicles with heat, eflornithine works inside the follicle to reduce the rate and coarseness of new hair growth—making it an ideal adjunct to shaving, waxing, threading, or laser therapy.

Fast Facts

Attribute

Details

Active ingredient: Eflornithine hydrochloride monohydrate 13.9%

Presentation: 30‑gram tube (≈ 30‑day supply)

Price: $55

Shipping: 2‑day shipping via eNavvi partner pharmacy

Frequency: Apply twice daily, at least 8 hours apart

Onset of benefit: Visible slowing of growth in 4‑8 weeks (max 6 months)

FDA status: Prescription‑only (Rx)

How Does Eflornithine Work?

Mechanism of Action

Hair shafts grow when follicles produce the structural protein keratin, a process that relies on polyamines—small molecules synthesized by the enzyme ornithine decarboxylase (ODC). Topical eflornithine is a selective, irreversible ODC inhibitor:

Blocks polyamine synthesis inside the hair bulb.

Slows keratin assembly and cell division in the follicle matrix.

Extends the anagen (growth) phase, reducing the speed and thickness of emerging hair.

The result is finer, slower‑growing hair that requires less frequent removal. Because eflornithine does not destroy follicles, growth gradually returns to baseline about eight weeks after discontinuation.

Who Benefits Most?

Ideal Candidates

Women bothered by unwanted facial or submental hair (e.g., hirsutism, PCOS)

Patients seeking a non‑laser option for darker skin phototypes

Those using laser/IPL who want to extend treatment intervals

People experiencing irritation from frequent waxing or depilatories

eNavvi Tip: Dermatologists and primary‑care providers can digitally prescribe eflornithine in seconds, and patients receive it at their doorstep within two business days—no in‑person pharmacy trip required.

When Not to Use Eflornithine

• Known hypersensitivity to eflornithine or cream excipients
• Broken, inflamed, or infected skin in the application area
• Children (< 12 years): safety not established
• Pregnancy: Category C—use only if anticipated benefits outweigh potential fetal risk
• Breastfeeding: Insufficient data; exercise caution and avoid application near the nipple area

Always discuss systemic conditions (e.g., severe acne, dermatitis), concurrent topical treatments (retinoids, benzoyl peroxide), and hair‑removal methods with your prescriber.

Dosage & Application Guide

Prep the skin: Remove hair by your usual method (shave, wax, etc.) and wait ≥ 5 min.

Clean & dry: Gently cleanse, pat dry.

Apply a thin film: Use pea‑sized dabs to cover only affected areas (avoid eyes, mouth, mucous membranes). Rub in until absorbed.

Frequency: 2× daily, morning & evening, at least 8 h apart.

Post‑application care: Avoid washing, swimming, or sweating heavily for 4 h after application.

Cosmetics: Makeup or sunscreen may be applied after the cream dries (~ 5 min).

If no clinical improvement is observed after 6 months, reassess therapy.

Expected Timeline

• Weeks 0‑4: Subtle reduction in stubble feel; less five‑o‑clock shadow.
• Weeks 4‑8: Noticeable slowdown in regrowth; hairs appear finer.
• Months 3‑6: Peak effect; many users can shave/wax half as often.
• > 6 months: Continue maintenance if satisfied; discontinue if inadequate response.

Stopping treatment leads to gradual return to baseline hair density within ~ 8 weeks.

Possible Side Effects

Most reactions are mild and limited to the skin surface:

• Transient burning or stinging at application site
• Redness, dryness, or itching
• Acneiform eruptions or folliculitis
• Tingling or rash
• Contact dermatitis (rare)

Management tips: Use a gentle cleanser, avoid alcohol‑based toners, and apply non‑comedogenic moisturizer if needed. Discontinue and consult a clinician if severe irritation or allergic rash develops.

Systemic absorption is < 1%, so systemic side effects are exceedingly rare.

Best‑Practice Tips for Clinicians

• Combine eflornithine with laser or IPL for synergistic results—slowing regrowth lets energy‑based treatments target fewer, slower‑cycling follicles.
• Consider hormonal evaluation (androgen levels, PCOS work‑up) for women with rapid, coarse facial hair.
• Document baseline photography; objective visuals help motivate adherence and gauge progress.
• Remind patients that consistency is key—twice‑daily use is required for optimal suppression.

eNavvi Makes Prescribing Effortless

With eNavvi, you can:

Select Eflornithine HCl 13.9% cream

E‑sign the prescription in < 30 seconds.

Ship—our partner pharmacy delivers the 30‑g tube for $55 (2‑day shipping included).

Patients receive automated refill reminders, and you can track adherence and outcomes in your eNavvi dashboard—streamlining follow‑up care.

Key Takeaways

• Topical eflornithine slows hair growth by inhibiting the ODC enzyme inside follicles.
• Twice‑daily application delivers visible results in 4‑8 weeks; reassess at 6 months.
• Common side effects are mild and local; systemic exposure is minimal.
• Ideal for women with unwanted facial hair and a complement to laser or traditional hair‑removal methods.
• eNavvi enables seamless prescribing and quick shipping, improving treatment initiation and adherence.

Ready to offer your patients a science‑backed solution for smoother skin? Log in to eNavvi, select Eflornithine HCl 13.9% cream, and make unwanted hair one less worry.

Disclaimer

This blog post is for informational purposes only and does not constitute medical advice. Patients should consult a licensed healthcare professional to determine whether eflornithine is appropriate for their individual needs.

In the realm of dermatology and pain management, chronic pruritus remains a challenging symptom, often refractory to standard therapies and significantly impacting patient quality of life. For physicians seeking innovative, patient-specific interventions, compounded topical formulations offer a tailored approach. The amitriptyline HCl/lidocaine HCl/pramoxine HCl 5/5/1% cream represents a multimodal compounded agent designed for localized itch relief, particularly in neuropathic or mixed-etiology pruritus. Available through eNavvi's ePrescribing platform at $35 for a 30-gram tube (30-day supply) with 2-day shipping, this formulation combines sodium channel blockade, local anesthesia, and sensory nerve modulation to address the itch-scratch cycle effectively.

This article explores the pharmacology, evidence-based efficacy, prescribing considerations, and integration into clinical practice for this compounded cream, optimizing for searches related to "compounded topical pruritus treatment," "neuropathic itch management," and "amitriptyline lidocaine pramoxine cream."

Pharmacodynamics and Mechanism of Action

The synergistic components of this cream target peripheral neural pathways implicated in pruritus pathogenesis:

• Amitriptyline HCl (5%): As a tricyclic antidepressant, amitriptyline inhibits voltage-gated sodium channels in peripheral nerves, reducing ectopic firing associated with neuropathic itch. Topical application minimizes systemic anticholinergic effects while providing analgesia comparable to local anesthetics. It is particularly efficacious in conditions involving nerve hypersensitivity, such as postherpetic neuralgia or brachioradial pruritus.
• Lidocaine HCl (5%): A amide local anesthetic that stabilizes neuronal membranes by blocking sodium influx, thereby interrupting itch and pain signal transmission. Its rapid onset (within minutes) makes it ideal for acute symptom control in inflammatory or uremic pruritus.
• Pramoxine HCl (1%): A non-amide anesthetic that desensitizes sensory nerve endings, offering antipruritic effects without the risk of amide cross-reactivity. Clinical data support its use in uremic and elderly pruritus, where it reduces itch intensity more effectively than vehicle controls.

This combination parallels ketamine-amitriptyline-lidocaine (KAL) formulations, which have demonstrated efficacy in chronic pruritus through retrospective analyses, with response rates of 50-70% in refractory cases. By substituting pramoxine for ketamine, this variant may reduce potential irritancy while maintaining multimodal blockade.

Clinical Indications and Evidence

Indicated for chronic pruritus of neuropathic, uremic, or idiopathic origin, this cream is suitable for conditions such as:

• Brachioradial pruritus or prurigo nodularis, where nerve modulation is key.
• Atopic dermatitis flares or psoriasis-associated itch, augmenting anti-inflammatory regimens.
• Cancer-related or CKD-associated pruritus, as adjunctive therapy.

