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Friday, September 24, 2010

Dispensing of Homoeopathic Medicines:

Posted by Drdevendra Kumar MD Homeo
-Sumit Goel.

Homoeopathic medicines, in the form of tinctures and solid or liquid potencies are routinely dispensed via a suitable vehicle. These are called as dosage forms.

Medicines that are to be dispensed for oral use are usually in the form of tinctures, liquid potencies or in the form of powder triturates.

* Mother tinctures are dispensed diluted in water or with a sweetening agent like simple syrup to mask the flavour. Alternatively, they may be converted into tincture triturates and dispensed.

* Liquid potencies, which, by far, are the most frequently used form of homoeopathic medicine, are rarely dispensed in their original form as drops. This is because, these are prepared in alcohol, which has an unacceptable burning taste.

Liquid potencies are dispensed

- by medicating globules

- by adding medicated globules to sugar of milk

- by adding medicated globules and sugar of milk to distilled water

- by medicating sugar of milk

- by medicating distilled water

* Powder triturates are potencies, usually upto 6X or 3C, which are insoluble in a liquid vehicle. These are not dispensed in the solid form above 6X or 3C as these are conveniently converted into a liquid potency. But, this is not the case in the Biochemic system of medicines where potencies in the decimal scale are dispensed as tablets above 6X potency also. Powder triturates of the desired potency are dispensed in their original form in measured doses.

FORMS OF VEHICLES FOR DISPENSING Dosage forms are preparations that provide the physician with the appropriate form in which the medication is to be dispensed to the patient.

THESE, LIKE ALL OTHER CONDITIONS OF HOMOEOPATHIC PHARMACY, SHOULD BE GOVERNED BY SIMPLICITY AND USEFULNESS TO THE PHYSICIAN AND PATIENT. IN OTHER RESPECTS, THE FORMS AND SHAPES OF VEHICLES ARE OF NO IMPORTANCE AND MAY BE VARIED TO SUIT TASTE AND CONVENIENCE ONLY.

Dosage forms in homoeopathy may be solid or liquid.

* Vehicles for solid dosage forms are globules, cones, sugar of milk and tablets.

* Vehicle for liquid dosage form are distilled water and syrup simplex.

* Sometimes, homoeopathic medicines may be dispensed in their original form without the aid of a vehicle for dispensing.

SOLID DOSAGE FORMS

Solid dosage forms are the more popular category of dispensing agents. Vehicles usually preferred are globules or pillules, cones, sugar of milk and tablets.

Advantages These show a greater stability than liquid dosage forms. These are more convenient to carry as compared to liquids.

GLOBULES

Medication of globules

* Hahnemannian methodology -

The pellets that are to be moistened with the medicine should be selected of the same size, hardly as large as poppy seeds, made by the confectioner, partly so that the dose may be made small enough and partly that homoeopathic physicians in the preparation of medicines as also in the giving of doses, may act alike and thus be able to compare the result of their practice with that of other homoeopaths in the most certain manner.

The moistening of pellets is best done with a quantity, so that a drachm or several drachms of pellets are put into a little dish of stoneware, porcelain or glass; this dish should be more deep than wide, in the form of a large thimble; several drops of the spirituous medicinal fluid should be dropped into it (rather a few drops too many), so that they may penetrate to the bottom and will have moistened all the pellets within a minute. Then the dish is turned over and emptied on a piece of clean double blotting paper, so that the superfluous fluid may be absorbed b it; and when this is done, the pellets are spread on the paper so as to dry quickly. When dry, the pellets are filled in a vial, marked as to its contents, and well stoppered.

* Hahnemann also says,

Globules from 5-600 of which should be in each little bottle and fill it only about half full, should be moistened with from 3-4 drops of the alcoholic medicinal dilution and not shaken in the corked up bottle, but rather stirred about it with a silver or glass pin and the bottle kept uncorked until by the evaporation of alcohol, they become dry and no longer adhere to each other; so that each globule may be taken out separately. In this way the homoeopath possesses indisputably the most convenient process for having his medicines always of the same good quality and ready for immediate use.

The medicated alcohol that evaporates whilst the globules are thus stirred for about an hour, is no loss for the globules that are thus dried in the bottle. For the purpose of moistening 600 of the smallest globules, a single drop would suffice and consequently in this desiccation by the evaporation of the superfluous medicated alcohol, they do not undergo any diminution of their medicinal power.

