Details to consider when preparing Shohl’s solution in the pharmacy…Dear Colleagues, this week we will examine the formula named Shohl’s solution, which has been published by the Pharmacists Associations of two different countries, the American and Australian Pharmacists Associations, and is used for systemic alkalinization in the urinary tract and kidneys.Allen’s Compounded Formulations
Shohl’s Solution (Sodium Citrate and Citric Acid Solution)
Rp.
Sodium Citrate Dihydrate 10 g
Citric Acid Monohydrate 6.68 g
Purified Water or Flavored Vehicle qs 100 mlIn this formula published by the American Pharmacists Association;
Sodium citrate dihydrate and citric acid monohydrate are dissolved in approximately 80 ml of purified water or dissolved in a flavored vehicle and stirred until completely dissolved. The formula is then brought to 100 ml with distilled water or a flavored vehicle and mixed thoroughly. The solution prepared in distilled water can be filtered if desired.
In the USA, especially in compounding pharmacies, various flavor options are offered to pediatric patients through dispensers containing different flavors, allowing the preparation of syrups with the flavor preferred by children.
For systemic alkalinization purposes, a 10 to 30 ml solution is diluted with 1 to 3 liters of water and should be taken after meals or before bedtime. The pH value of the aqueous solution is between 4 and 4.4.
This preparation contains 500 mg sodium citrate (5 mEq sodium ion) and 334 mg citric acid per 5 ml.
Indications: It is used in chronic metabolic acidosis caused by renal tubular acidosis, in the treatment of uric acid, and in the management of cystine stones forming in the urinary system.
Store in tightly closed containers at room temperature, although refrigeration may improve palatability. Preservative-free formulas can remain stable for 14 days when kept refrigerated.
Examining the formulas published by the American Pharmacists Association and referred to as Modified Shohl’s, which contain two different formulas;Modified Shohl’s Solution (Albright’s Solution)
1)
Rp.
Citric Acid 140 g
Hydrate Sodium Citrate 90 g
Purified Water ad 1000 ml
2)
Rp.
Citric Acid 6 g
Sodium Citrate 10 g
Purified Water ad 100 mlModified Shohl’s solution in the literatureSuby- Albright Solution “G” there is another formula under the heading. The formula contains sodium carbonate and is less irritating, but less acidic, and form G is less effective in preventing urinary stone formation in the bladder compared to other formulas.Suby- Albright Solution “G”
Rp.
Citric Acid Monohydrate 32.25 g
Magnesium Oxide 3.84 g
Anhydrous Sodium Carbonate 4.37 g
Sterile Distilled Water qs 1000 mlIn general, while patient compliance is higher in flavored syrups, stability is longer in sugar-free formulas.
In preparations named Albright’s solution, Shohl’s solution, and sodium citrate and citric acid oral solution, one milliliter of solution is equivalent to 1 mEq of sodium and bicarbonate. Citric acid present in the formulas consists of colorless translucent crystals or white granules with the appearance of fine powder. It is odorless and has a strong acidic taste.
Since its hydrous form contains 1 molecule of water, its concentration in the formula is expressed in terms of anhydrous citric acid; it is soluble in water.
Sodium citrate is a colorless crystal or white crystalline powder formed in anhydrous form. It contains 2 molecules of water. The concentration is expressed as anhydrous sodium citrate; it is soluble in water.
Shohl’s solution published by the Pharmaceutical Society of AustraliaRp.
Sodium citrate 20 g
Citric acid monohydrate 4 g
Lemon syrup 10 ml
Methyl hydroxybenzoate solution 1 ml
Purified water, freshly boiled and cooled to 100 mlThis formula is a pediatric formula and contains 20% sodium citrate (limit 18.5% to 21% w/v C6H5Na3O7.2H20) The dose is generally adjusted according to electrolyte requirements. It should be taken diluted with water. Methyl hydroxybenzoate solution is included in the formula for preservative purposes. The period of use is 28 days from the date of preparation. Previously boiled and cooled water is used in the formula. In pharmacy, water should be understood as distilled water. The shelf life of distilled water is limited. In any case, it must be boiled before use. Here, the process of boiling and cooling the water aims to prevent oxidation, a degradation reaction seen in solution dosage forms. To prevent the oxidation reaction, solutions should be prepared under nitrogen or carbon dioxide gas. If prepared manually in pharmacy laboratories, it is necessary to boil the water used to remove dissolved oxygen from the solution. Freshly distilled water can also be used for the same purpose. Adding antioxidant substances to the medium is also an appropriate method. After opening the packaging of solutions, microbial contamination and contamination during use lead to degradation. Preservatives should be added to prevent this.In conclusion;It is observed that Shohl’s solution does not have a single standard formula, and in addition to formulas containing flavored vehicles used in its preparation, it is seen that the formula is prepared either using pre-boiled and cooled distilled water or solely using distilled water.
It should be taken into account that a Pharmacist, compounding medications in their pharmacy by utilizing all their professional knowledge and skills, According to the Art (Secundum Artem)can prepare this formula.
Wishing you a good week…Source:1-RxMediaPharma®2016 Interactive Drug Information Resource.
2-Australian Pharmaceutical Formulary (and handbook 21st edition)3-Allen’s Compounded Formulations / The Complete U.S. Pharmacist Collection
4-Solutions / Zelihagül DEYİM
Spec. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657http://www.majistralformul.com/