Retrospective studies on analogous compounded topicals (e.g., KAL) report significant itch reduction in 60% of patients with minimal adverse events, primarily transient erythema. Pramoxine-inclusive formulations have shown superior efficacy in hemodialysis patients, underscoring its role in uremic pruritus. While large-scale RCTs are limited for this exact combination, mechanistic overlap with validated agents supports its use in treatment-resistant cases.

Prescribing Guidelines and Safety Profile

Prescribe as a thin layer applied 2-4 times daily to intact skin, avoiding occlusion to prevent enhanced absorption. The 30-gram tube supports a 30-day course for localized areas.

Adverse Effects: Primarily local (e.g., transient stinging in 10-20% of users); systemic risks (e.g., sedation from amitriptyline) are rare with topical use but warrant monitoring in elderly or renally impaired patients.

Contraindications: Hypersensitivity to components; caution with concurrent antiarrhythmics or MAOIs due to potential interactions.

Monitoring: Assess response at 2 weeks; discontinue if irritation persists.

eNavvi facilitates seamless prescribing with real-time pricing transparency ($35/30g, 2-day shipping) and integration with networks like Mark Cuban Cost Plus Drug Company. As a physician-founded platform, it streamlines compounded medication orders, reducing administrative burden.

Integrating into Practice: A Cost-Effective Option

For physicians managing refractory pruritus, this cream offers a low-cost, accessible alternative to systemic therapies, aligning with guidelines emphasizing topical-first approaches. Leverage eNavvi for efficient ePrescribing and patient education on adherence.

In summary, amitriptyline HCl/lidocaine HCl/pramoxine HCl 5/5/1% cream provides a compelling option for pruritus management, backed by mechanistic rationale and supportive evidence from similar formulations. Explore prescribing via eNavvi to enhance patient outcomes.

Disclaimer: This content is for educational purposes and not a substitute for clinical judgment. Consult primary literature and patient-specific factors before prescribing.

Scars are not one-size-fits-all. From hypertrophic nodularity to post-inflammatory hyperpigmentation (PIH) and atrophic collagen loss, their presentations—and responses—vary. While over-the-counter silicone gels help some patients, many require targeted formulations to address pigmentation, erythema, and remodeling more precisely.

Compounded scar treatments from eNavvi offer:

• Precision ingredients adjusted to patient phenotype, Fitzpatrick type, and healing stage
• Silicone-plus vehicles (Pracasil® Plus) to enhance absorption while maintaining a moist, occlusive environment
• Streamlined application through single-tube, multitarget formulations that improve adherence

All preparations are fulfilled by Foothills Professional Pharmacy, PCAB-accredited and licensed in all 50 states, with 2-day nationwide shipping and flat transparent pricing: $55 for a 30g, 30-day supply.

Key Compounded Scar Therapies Available on eNavvi

1. Hydroquinone 6% in Pracasil® Plus Base

This high-potency skin-lightening agent remains the gold standard for post-inflammatory hyperpigmentation. Compounded in a silicone-based gel, it provides dual-action benefit: hydroquinone reduces melanin synthesis via tyrosinase inhibition, while Pracasil® Plus softens and flattens scar tissue.

Clinical Use: Best for mature, pigmented scars—especially in Fitzpatrick III–VI skin after acne surgery, trauma, or lasers.

Prescribing Note: Apply a thin layer twice daily for up to 12 weeks; always pair with SPF 50+.

Caution: Contraindicated in pregnancy and breastfeeding. Limit continuous use to under 6 months to reduce risk of ochronosis.

2. Niacinamide 2% + Tretinoin 0.1% in Pracasil® Plus

This multitarget formula combines anti-inflammatory, barrier-restoring, and collagen-remodeling effects, making it ideal for early hypertrophic or mixed-type scars. Niacinamide reduces cytokine activity and transepidermal water loss, while tretinoin upregulates collagenase activity to encourage smoother remodeling.

Clinical Use: Begin 2 weeks post-procedure once epithelialized. Excellent for early surgical, ablative, or traumatic scars.

Prescribing Note: Apply a pea-sized amount nightly for 12–16 weeks. Titrate to every other night for sensitive skin.

Caution: Mild irritation and photosensitivity are expected—ensure patients use broad-spectrum sun protection.

3. Niacinamide 2% in Pracasil® Plus (Mono‑Active)

A minimalist yet effective option for sensitive skin or post-procedural cases unable to tolerate retinoids or hydroquinone. This formulation strengthens the skin barrier, reduces mast-cell-mediated inflammation, and soothes reactivity—making it suitable for both adult and pediatric patients.

Clinical Use: Ideal for postsurgical scars in pregnancy, pediatric dermatology, or rosacea-prone skin.

Prescribing Note: Apply twice daily for a minimum of 8 weeks. Often used as maintenance after more intensive therapies.

Caution: Safe across all skin types and life stages. No known contraindications.

How to Prescribe Scar Compounds via eNavvi

eNavvi’s workflow is designed for clinical speed and patient clarity:

Log in to your eNavvi account and select “Compounded eRx," then "Scar"

Choose your formulation—default SIG, volume, and quantity are preloaded.

E-sign the order and counsel your patient on application schedule and photoprotection.

Track healing via 4-week photographic intervals and adjust formulation or frequency as needed.

Clinical Data Snapshot

• Pracasil® Plus base (silicone + pracaxi oil) achieved >38% improvement on the Vancouver Scar Scale in a 12-week prospective series.
• Hydroquinone 6% improves PIH by 60–70% within 8–12 weeks in skin-of-color studies.
• Tretinoin 0.1% promotes 21% increase in dermal collagen fiber organization after 6 months (histologically confirmed).
• Niacinamide 2% improves barrier strength and reduces inflammation within 6 weeks in split-scar studies.

Key Takeaways for Dermatology Practices

• Compounded scar gels allow personalized, phenotype-specific interventions across scar types and skin tones.
• The Pracasil® Plus base enhances bioavailability while reducing irritation and occlusion-induced maceration.
• All formulas are affordably priced at $55 and ship nationwide within 48 hours—supporting timely care across geographies.
• This model supports high-acuity procedures, enhances adherence, and integrates seamlessly into post-op protocols.

Understanding Primary Focal Hyperhidrosis

Primary focal hyperhidrosis is a chronic condition affecting approximately 5% of the population, characterized by excessive sweating of the axillae, palms, soles, or face—often beginning in adolescence. The condition results from overactive sympathetic stimulation of eccrine sweat glands, independent of thermoregulatory need.

Before initiating treatment, it’s essential to rule out secondary causes like hyperthyroidism, infections, diabetes, or medication side effects.

First-Line Treatments: Where OTC Antiperspirants Fall Short

Clinical guidelines from the American Academy of Family Physicians (AAFP) and the International Hyperhidrosis Society recommend topical aluminum chloride hexahydrate (15–20%) as a first-line option. This agent works by mechanically obstructing sweat ducts.

However, up to 20% of users experience irritant contact dermatitis, and many with moderate-to-severe hyperhidrosis find it ineffective long-term.

When to Consider Compounded Topical Anticholinergics

For patients who do not respond to or cannot tolerate aluminum salts alone, topical anticholinergic therapy becomes a logical next step. These agents block muscarinic receptors in the skin, reducing sweat production without the systemic side effects of oral anticholinergics.

While commercial products like glycopyrronium wipes are FDA-approved, they are expensive and often limited to single-use formats. Compounded formulations offer:

• Customizable concentrations
• Larger volumes for broader or off-label application
• Lower cost and faster access

How eNavvi’s Compounded Solutions Work

Pharmacy solutions on eNavvi offer two compounded formulations for primary focal hyperhidrosis, prepared by Foothills Professional Pharmacy:

Aluminum Chloride 25% + Glycopyrrolate 0.5% Solution

• Ideal for mild-to-moderate axillary hyperhidrosis
• Dual mechanism: physical ductal blockage and cholinergic inhibition
• Nightly use x2 weeks, then PRN

Glycopyrrolate 1% Spray

• Best suited for moderate-to-severe or multi-site sweating
• Convenient once-daily spray format
• Particularly useful for craniofacial, palmar, or truncal application

These solutions use quick-evaporating, low-residue vehicles that enhance skin penetration and limit messiness—important for daily adherence.

