title: Investigation of product quality between extemporaneously compounded progesterone vaginal suppositories and an approved progesterone vaginal gel.
abstract: The purpose of this investigation was to compare quality parameters, including product appearance, content uniformity, pH, weight uniformity, microbial limit testing and preservative effectiveness testing on extemporaneously compounded progesterone vaginal suppositories obtained from 10 randomly chosen compounding pharmacies (90 suppositories each) across the United States, to the Food and Drug Administration (FDA) approved prescription progesterone gel product (Prochieve/Crinone) which is manufactured in a cGMP regulated facility. The content uniformity and pH were determined using qualified methods. The microbial limits testing and preservative effectiveness testing were conducted according to compendial methods. Only one pharmacy provided suppositories that were all within the potency limits required for the prescription progesterone gel product. The other pharmacies provided at least some suppositories where progesterone content was either subpotent or superpotent for progesterone. The pH of most of the compounded suppository products was in the range of 4.22 to 7.68 with a median of 6.30 (normal vaginal pH is <5), whereas the gel product was 2.80. For compounded product from one of the pharmacies, microbial limits testing indicated CDC group IVC-2 and Comamonas acidovorans were detected. This data indicates that pharmacy compounded delivery systems for progesterone should be used with caution.
authors.affiliation: PharmaForm, LLC, Austin, TX 78758, USA. vmahaguna@pharmaform.com
authors.forename: Vorapann
authors.initials: V
authors.lastname: Mahaguna
authors.forename: J Mario
authors.initials: JM
authors.lastname: McDermott
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
authors.forename: Felipe
authors.initials: F
authors.lastname: Ochoa
mesh_terms: D002626:Chemistry, Pharmaceutical / Q000379:methods; D004339:Drug Compounding / Q000379:methods* / Q000592:standards; D004349:Drug Packaging / Q000379:methods / Q000592:standards; D004355:Drug Stability; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007218:Industrial Microbiology / Q000379:methods / Q000592:standards; D010316:Particle Size; D004364:Pharmaceutical Preparations / Q000592:standards; D010593:Pharmaceutical Services; D010602:Pharmacopoeias as Topic / Q000592:standards; D011310:Preservatives, Pharmaceutical / Q000737:chemistry / Q000493:pharmacokinetics; D011374:Progesterone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry / Q000493:pharmacokinetics*; D011786:Quality Control; D013488:Suppositories / Q000008:administration & dosage / Q000737:chemistry / Q000493:pharmacokinetics*; D013696:Temperature; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage / Q000737:chemistry / Q000493:pharmacokinetics*
chemical_list: C400424:Crinone; D004364:Pharmaceutical Preparations; D011310:Preservatives, Pharmaceutical; D013488:Suppositories; D014622:Vaginal Creams, Foams, and Jellies; D011374:Progesterone