* According to Dr. Willmar Schwabe's Pharmacopoea Homoeopathica Polyglotta, moisten the pellets with the potencies in a bottle of moderate size, 2/3rd filled with globules, drop in the potency, cork the bottle and shake it so that all the globules may become uniformly moistened. Then turn the bottle, standing it on the cork and let it remain from 9 to 10 hours. Then loosen the cork a little, and let the liquid that may be in the neck of the bottle drain out. In a few days the pellets are entirely dry and ready to be filled into smaller vials.

* In medicating pilules and globules, a suitable quantity of them should be placed in a bottle and the tincture with which they are to be saturated should be poured over them in sufficient quantity to thoroughly moisten every one of them; and the regular admixture of the tincture and the pilules or globules should be insured by repeatedly shaking or better still, by grasping the bottle firmly and giving the hand a rapid circular motion, holding the bottle, first perpendicularly, then horizontally.

Some fill the bottles with the tincture and leave the pilules and globules to macerate for several days; while others carefully ascertain how much they will absorb and add exactly that quantity. Whichever plan is followed, the greatest possible care is required to secure perfect saturation.

The latter process, when carefully carried out, has the advantage of avoiding all exposure of the pilules and globules in drying; whereas if the former plan is followed, it is necessary after a time to pour off the excess of the tincture and to dry the pilules and globules between sheets of filtering paper - a plan that is objectionable on many accounts. (British Homoeopathic Pharmacopoeia)

Utility

* The globules retain their virtue from 18 to 20 years, if they are protected from heat and sunlight and the bottle is only opened in places, odourless and free from dust.

* These serve a convenient dosage form when a large number of doses are to be dispensed for frequent or repeated use.

Precaution

In medicating cane sugar globules, care should be exercised not to use a dilution having an alcoholic strength of much less than 88 Pecent or that of dispensing alcohol.

Globules have to be discarded, in any of the following conditions -

* When there is a change in the colour of the globules, i.e. they become 'yellow'.

* When the globules stick to each other or to the walls of the container. This occurs when the globules absorb moisture or the water content in the medication is high. Globules do not stand medication in these cases.

* When there is a change in the taste or the odour of the globules.

* Presence of impurities.

CONES Medication of cones The process of medication of cones is same as that of globules. They are medicated by pouring sufficient quantity of medicine upon them and pouring off the excess. The common size, numbered 6 should absorb 2 drops of dispensing alcohol.

Storage

Medicated cones should be kept in a dry place to prevent fermentation due to dampness.

Utility

They are used for preservation of potentized medicines for a longer time.

SUGAR OF MILK

Medication of sugar of milk

* To prepare the pellets to give to patients, one or a couple of such little pellets are put into the open end of a paper capsule containing two or three grains of powdered sugar of milk; this is then stroked with a spatula or the nail of the thumb with some degree of pressure until it is felt that the pellet or pellets are crushed and broken.

* Pour the number of drops (or minims) on measured quantity of sugar of milk in the proportion of 1grain, 2grains or 4grains as desired.

Precaution

Do not medicate sugar of milk with medicines prepared with dilute alcohol or distilled water as the sugar of milk will be thereby partially dissolved.

TINCTURE TRITURATIONS

These are preparations of sugar of milk saturated with the mother or strong tincture of the desired drug. They are convenient for dispensing lower potencies of vegetable drugs.

In making 1X potency of Tincture Trituration (T.T.), take 10ml of the desired mother or strong tincture and 10gm of sugar of milk. Warm the sugar of milk and the mortar, moderately mix the tincture with the sugar of milk and triturate it for one hour; when it will be found that the menstrum is completely volatilized and a stable and perfectly dry substance is obtained. Label it 1X with the name of the drug as (T.T.) tincture trituration. Prepare 2X and all succeeding tincture triturations by adding one part of the preceding tincture triturate to nine parts of sugar of milk and triturating for one hour.

TABLET TRITURATES OR MOULDED TABLETS

These act as effective, cohesive and protective excipient of the drug. Tablet triturates are powders that are moulded in the form of a tablet. The tablet triturates retain their shape under normal conditions and may be swallowed whole or crushed into a powder. The tablet triturates are allowed to dissolve on the tongue or in a teaspoonful of water. Drugs are triturated with sugar of milk in given proportion for not less than two hours till thorough comminution is obtained. Tablet triturates are then made by making a stiff paste of the medicinal powder with 60 Pecent alcohol. The apparatus used for their preparation consists of a stainless steel upper plate with perforations that correspond in size, position and number to the range of pegs fixed in a lower stainless steel plate. The plates are made in a range of sizes - 1/2 to 4 grains and about 50 to 250 tablet triturates are prepared at a time. Plates may be designed to produce tablets in various shapes. The stiff paste prepared is pressed into the perforations of upper plate. A spatula is used to ensure that each cavity is filled and to smooth off the excess. The filled paste is then pressed down on the lower plate, thus leaving the paste in the form of tablets, resting on each peg. The tablets are then left to dry for 1 to 2 hour. The alcohol evaporates and the partially dissolved sugar of milk rapidly recrystallizes and is ready for administration.