Evidence Supporting Topical Anticholinergics

• 20% aluminum chloride has shown >80% efficacy in reducing axillary sweat levels in randomized trials.
• 1% glycopyrronium cream, in a 518-patient phase 3b study, demonstrated long-term efficacy and QoL improvements over 72 weeks.
• Smaller studies have confirmed that 1–2% glycopyrrolate solutions or sprays are effective for axillary and facial sweating, offering comparable benefits to botulinum toxin with fewer side effects.
• Anticholinergic-related adverse effects are rare, with <5% discontinuation due to mild erythema or dry mouth.

How to Prescribe Through eNavvi

Choose your formula:

• For mild axillary cases: start with Aluminum Chloride 25% + Glycopyrrolate 0.5% at bedtime.
• For multi-site or persistent cases: go with Glycopyrrolate 1% spray once daily.

Send an e-prescription to Foothills Professional Pharmacy – Mail Service

Counsel patients on correct usage:

• Apply to dry skin at night, wash off after 6–8 hours
• Avoid mucous membranes and occlusion
• Use caution in patients with glaucoma, BPH, or myasthenia gravis

Monitor response using the Hyperhidrosis Disease Severity Scale (HDSS) and escalate to systemic or procedural options only if needed.

Key Takeaways

• Topical therapy is the safest first-line option for primary focal hyperhidrosis.
• Combining aluminum chloride with glycopyrrolate provides dual-action efficacy with limited irritation.
• eNavvi’s pharmacy partners offer compounded therapies that costs <$1.50/day
• Evidence supports these concentrations as effective, safe alternatives to systemic medications or invasive interventions.

Early intervention with topical solutions can delay or prevent the need for oral agents, botulinum toxin, or surgical procedures.

Snapshot of the 2024 AAD Update

The newest American Academy of Dermatology (AAD) guideline reiterates three directives physicians already know—but now frames them as strong recommendations:

• Always pair topical or oral antibiotics with benzoyl peroxide to blunt resistance.
• Lean on fixed-dose combinations (antibiotic ± BPO ± retinoid) to simplify regimens and boost adherence.
• Reserve oral antibiotics to ≤4 months and surround them with topical retinoids or BPO for long-term control.

Benzoyl peroxide remains resistance-free after decades of use, yet works best when coupled to either a topical antibiotic or a retinoid.

Meanwhile, European data presented at EADV 2024 elevated spironolactone’s status: in a 133-patient RCT, low-dose spironolactone outperformed doxycycline at months 4 and 6 for adult female acne, with superior quality-of-life scores.

Which eNavvi Compounds Map to Those Rules?

Below are the turnkey formulas available through Foothills Professional Pharmacy (licensed in all 50 states, two-day shipping). Each 30 g cream is $35 for a 30-day supply, and oral generics start at $6.

1. Day-time Antimicrobial Powerhouse

Benzoyl Peroxide 10 % / Clindamycin 2 % Cream

• What it covers: Oxidative killing of C. acnes plus ribosomal inhibition.
• When to choose it: Moderate inflammatory papules where you still want a separate retinoid at night.

2. Night-time Duals That Check Every Box

Clindamycin 2 % / Tretinoin (0.025 %, 0.05 %, 0.1 %) Creams

• Combines antimicrobial cover with comedolysis and epidermal remodeling.
• Three tretinoin strengths let you titrate irritation vs efficacy

3. Barrier-Friendly Retinoid Hybrids

Tretinoin (0.025–0.1 %) / Niacinamide 2 % Creams

• Niacinamide calms retinoid-induced erythema and restores ceramide synthesis within four weeks.
• Ideal for reactive or rosacea-prone skin where plain tretinoin is a hard sell.

4. Multifactorial Blend for PIH-Prone Skin

Tretinoin / Niacinamide 2 % / Azelaic Acid 8 % / Sodium Hyaluronate 0.25 %

• Adds tyrosinase inhibition and further anti-inflammatory action while hyaluronate cushions barrier disruption.
• Reach for this in Fitzpatrick IV–VI, especially if post-inflammatory hyperpigmentation shadows every lesion.

5. Topical Anti-Androgen Strategies

Spironolactone 5 % / Niacinamide 2 % Cream (± Tretinoin 0.025 %)

• Peripheral androgen blockade plus barrier support.
• Useful for jawline or truncal flares in adult women who can’t—or won’t—take oral hormonal therapy.

Systemic Staples at Mail-Order Prices

• Doxycycline 100 mg Capsules — 30 for $6 or 60 for $10.
  • Stick to 100 mg once-daily for 12–16 weeks, layer with a BPO wash or the BPO/Clinda cream above, then stop.
• Spironolactone 50 mg Tablets — 30 for $6; larger counts discounted.
  • Begin at 50 mg daily; many patients plateau nicely at 100 mg. Electrolytes are optional in healthy, normotensive women, per EADV investigators.

Practical Workflow Tips

Phenotype matching

• Oily teens: BPO/Clinda AM + higher-strength tretinoin combo PM.
• Sensitive adults: Niacinamide-rich tretinoin PM ± oral doxycycline for inflammatory nodules.

Antibiotic stewardship
Document the topical retinoid or BPO partner at initiation; many EHRs surface this for quality measures.

Tele-derm convenience
The eNavvi portal pre-populates strength, quantity, SIG, and refills. A 60-second order equals a two-day doorstep delivery with counseling inserts—no samples needed.

Hormonal acne pearls
Combining oral and topical spironolactone can address both systemic and local androgen drive without raising potassium more than monotherapy does.

Key Takeaways

• Guideline-aligned: Every cream here maps directly to 2024 AAD recommendations.
• Cost-transparent: One-price ($35) multi-agent creams sidestep prior-auth hassles.
• Fast fulfillment: 48-hour shipping to any U.S. state keeps momentum after virtual visits.

Clinical pearl: If you must resort to an oral antibiotic, set the stop date in the eNavvi order so pharmacy and patient both know when to taper off.

Disclosure & Dating: Pricing supplied by eNavvi, June 24 2025.

What is eNavvi and why should physicians care?

Imagine prescribing in under a minute, with instant cash-price comparisons and no phone calls to the pharmacy. eNavvi is a browser-based digital prescription pad created by physicians, for physicians. It replaces paper pads and clunky EMR modules with a streamlined dashboard that transmits HIPAA-compliant digital prescriptions directly to 35,000+ U.S. pharmacies. enavvi.com

Key advantages

• Zero cost – unlimited digital prescriptions every month are free under the ad-supported plan. enavvi.com
• Price transparency – Real-time cash pricing lets you pick the most affordable option. formulary.enavvi.com
• Anytime, anywhere access – Works on any device—EMR plug-in. enavvi.com

How does eNavvi work in a typical clinical encounter?

Search the drug by generic or brand name.

Compare prices across local pharmacies or mail-order partners in seconds.

Select the pharmacy that fits your patient’s budget.

E-sign & send the script—eNavvi routes it and logs confirmation.

Time-saver: Physicians report cutting pharmacy call-backs by 30-45 minutes per clinic day. enavvi.com

Is eNavvi safe and compliant?

eNavvi is HIPAA-certified, employs Vanta-verified encryption. enavvi.com

How do I start using eNavvi?

Create an account with NPI verification—it takes about 3 minutes.

Receive unlimited free Digital Rx credits each month

Bookmark the dashboard so you can launch it alongside your EMR or telehealth platform.

Invite your colleagues.

Quick benefits recap

• Cuts administrative overhead
• Boosts medication adherence via lower out-of-pocket costs
• Fits telehealth, urgent care, concierge, and direct-primary-care workflows
• Free to start—no credit card required

What Is Keratosis Pilaris?

Keratosis Pilaris (KP) is a benign but often cosmetically distressing skin condition characterized by rough, follicular papules, most commonly found on the upper arms, thighs, cheeks, and buttocks. The disorder stems from abnormal keratinization of hair follicles, resulting in the formation of small plugs that block follicular openings.

While not medically dangerous, KP can significantly affect quality of life, particularly in adolescents and young adults. Topical therapy remains the mainstay of treatment, and compounded options like those available on eNavvi can provide tailored, multi-mechanism therapy to maximize clinical response.

Pathophysiology: What’s Really Going On?

• Follicular hyperkeratinization: Overproduction of keratin traps hair shafts and leads to comedone-like plugs.

