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Progesterone Vaginal Suppositories                      Send Link

Progesterone Vaginal Suppositories
Letter from Barry Mizes
Bajamar Women's HealthCare Pharmacy


Dear Dr. Perloe:
As you noted, the article we sent does indicate that progesterone is absorbed better rectally versus vaginally. Our own practical experience confirms this, since we have seen patients improve when they switch from vaginal to rectal use. In addition, most of the physicians we work with specify rectal use, and in those cases where it is not specified, we always recommend rectal use.

In terms of the diarrhea, that is typically related to the suppository base material that is chosen by the pharmacy doing the compounding. Most pharmacies are forced to use a PEG (polyethylene glycol) base, because it melts at a slightly higher temperature. Since most pharmacies do not have the capability to seal the suppositories in a leakproof plastic shell, the higher melting point gives them a bit more leeway in dispensing the suppositories in warm weather. However, the PEG base is much, much harsher, and almost universally causes diarrhea, gas, cramping, bloating etc. The other base that is available is called a fatty acid base (FA), and although it melts at a lower temperature, it is much less problematic for the patient. It is a specially fractionated fatty acid derivative, and does not cause any of the reactions that are typical for the PEG base. However, unless one has the capability to make and seal the finished suppository in a plastic shell, you cannot compound with the FA base, since it melts easily in warm weather. We use only the FA base unless the physician specifically requests a PEG base, and this has eliminated the diarrhea problems for almost all of our patients who use suppositories. In addition, the use of a sealed plastic shell is cleaner and more hygienic, since the suppository itself is never handled by the pharmacist, and it remains sealed until the patient opens the shell at the time of use.

Regardless of where your patients get their suppositories, you might want to consider specifying a fatty acid base on the prescription itself in order to minimize problems from rectal suppository use. If your patients typically get their suppositories from a single local pharmacy, you might want to check with the pharmacist there and verify what base they are using. If you would like us to work with your patients, you can be assured that we only use the fatty acid base (unless directed otherwise), and that we form and seal our suppositories in individual, sealed, plastic shells.

If you need anything else, just let me know.

Barry Mizes
Bajamar Women's HealthCare Pharmacy
1-800-255-8025 Rx line
314-997-3414 voice
314-997-2948 fax