TABLETS

Medication of tablets

Tablets may be prepared premedicated or they may be medicated by the same process as globules, but small quantity of medicine is used to medicate the tablets.

1 grain tablet is medicated with a drop of medicine powered upon it.

LIQUID DOSAGE FORM

* The oral use of liquids is advantageous on the basis of ease of administration to those individuals who have difficulty in swallowing solid dosage forms.

* A drug administered in solution is immediately available for absorption. It is more rapidly and more efficiently absorbed than the same drug and dose in a solid dosage form.

DISTILLED WATER

Medication of water and its importance

* Such a globule, placed dry upon the tongue, is one of the smallest doses for a moderate recent case of illness. Here but few nerves are touched by the medicine. A similar globule, crushed with some sugar of milk and dissolved in a good deal of water and stirred well before every administration will produce a far more powerful medicine for the use of several days. Every dose, no matter how minute, touches, on the contrary, many nerves. (Aphorism 272)

* There are numerous patients of so excitable a nature, that they may be sufficiently affected by the dose of a small pellet laid dry upon the tongue, in slight acute ailments. It is most useful to give to the patient the powerful homoeopathic pellet or pellets only in solution, and this solution in divided doses. In this way, the medicine can be given, dissolved in seven to twenty tablespoons of water without any addition; in acute and very acute diseases every six, four or two hours; where the danger is urgent, even every hour or every half-hour, a tablespoonful at a time as a dose. In taking one and the same medicine repeatedly, if the dose is in every case varied and modified only a little in its degree of dynamization, then the vital force of the patient will calmly and willingly receive the same medicine even at brief intervals very many times in succession with the best results. This modification of doses is possible only in aqueous medium.

* Medicines prepared according to fifty millesimal scale are dispensed only in aqueous medium.

* Doses, prepared either in globules or sugar of milk can be dissolved in distilled water and dispensed in aqueous medium, taking care that the dose is in every case modified a little in its degree of dynamization.

Disadvantages

* The dispensing of aqueous vehicles has this disadvantage that they are less stable than solid dosage forms, since deleterious changes take place more readily in solution.

Medicines to be dispensed in distilled water must be recently prepared, for immediate use, because deterioration is likely, if they are stored longer. The patient is to be warned against long storage by a label instructing that any unused part must be discarded after a specified date. There is no official recommendation as to the shelf life of such a preparation.

* They are bulky to carry around.

* A spoon is needed to administer the dose.

* Accidental breakage of the glass container results in complete and messy loss of the contents.

* Unpleasant flavour of tinctures is difficult to mask, if dispensed in water.

The preparation should be stable. It should maintain a status quo with reference to its curative properties. Preservation is necessary to prevent changes and microbial growth.

Since water commences after a few days to be spoil, whereby the power of the small quantity of medicine contained is destroyed, the addition of a little alcohol is necessary, or where this is not practicable, or if the patient cannot bear it, add a few small pieces of hard charcoal to the watery solution.

SIMPLE SYRUP Syrups are medicated or flavoured aqueous solutions of sucrose used for dispensing. In dispensing of tinctures, flavour becomes an important factor. To mask the taste of the nauseous ingredients, a flavouring agent, like simple syrup is used. Syrups contain a high proportion of sucrose and usually have a sweet or fruity flavour.

MEDICATED POWDERS

Trituration of drug substances, insoluble in water and alcohol, to form the mother substance and further potencies prepared by trituration from the mother substance, can dispensed in their original form as medicated powders.

Medicated powders, to be dispensed in a particular potency, are prepared by adding to each 10 g of milk sugar, 1 cubic centimeter of the next lower than the desired strength of dilution, mixing the same in a mortar with spatula, then triturating with a pestle until fully dry. The resulting powder will represent the degree of strength next above the dilution used in its preparation and should be so marked (H.P.U.S.).

The medicine should be taken dry and allowed to dissolve on the tongue, or be moistened with two or three drops of water on a spoon.

Advantages

* Powders show a greater stability than liquid dosage forms.

* The smaller particle size of powders give a greater and more rapid diffusion than that obtained from other solid forms like globules and tablets.

* In this form, each dose can be separately enclosed as unit dose.

SELF ASSESSMENT

* Describe the different methods of dispensing homoeopathic medicines.

* What are the vehicles used in dispensing of homoeopathic medicines? Discuss the role of globules and distilled water in dispensing medicines.

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