• Barrier dysfunction: KP often coexists with xerosis and atopic skin conditions.

• Inflammation: Chronic plugging can trigger perifollicular inflammation and erythema.

• Secondary pigment changes or scarring may occur in darker skin tones or with repeated trauma.

Who Gets Keratosis Pilaris?

• Children and Adolescents: Most common age of onset; may improve with age

• Atopic Individuals: Strong correlation with eczema, asthma, or allergic rhinitis

• Patients with Dry Skin: Worse in cold, dry climates

• Genetic Predisposition: Often autosomal dominant in inheritance

Clinical Features

• Rough “chicken skin” texture

• Sandpaper-like papules on extensor surfaces

• Red or brown hyperpigmentation (especially in Fitzpatrick III–VI)

• May be asymptomatic or pruritic

Treatment: Why Compounding?

Standard treatments include keratolytics (lactic acid, salicylic acid), retinoids, and emollients, but many over-the-counter options are underpowered, especially for inflammatory or resistant KP.

Compounded topicals provide:

• Higher concentration actives than OTC

• Combination therapies in a single application

• Formulations designed for patient tolerability

• Cost-effective options, with fast nationwide delivery through eNavvi

eNavvi’s Compounded Formula for Keratosis Pilaris

Diclofenac Sodium / Tacrolimus / Tretinoin / Ammonium Lactate

2% / 0.05% / 0.025% / 12%

Cream – 30 GMS – $45.00 / 30 Days – 2-Day Shipping Nationwide

When to Use This Formula

• Inflammatory KP with erythema and chronicity

• Refractory KP unresponsive to OTC urea/lactic acid

• Sensitive or atopic skin (tacrolimus offers a steroid-sparing option)

• Hyperkeratotic and pigmented lesions needing keratolytic + retinoid synergy

Mechanism Breakdown:

• Ammonium Lactate: Lactic acid derivative with keratolytic action. Softens keratin plugs and smooths skin texture.

• Tretinoin: Retinoid that increases cell turnover. Helps prevent follicular plugging.

• Diclofenac Sodium: NSAID and COX-inhibitor. Reduces perifollicular inflammation.

• Tacrolimus: Calcineurin inhibitor. Modulates immune response in inflammatory KP, especially useful for atopic skin.

Side Effects & Monitoring

• Tretinoin: Can cause irritation and peeling. Recommend starting every other night; combine with moisturizer and use sunscreen.

• Ammonium Lactate: May cause burning on broken skin. Avoid use on abraded or sensitive areas.

• Tacrolimus: May cause transient burning or stinging. Educate patients that this usually resolves with continued use.

• Diclofenac: May cause photosensitivity and mild dryness. Counsel on daily sun protection.

Clinical Tips

• Start low, go slow: Use every other night, increasing to nightly as tolerated.

• Combine with emollients: Apply a bland moisturizer in the morning.

• Expect improvement in 4–6 weeks: Complete clearance may take 8–12 weeks.

• Maintenance: Consider reducing frequency or switching to lactic acid monotherapy once improved.

Why eNavvi?

• Formulations Built for Function: High-potency actives with excellent base tolerability

• Affordable Pricing: $45 for a 30-day supply

• Rapid Fulfillment: 2-day delivery, all 50 states

• Provider-Ready Templates: Save time with pre-set prescriptions

• Clinical Flexibility: Adjust concentrations based on patient need

Conclusion

Keratosis pilaris can be more than a cosmetic nuisance—it often coexists with underlying inflammation, barrier dysfunction, and emotional distress. eNavvi’s compounded formula combining keratolytics, anti-inflammatories, and retinoids offers physicians a comprehensive and effective option, especially in treatment-resistant or atopic cases.

Tailored, potent, and accessible: compounded therapy represents the future of KP care.

What Is Eczema?

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterized by episodic flares of pruritus, erythema, scaling, and lichenification. It is part of the atopic triad (along with asthma and allergic rhinitis) and reflects a complex interplay between genetic, immunologic, and environmental factors. Eczema is not a single disease but a spectrum of inflammatory skin conditions that require individualized treatment strategies.

Pathophysiology: The Underlying Immune Dysfunction

Eczema arises from a combination of epidermal barrier dysfunction and immune dysregulation. Key physiological features include:

• Filaggrin gene mutations, leading to a compromised skin barrier and increased transepidermal water loss
• Th2-skewed immune response, with elevated IL-4, IL-13, and IgE levels
• Colonization with Staphylococcus aureus, often contributing to inflammation and secondary infection
• Heightened mast cell activity, promoting pruritus and dermal reactivity

This pathophysiology supports a dual treatment approach: barrier repair and inflammation modulation, often in combination with antimicrobial or immunosuppressive strategies.

Who Gets Eczema?

• Children: Onset before age 5 is common; many outgrow symptoms but may develop other atopic disorders
• Adults: Adult-onset eczema or persistent childhood eczema can be more severe and treatment-resistant
• At-risk Populations: Individuals with a personal or family history of atopic diseases, or those living in urban or cold climates, have higher prevalence

Clinical Features

Common Symptoms:

• Intense itching
• Red, scaly patches (flexural areas in children; face, neck, or hands in adults)
• Xerosis (dry skin), cracking, and oozing
• Chronic lesions may become lichenified

When to Refer:

• Dermatologists: For moderate-to-severe disease, treatment failures, or use of systemic agents
• Allergists/Immunologists: When eczema is associated with food allergies, asthma, or requires biologic therapy
• Primary Care/Family Medicine: Initial diagnosis and mild disease management

Topical Treatment Options and Compounding Strategies

1. Atopic Eczema with Secondary Infection

eNavvi Compound: Betamethasone Valerate 0.1% / Mupirocin 2% Cream or Ointment
Mechanism:

• Betamethasone Valerate: Medium-potency corticosteroid; reduces inflammation and pruritus
• Mupirocin: Topical antibiotic targeting S. aureus colonization
  Use Case:
• Ideal for weeping, infected, or impetiginized lesions
• Choose cream for acute, moist lesions; ointment for dry or lichenified areas
  Cautions:
• Limit long-term use of topical steroids to avoid atrophy
• Monitor for bacterial resistance with prolonged mupirocin use

Available at:

• Foothills Professional Pharmacy – $35.00 / 30 Days – 2 Day Nationwide Shipping

2. Scalp Eczema / Seborrheic Dermatitis

eNavvi Compound: Clobetasol Propionate 0.055% Oil Suspension
Mechanism:

• Super-potent corticosteroid; anti-inflammatory and antiproliferative
• Oil base facilitates penetration through hair and sebaceous glands
  Use Case:
• Recalcitrant scalp eczema, seborrheic dermatitis, or psoriasiform flares
  Cautions:
• Limit to short-term use (2–4 weeks) due to risk of local and systemic corticosteroid side effects
• Avoid in infants and on thin skin areas

Available at:

• Foothills Professional Pharmacy – $35.00 / 30 Days – 2 Day Nationwide Shipping

3. Scalp Eczema with Steroid Sensitivity or Long-Term Management

eNavvi Compound: Tacrolimus 0.12% Solution
Mechanism:

• Calcineurin inhibitor; inhibits T-cell activation without skin thinning
  Use Case:
• Steroid-sparing maintenance for scalp and facial eczema
• Preferred in sensitive skin areas like the eyelids, neck, or intertriginous zones
  Cautions:
• Transient burning or stinging upon application
• Black box warning for potential cancer risk (based on animal studies); long-term human risk unproven

Available at:

• Foothills Professional Pharmacy – $35.00 / 30 Days – 2 Day Nationwide Shipping

Choosing the Right Topical Based on Clinical Presentation

PresentationRecommended CompoundRationaleInfected, crusted lesionsBetamethasone/MupirocinCombines anti-inflammatory and antimicrobial actionThick scalp plaquesClobetasol OilDeep follicular penetration for stubborn lesionsSteroid-sensitive skin or long-term useTacrolimus SolutionSteroid-sparing, no skin thinningAcute flare on face or flexuresBetamethasone/Mupirocin (short-term)Control inflammation, prevent bacterial superinfection

Conclusion

Eczema management requires a personalized approach based on disease severity, location, comorbidities, and response to previous treatments. Compounded topical therapies through eNavvi allow for customization, cost-efficiency, and expedited delivery, giving clinicians and patients access to high-quality, pharmacist-vetted formulations. With options like betamethasone-mupirocin creams, clobetasol oils, and tacrolimus solutions, podiatrists, dermatologists, and primary care providers alike can tailor treatment to optimize outcomes for every patient.

Introduction

Warts, particularly plantar warts caused by human papillomavirus (HPV), are a frequent challenge in podiatric practice. While many resolve spontaneously, persistent or painful lesions often require medical intervention. Traditional options include cryotherapy, salicylic acid, laser ablation, and immunotherapy. However, compounded topical therapies have emerged as a customizable, effective, and well-tolerated approach—especially for recalcitrant or multiple lesions.

eNavvi’s compounding platform offers podiatrists a streamlined way to access these formulations, empowering clinicians to tailor treatment based on lesion severity, patient profile, and therapeutic goals.

Why Consider Compounded Therapies?

• Customizable Concentrations: Titrate based on wart size, location, and thickness.
• Combination Formulations: Enhance efficacy by using synergistic agents.
• Improved Tolerability: Balance potency and safety for sensitive areas like plantar surfaces.
• Non-Invasive Delivery: Topical therapies offer alternatives to destructive or painful procedures.

Commonly Compounded Wart Treatments on eNavvi

Below are the most frequently used compounded wart treatments available through eNavvi, along with their mechanisms of action, indications, and cautions.

1. Cantharidin 0.7% (± Salicylic Acid 30%)

• Mechanism: Vesicant derived from blister beetle extract; induces intraepidermal blistering and local immune response.
• Indication: Non-painful application for pediatric or needle-phobic patients. Often used on thick plantar warts.
• Use: Applied in-office and occluded for several hours before removal.
• Side Effects: Blistering, pain, erythema, and potential secondary infection.
• Precautions: Avoid mucosal surfaces and use with care in diabetic patients or those with peripheral neuropathy.

2. Salicylic Acid (10–40%) in Lactic Acid or Occlusive Base

• Mechanism: Keratolytic agent that softens and exfoliates the stratum corneum, facilitating viral clearance.
• Indication: First-line for smaller, superficial lesions; safe for at-home use under guidance.
• Use: Daily application with or without occlusion.
• Side Effects: Local irritation, maceration, desquamation.
• Precautions: Limit use on infected or highly macerated skin. Higher strengths (>30%) best reserved for in-office protocols.

3. Imiquimod 5% Cream

• Mechanism: Toll-like receptor 7 agonist; stimulates local cytokine release (IFN-α, IL-12) to boost immune-mediated wart clearance.
• Indication: Recalcitrant, multiple, or mosaic warts; particularly helpful for immunocompetent patients.
• Use: Typically applied 3x weekly with occlusion; review response at 4–8 weeks.
• Side Effects: Erythema, pruritus, erosion, flu-like symptoms in rare cases.
• Precautions: Avoid overuse to minimize inflammatory response; not ideal for immunocompromised individuals.

4. 5-Fluorouracil (5-FU) 5% with Salicylic Acid 17–30%

• Mechanism: Antimetabolite that disrupts viral DNA synthesis; synergistic with salicylic acid’s keratolytic action.
• Indication: Thick or treatment-resistant warts, especially in older adolescents or adults.
• Use: Applied daily under occlusion, typically at night for 6–12 weeks.
• Side Effects: Irritation, erosion, photosensitivity.
• Precautions: Contraindicated in pregnancy; avoid sun exposure on treated areas.

5. Cimetidine (Oral or Topical, Off-label)

• Mechanism: H2 receptor antagonist with immunomodulatory effects; enhances T-cell mediated response.
• Indication: Multiple warts, especially in pediatric or immunologically naive patients.
• Use: Topical versions are compounded at 5–10%; oral regimens can be considered adjunctively.
• Side Effects: Minimal topically; oral use may cause headaches or GI upset.
• Precautions: Topical use is generally safe; limited robust data on efficacy.

eNavvi’s Advantage for Podiatrists

eNavvi’s digital compounding pad streamlines access to high-quality, physician-curated wart treatments. Each compound is:

• Delivered Nationwide with transparent cash pricing.
• Integrated with podiatry-specific templates to reduce prescribing friction.

You can select from our prebuilt wart treatment protocols or customize formulations based on lesion size, location, and patient tolerance.

Conclusion

Compounded topical wart treatments offer podiatrists a flexible, evidence-based approach to managing verrucae, particularly for refractory or challenging cases. eNavvi’s platform enhances your ability to deliver precision therapy while minimizing procedural burden. From cantharidin and salicylic acid to advanced immunomodulators, compounded options can be tailored to your clinical goals—and your patient’s lifestyle.

Introduction

PT-141, chemically known as Bremelanotide Acetate, is a synthetic peptide analog of α-melanocyte-stimulating hormone (α-MSH). It acts primarily as a melanocortin receptor agonist, targeting central nervous system pathways involved in sexual arousal and desire. Its novel mechanism of action has led to growing clinical interest, particularly in managing sexual dysfunction where traditional vasodilator agents (e.g., PDE5 inhibitors) have been insufficient or contraindicated.

Mechanism of Action

PT-141 activates melanocortin receptors MC3R and MC4R located primarily within the hypothalamus. These receptors modulate pathways associated with sexual arousal, libido, and sexual satisfaction through central nervous system signaling rather than peripheral vasodilation. Unlike PDE5 inhibitors (e.g., sildenafil), PT-141's primary therapeutic effect is centrally mediated, enhancing sexual desire independently from direct vascular mechanisms¹.

FDA Approval and Indications

PT-141 was approved by the FDA in June 2019 under the brand name Vyleesi® specifically for the treatment of:

• Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women².

The indication includes women who experience persistent low sexual desire causing marked distress or interpersonal difficulties and is not attributed to existing medical or psychiatric conditions, relationship problems, or medication side effects.

Clinical Use and Administration

Approved Administration

• Subcutaneous injection:
  The FDA-approved product, Vyleesi®, is administered via a disposable autoinjector device approximately 45 minutes before anticipated sexual activity. Patients are advised not to exceed one dose in 24 hours and a maximum of eight doses per month².

Off-label Administration

• Intranasal administration (compounded):
  Due to patient preference for non-injectable options, compounding pharmacies frequently formulate PT-141 as intranasal sprays. This method bypasses hepatic first-pass metabolism, rapidly crossing the blood-brain barrier and initiating a faster onset of action. The standard compounded intranasal concentration typically ranges from 1 mg/ml to 10 mg/ml, dosed approximately 30–60 minutes prior to anticipated sexual activity³.

Benefits of PT-141

• Centrally Mediated Libido Enhancement:
  Unlike PDE5 inhibitors that rely primarily on vascular response, PT-141 directly enhances libido by central pathways.
• Applicable Across Sexes:
  While FDA approval is specific to women, clinical and anecdotal evidence suggest efficacy in men, particularly those inadequately responsive to PDE5 inhibitors.
• Rapid Onset:
  The compounded intranasal formulation typically offers quicker onset (within 30–60 minutes), enhancing usability and spontaneity.
• Alternative for Vasculogenic ED Non-Responders:
  Useful in patients who do not respond to traditional erectile dysfunction medications due to underlying cardiovascular conditions or other contraindications⁴.

Risks and Side Effects

PT-141 has several potential adverse effects, including:

• Nausea (most common): Occurs in approximately 40% of patients; typically mild and transient.
• Flushing: Usually brief, transient, and mild to moderate in intensity.
• Headache, dizziness: Generally mild but can impact patient adherence.
• Injection site reactions: For the subcutaneous route, including redness, pain, or swelling.
• Transient hypertension: Elevated blood pressure observed in some patients, caution advised in hypertensive individuals²⁵.

Patients with uncontrolled hypertension or significant cardiovascular disease should approach treatment with caution.

Compounded Intranasal PT-141: Clinical Considerations

Formulation and Dosing

• Standard Intranasal Formulation: Typically compounded at concentrations of 1 mg/ml to 10 mg/ml.
• Dose Recommendations: Usually initiated at 1–2 sprays (approximately 0.5–2 mg per spray) per nostril, titrated based on patient response and tolerability.

Pharmacokinetics

• Rapid Absorption: Intranasal delivery bypasses the gastrointestinal tract and hepatic metabolism, enhancing rapid onset of action compared to subcutaneous or oral administration.
• Shorter Duration: Effects typically last several hours, correlating well with desired timing of sexual activity³.

Patient Counseling Points

• Timing and Spontaneity: Educate patients on the optimal timing of administration (30–60 minutes pre-activity).
• Side Effects Management: Nausea can be minimized by starting at lower doses and gradually titrating upward as tolerated.
• Safety Profile: Regularly monitor blood pressure in susceptible patients, especially during initial treatment phases.

Summary and Clinical Pearls

PT-141 (Bremelanotide Acetate) offers a unique therapeutic option for managing sexual dysfunction through central nervous system modulation of libido pathways. FDA-approved for premenopausal women with HSDD, it also demonstrates off-label efficacy in male populations and those resistant to traditional vasodilators. Compounded intranasal formulations further enhance patient adherence, convenience, and rapidity of onset.

Introduction

Androgenetic alopecia (male pattern baldness) is the most common form of hair loss in men, affecting approximately 30–50% of men by age 50. Compounded topical creams enable precise local delivery of active agents, combination therapies, and reduced systemic exposure—key advantages in long-term management of hair loss.

Pathophysiology & Therapeutic Targets

Follicular miniaturization in androgenetic alopecia is driven by dihydrotestosterone (DHT). Effective topical therapies aim to:

• Inhibit DHT at the follicle (5α-reductase blockers)
• Promote vasodilation to prolong the anagen phase (minoxidil)
• Optimize local drug exposure while minimizing systemic levels

Compounded Formulations

1. Topical Finasteride (0.1–0.5%)

• Mechanism: Selective inhibition of type II 5α-reductase reduces DHT within the follicle.
• Clinical Data: A 0.25–0.5% finasteride spray produced significant increases in terminal hair count versus placebo, matching the efficacy of oral finasteride with minimal systemic DHT suppression.
• Dosing: Apply once daily to areas of thinning.

2. Topical Minoxidil (2–10%)

• Mechanism: Potassium-channel opener that enhances perifollicular blood flow and prolongs anagen.
• Evidence: A 5% solution outperforms 2% and placebo in non-vellus hair count; higher concentrations up to 10% have been explored in compounding settings.
• Dosing: Typically applied twice daily.

3. Topical Dutasteride (0.1–0.5%)

• Mechanism: Dual inhibition of 5α-reductase types I and II, offering more potent DHT reduction.
• Data: Topical dutasteride has demonstrated hair-regrowth comparable or superior to finasteride with negligible systemic exposure in early trials.
• Dosing: Often applied once daily, with titration based on response.

4. Combination Formulations

• Rationale: Synergistic targeting of DHT inhibition and vasodilation.
• Clinical Insight: A cream combining 5% minoxidil with 0.25% finasteride yielded faster and greater improvements in hair density compared to minoxidil alone (86.7% vs 69.1% efficacy at 24 weeks).

Vehicle Considerations & Stability

• Bases: Ointments (e.g., petrolatum), gels (e.g., pluronic lecithin organogel), and emulsions affect drug release and scalp retention.
• Stability: Nonaqueous vehicles preserve the integrity of finasteride and dutasteride; maintaining pH between 4.5 and 7.5 optimizes stability and minimizes irritation.
• Patient Tolerance: Lightweight gels enhance compliance in oily scalps; ointments may suit dry or sensitive skin types.

Compounding Best Practices

Use USP-grade active pharmaceutical ingredients to ensure purity.

Assign beyond-use dates based on vehicle compatibility (typically 30–60 days for nonaqueous preparations).

Adjust pH with appropriate buffers for skin compatibility.

Dispense in airless or amber containers to protect photolabile compounds.

Verify uniformity and potency through in-process assays.

eNavvi’s Online Compounding Platform

• Custom Prescriptions: Access vetted templates or fully tailor finasteride, minoxidil, dutasteride, or combination creams.
• Transparent Pricing: View cash prices upfront with no hidden fees.
• Nationwide Delivery: Accredited compounding pharmacies ship to all 50 states within two business days.

Introduction

Anal fissures and hemorrhoids are among the most common anorectal disorders, affecting up to 50% of adults by age 50 and causing significant discomfort, pain, and bleeding.¹ Tailored topical therapies delivered via compounded creams can optimize drug concentrations, combine synergistic agents, and improve patient adherence. This blog provides high-level clinical insights into the most commonly compounded formulations for anal fissures and hemorrhoids, along with practical guidance on vehicle selection, stability, and eNavvi’s streamlined compounding services.

Pathophysiology & Therapeutic Targets

• Anal fissures are linear tears in the anoderm caused by trauma (e.g., hard stools), leading to internal sphincter hypertonia, local ischemia, and pain.
• Hemorrhoids arise from dilated vascular cushions in the anal canal due to increased venous pressure, resulting in pruritus, pain, and bleeding.

Topical treatments aim to:

Reduce sphincter pressure (improve blood flow and pain control).

Promote mucosal healing (protective agents and growth factors).

Alleviate inflammation and pruritus.

Compounded Formulations for Anal Fissures

1. Glyceryl Trinitrate (Nitroglycerin) 0.2–0.4% Cream

• Mechanism: Nitric oxide donor that relaxes internal anal sphincter, enhancing perfusion.
• Dosing: Apply a pea-sized amount twice daily.
• Evidence: A randomized dose-finding study demonstrated improved healing rates in chronic fissures with 0.2–0.4% NTG versus placebo

2. Topical Calcium Channel Blockers

• Nifedipine 0.5% Cream
  • Superior to 0.2% NTG for pain relief, healing rate, and fewer side effects
• Diltiazem 2% Ointment
  • Effective in reducing sphincter tone and promoting fissure healing, often used when nifedipine is contraindicated.

3. Sucralfate 7% (± Metronidazole 1%) Cream

• Mechanism: Forms a protective polyanion gel that enhances mucus production and growth factor activity, promoting epithelial repair.
• Combination Therapy: Adding metronidazole 1% may offer antimicrobial support without compromising healing; studies show efficacy comparable to diltiazem 2%

Compounded Formulations for Hemorrhoids

1. Lidocaine 2–5% & Hydrocortisone 2% Cream

• Lidocaine (2–5%) provides rapid analgesia via sodium channel blockade; 5% formulations (e.g., RectiCare®) can be applied up to six times daily.
• Hydrocortisone 2% reduces inflammation, pruritus, and edema.
• Dosing: Apply a thin film 2–3 times daily to the perianal area; rectal cream versions may be inserted twice daily.

2. Phenylephrine 0.25–1% Cream

• Mechanism: α-adrenergic agonist that vasoconstricts hemorrhoidal vessels, reducing edema and discomfort.
• Use: Typically compounded for precise titration when OTC strengths are insufficient.

Vehicle Selection & Stability

• Bases: Nonaqueous vehicles (e.g., white petrolatum, pluronic lecithin organogel) enhance adhesion and residence time, reducing leakage.
• Stability: Studies recommend petrolatum bases to maintain potency of NTG, nifedipine, and hydrocortisone preparations.

Compounding Best Practices

Quality Control: Use USP-grade active ingredients; conduct batch testing.

pH Adjustment: Maintain pH 4.5–7.0 for skin compatibility.

Preservatives: Incorporate as needed for water-containing formulations.

Packaging: Utilize airless dispensers or light-protective tubes for photolabile agents.

eNavvi’s Online Compounding Platform

• Digital Prescription Pad: Select from clinician-vetted templates or customize formulations.
• Transparent Pricing: Cash prices displayed upfront, with no hidden fees.
• Fulfillment: Partner pharmacies accredited for compounding deliver nationwide in two days to all 50 states

Compounded medications are playing an increasingly pivotal role in contemporary healthcare, offering tailored solutions when commercially available drugs cannot fully meet patient-specific needs. As physicians, understanding the ins and outs of compounding is essential for optimal patient care.

What Are Compounded Medications?

Compounded medications involve the customized preparation of pharmaceutical ingredients to create a medication tailored specifically for an individual patient. Unlike commercially produced pharmaceuticals, compounded medications are not FDA-approved, but instead are carefully prepared by licensed pharmacists to address specific patient needs, such as dosage modifications, allergen removal, or specialized dosage forms.

Who Compounds Medications?

Primarily, pharmacists perform compounding within licensed pharmacies. In the United States, compounding pharmacies are categorized into two types:

• 503A Pharmacies: These traditional compounding pharmacies prepare medications based on individual prescriptions, primarily regulated by state pharmacy boards.
• 503B Outsourcing Facilities: These larger-scale facilities produce compounded drugs in batches, often to address shortages and are directly overseen by the FDA to adhere to stricter manufacturing standards.

Why Use Compounded Medications?

Physicians prescribe compounded medications to:

• Provide personalized dosages or dosage forms (e.g., liquids instead of tablets for pediatric or geriatric patients).
• Eliminate allergens or intolerable excipients from standard preparations.
• Improve medication adherence through customized flavorings or combined medications.
• Address unmet medical needs, including treatments for rare or discontinued medications.
• Offer critical alternatives during drug shortages.

Risks and Benefits of Compounding

Benefits:

• Personalized therapy increases patient compliance and satisfaction.
• Accessibility to medications during shortages or for rare conditions.
• Flexibility in adjusting therapies based on clinical judgment and emerging research.

Risks:

• Lack of FDA approval, resulting in limited efficacy and safety data.
• Potential for quality and consistency issues, including contamination or incorrect dosing.
• Complex and evolving regulatory landscape, requiring diligent oversight by prescribers.

Trends in the Compounding Industry

The compounding market is experiencing significant growth, driven by the rising demand for personalized therapies and increasing drug shortages. The U.S. compounding pharmacies market was valued at approximately $6.31 billion in 2024, projected to exceed $10 billion by 2033, underscoring the increasing reliance on personalized medicine.

However, with this growth comes heightened regulatory oversight aimed at ensuring patient safety. Recent regulatory updates, such as the revised USP <795> and <797> standards implemented in 2023, have increased quality control measures to mitigate risks.

Cutting-Edge Technologies in Compounding

Innovation is reshaping the compounding pharmacy landscape, enhancing precision and safety:

• Automation and Robotics: Reduce human error, improve accuracy, and enhance sterility.
• 3D Printing: Allows precise customization of dosages and complex delivery systems.
• Nanoformulations: Enhance bioavailability and targeted drug delivery.
• Digital Workflows and E-prescribing: Improve safety and accuracy in prescription management.

Dermatology: A Key Application for Compounding

Dermatology heavily relies on compounded medications due to the need for highly individualized treatments. Compounded topical creams are especially prevalent for conditions like acne, psoriasis, melasma, and hair loss, offering patients effective customized therapies not commercially available.

Examples include:

• Custom acne creams combining benzoyl peroxide, clindamycin, and retinoids.
• Specialized formulations for hyperpigmentation, often combining hydroquinone with tretinoin and corticosteroids.
• Tailored hair growth solutions combining minoxidil and finasteride, providing localized therapy with reduced systemic effects.

Dermatologists frequently collaborate with compounding pharmacists to provide tailored therapies, ensuring optimal outcomes and patient satisfaction.

Conclusion

Compounded medications represent an essential bridge in personalized patient care, especially in dermatology. Physicians should balance the clear benefits of compounding—personalization, accessibility, and therapeutic flexibility—with the importance of mitigating risks through careful pharmacy selection and rigorous adherence to evolving guidelines.

At eNavvi, we support physicians by promoting informed prescribing practices and providing transparent medication solutions to enhance patient care outcomes.

For further insights on personalized prescribing solutions, visit eNavvi.com.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, affecting millions globally. First described by James Parkinson in 1817 as "paralysis agitans," it was later renamed Parkinson’s disease by neurologist Jean-Martin Charcot.

Pathophysiology of Parkinson’s Disease

PD results primarily from degeneration of dopamine-producing neurons in the substantia nigra pars compacta. Loss of dopamine disrupts motor control, causing hallmark symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. Pathological features include Lewy bodies—aggregates of misfolded alpha-synuclein protein—and significant mitochondrial dysfunction, neuroinflammation, and impaired cellular protein handling.

Standard Treatments

Current treatment strategies focus on symptomatic relief:

• Levodopa (with Carbidopa/Benserazide): Remains the gold standard, significantly improving motor symptoms.
• Dopamine Agonists: Used alone in early PD or as adjunctive therapy, they manage motor fluctuations but may cause side effects like impulse control disorders.
• MAO-B and COMT Inhibitors: Extend dopamine availability and reduce fluctuations.
• Amantadine: Helps manage dyskinesias caused by long-term levodopa use.
• Anticholinergics: Reserved for younger patients to manage severe tremor due to significant side effects in older adults.

Adjunctive and Supportive Therapies

Comprehensive care for PD includes:

• Exercise and Physical Therapy: Crucial for improving mobility, balance, and overall function.
• Occupational and Speech Therapy: Facilitate daily activities, speech clarity, and manage swallowing difficulties.
• Nutritional Support: Mediterranean diets rich in fiber, hydration management, and dietary modifications for medication optimization.
• Mental Health and Cognitive Support: Routine screening and management of depression, anxiety, and cognitive impairment significantly enhance patient quality of life.

Emerging Treatments

The future of PD care looks promising, with several innovative therapies under investigation:

• Gene Therapy: Targeted genetic interventions to restore dopamine production or protect neuronal function.
• Stem Cell Therapy: Potential to replace lost dopamine-producing neurons, with pivotal trials underway.
• Alpha-Synuclein Targeted Therapies: Immunotherapies and aggregation inhibitors aimed at reducing toxic protein accumulation.
• Advanced Deep Brain Stimulation (DBS): Adaptive, personalized neuromodulation providing tailored symptom relief with fewer side effects.
• Digital Therapeutics and Wearables: Continuous symptom monitoring and digital interventions enhancing personalized care.

At eNavvi, we recognize the critical role comprehensive management and emerging treatments play in improving Parkinson’s disease outcomes. Through clear medication insights and digital prescribing solutions, we aim to empower healthcare providers in delivering optimal patient care.

Visit eNavvi.com to learn more about how our tools can support your clinical practice.

Managing diabetes effectively requires precise and timely insights into glucose levels. Continuous Glucose Monitors (CGMs) provide an advanced solution, offering real-time glucose tracking that significantly enhances diabetes care. In this guide, we'll explore what CGMs are, how they work, their differences, and why they're essential.

Understanding CGMs

Continuous Glucose Monitors are small, wearable devices that measure glucose concentrations in the interstitial fluid beneath the skin. Instead of relying solely on fingerstick blood tests, CGMs continuously track glucose levels, providing dynamic insights throughout the day and night.

How Do CGMs Work?

CGMs include a tiny sensor inserted under the skin—typically on the abdomen or arm—which measures glucose via an enzymatic reaction. The sensor sends data wirelessly to a connected device, such as a smartphone or insulin pump. Users receive real-time glucose readings, trends, and alerts for potential hypo- or hyperglycemic events.

CGM Devices Available Today

Several CGMs dominate the market, each with unique features:

• Dexcom G6/G7: Renowned for accuracy, no fingerstick calibrations needed, and excellent smartphone integration.
• Abbott FreeStyle Libre 2/3: Offers convenient scanning (flash monitoring), alarms, and extended sensor life (up to 14 days).
• Medtronic Guardian Connect: Features predictive alerts and integrates seamlessly with Medtronic insulin pumps.
• Eversense: A unique implantable CGM that provides continuous readings for up to 90 days.

Key Differences Among CGMs

When choosing a CGM, consider factors like sensor duration (ranging from 7 to 90 days), accuracy (assessed by the Mean Absolute Relative Difference, or MARD), ease of calibration, data integration capabilities, alarms, and cost.

Who Should Use a CGM?

CGMs are highly beneficial for:

• Individuals with Type 1 Diabetes requiring meticulous glucose control.
• People with Type 2 Diabetes who use intensive insulin therapy.
• Those experiencing Hypoglycemia Unawareness, who don't recognize early signs of low glucose.
• Pregnant women managing Gestational Diabetes.

Increasingly, CGMs are also considered for hospital use and preventative metabolic health management.

Benefits of Using CGMs

• Improved glucose control: Immediate insights enable swift, informed adjustments to insulin therapy.
• Safety: Alerts help prevent severe glucose excursions.
• Quality of life: Reduced anxiety, greater confidence, and fewer fingersticks make diabetes management less burdensome.

The Future of CGMs

CGMs continue to evolve rapidly. Integration with insulin delivery systems (closed-loop or "artificial pancreas" technology), extended sensor lifespan, and improved analytics promise a future of increasingly effortless diabetes management.

Prescribing CGMs Made Easy with eNavvi

At eNavvi, we recognize the value CGMs bring to diabetes care. That's why we've made prescribing CGMs simpler and more transparent than ever. Physicians can now easily prescribe CGMs digitally through eNavvi, ensuring patients receive prompt access to the devices they need at clear, competitive cash prices.

Take advantage of seamless prescribing and help your patients achieve better diabetes outcomes with CGMs—available now on eNavvi.

In the world of healthcare, medications are tailored to meet the diverse needs of patients. This is where compounding pharmacies step in, providing custom medications absent from the broader marketplace. However, when GLP-1 agonists like semaglutide surged in popularity for managing diabetes and weight, compounding these medications sparked controversy. There is a nuanced landscape here that extends beyond mere reporting, and we're keen to unpack the intricacies.

Understanding Compounding Pharmacies

Compounding pharmacies are essential for providing personalized medication solutions. They adjust drug formulations to eliminate specific allergens, alter dosage forms, or change delivery methods to better suit individual needs. Regulated under the U.S. Drug Quality and Security Act (DQSA), these pharmacies are an important cog in the healthcare machine, especially when standard formulations aren't available or applicable. However, the act itself stems from serious safety lapses, including the 2012 meningitis outbreak from contaminated products. As such, compounding is an area littered with both innovation and caution.

The Rise of GLP-1 Agonists

GLP-1 agonists such as semaglutide and tirzepatide are integral for diabetes and weight management. Their efficacy is undeniable, leading to an impressive rise in demand. However, the popularity of FDA-approved versions like Ozempic and Wegovy outstripped supply, creating a significant gap. This is where compounding pharmacies saw an uptick in requests for off-label use, leading to an increase in compounded GLP-1 products. The lack of FDA approval for these compounded versions, however, raises multiple concerns regarding their safety and efficacy. It's a complex interplay of demand, regulation, and healthcare needs.

Controversies Unveiled

Safety and Quality Concerns

Compounded GLP-1 agonists carry risks not present with their FDA-approved counterparts. Issues such as impurities in compounded products were noted, with significant discrepancies reported in active ingredient content. Tragically, adverse events have been linked to compounded semaglutide, including reports of hospitalizations and even deaths. The FDA warns against compounded semaglutide made from salts, which diverge significantly from the approved peptide forms.

Regulatory Measures and Legal Scrutiny

To combat these safety risks, the FDA proposed new rules to restrict compounding certain drugs, including GLP-1 agonists. Companies like Novo Nordisk have also taken legal action against pharmacies selling adulterated semaglutide products. As we navigate these waters, understanding where regulatory bodies draw lines is crucial in ensuring patient safety while allowing compassionate access to essential treatments.

Ethical and Legal Challenges

The landscape of compounding pharmacies is peppered with legal and ethical questions. Past cases have revealed kickback schemes with prescriptions tied to high Medicaid reimbursements. Moreover, the online sales of counterfeit GLP-1 agonists have exacerbated the issue. These clandestine operations exploit regulatory gray areas at the cost of patient safety, highlighting the critical need for tighter oversight.

Balancing Accessibility and Risk

Compounding pharmacies fill a significant gap by providing access where conventional medications fall short. Customizing doses, creating allergy-friendly formulations, and addressing drug shortages are commendable actions. However, these advantages must be weighed against the risks inherent in compounded, non-FDA approved medications, especially concerning GLP-1 agonists. It's about finding a balance between innovation and caution.

Steps Forward for Patients and Providers

The burgeoning field of compounded GLP-1 agonists requires careful navigation. Patients must verify their sources rigorously, ensuring they use state-licensed pharmacies and avoid dubious online sellers. Practitioners should prioritize FDA-approved medications to assure maximum safety while continuing to push for enhanced regulations holding compounding practices accountable. This accountability paves the way for a safer, more accurate, and reliable compounding industry, ensuring patient safety as a cornerstone of healthcare advancement.

As eNavvi grows, our platform remains committed to empowering healthcare providers with transparent pricing and real-time pharmacy network integration. This commitment aims to streamline prescribing processes and grant peace of mind in an ever-evolving medical landscape. For more information on how we pioneer this change, visit eNavvi.

Navigating the complexities of oncology treatment can be daunting, especially given the rise of biosimilars—a promising new group of drugs designed to be close replicas of existing biologic drugs after their patents expire. With eNavvi, we strive to empower physicians with up-to-date knowledge and tools that can enhance decision-making and patient care.

Understanding biosimilars, their efficacy, costs, and patient considerations is pivotal in oncology today.

What Are Biosimilars?

Biosimilars are biologic medical products that are highly similar to already approved reference biologics, with no clinically meaningful differences in terms of safety, purity, and potency. Unlike generic drugs for non-biological medicines (which are identical), biosimilars are "similar" because of the complex nature and manufacturing process of biological drugs.

Key Characteristics:

• Similarity: Biosimilars must have no clinically meaningful differences from the reference product.
• Complexity: Due to their biological nature, even slight variations in manufacturing can lead to differences.
• Regulatory Rigour: Regulatory bodies like the FDA and EMA conduct strict reviews to ensure safety and efficacy.

The Efficacy of Biosimilars in Oncology

Biosimilars in oncology have shown to effectively replicate the effects of their reference products, offering similar safety and effectiveness at potentially lower costs.

Clinical Trials and Studies

Numerous studies have validated the effectiveness of biosimilars. The European Medicines Agency's approval is contingent upon rigorous clinical trials that confirm these findings. For oncologists, understanding these studies can be critical to inform patient treatment choices.

Practical Applications

In clinical settings, biosimilars have been increasingly adopted. For instance, biosimilars for cancer treatments like supportive care drugs (e.g., filgrastim) and monoclonal antibodies (e.g., rituximab) have become more prevalent.

Cost Considerations

Financial Savings

One of the principal benefits of biosimilars is cost reduction. Since they are cheaper to produce than their biologic counterparts, biosimilars can significantly decrease costs, enhancing access to life-saving treatments.

Insurance and Market Dynamics

While insurers increasingly favor biosimilars due to their lower price point, the actual cost savings to patients can vary depending on insurance coverage and out-of-pocket expenses. For healthcare providers, understanding biosimilars' cost dynamics and reimbursement strategies is essential.

Patient Considerations

Patient Education

Education is key when it comes to transitioning patients to biosimilars. It’s crucial that patients understand the biosimilar's role in their treatment to ensure adherence and satisfaction.

Monitoring and Pharmacovigilance

Post-prescription, continuous monitoring ensures that any adverse effects are promptly identified and managed. As healthcare providers, our vigilance in this area can strengthen the trust in biosimilar therapies.

The Role of eNavvi in Facilitating Biosimilar Treatment

At eNavvi, we’re committed to enhancing prescription efficiency and cost transparency, including for biosimilar drugs. Our platform enables healthcare providers to compare real-time pricing across pharmacies, ensuring that patients receive their medications at the best possible rate.

Benefits with eNavvi

• Real-time Price Comparison: Immediately see and compare biosimilar costs in local and mail-order pharmacies.
• Enhanced Access: Ensure patients receive prescriptions promptly, minimizing treatment delays.
• Decision Support: Streamline your prescription process beyond EMR constraints with complete price transparency.

Explore more with eNavvi to empower your practice and ensure patients receive comprehensive care affordably and effectively.

Conclusion

The incorporation of biosimilars in oncology is an evolving landscape offering considerable promise in reducing costs without compromising efficacy or safety. Understanding these nuances can profoundly impact treatment outcomes and patient satisfaction. At eNavvi, we bolster this mission by offering tools that provide transparency and enhance your clinical autonomy.

We hope this guide has been helpful for your practice. As always, our goal is to support you with the right resources. For further reading or to explore our platform, visit us.