Mr.

M Raj Kumar
Dean of Academics
Department of Pharmaceutics
MIXTURES
CONTENTS
Introduction
1.Definition.
2.Advantages.
3.Disadvantages.
Classification or Types
Formulation
Storage
 MIXTURES
A mixture is a liquid preparation meant for
oral administration in which medicament or
medicaments are dissolved , suspended or
dispersed in a suitable vehicle.
 ADVANATAGES
1. Easy to administer.
2. Suitable for insoluble drug.
3. Suitable for immiscible drug.
4. The bioavailability is more compare to solid dosage form.
DISADVANATAGES
1. Less soluble than solid dosage form.
2. Incompatibilities.
3. Stability.
4. Expensive.
5. Bulky to carry.
 CLASSIFICATION

1. Simple mixture containing soluble substances

2. Mixture containing diffusible solids

3. Mixture containing indiffusible solids

4. Mixture containing Precipitate forming liquids

5. Mixture containing Slightly soluble liquid

 DIFFUSIBLE MIXTURES
 Diffusible solids are insoluble in water.
 Uniformly dispersed in the vehicle on shaking.
 No need of suspending agent.
 Example:

 Bismuth carbonate.
 Bismuth subnitrate.
 Magnesium carbonate.
 METHOD OF DISPENSING
1. Powder drug in mortar add soluble drug and mix.
2. Measure 3/4th of vehicle. Make smooth cream by portion of vehicle.
3. Transfer content from mortar into a measuring
apparatus.
4. Add any liquid ingredient.
5. Add more vehicle to produce final volume.
6. Fill in bottle and label. Cork it.
7. Attach label “ Shake well before use”
wrap bottle and dispense.
METHOD OF DISPENSING

Drug+ soluble material + Vehicle a part from 3/4th

Smooth cream
Add remaining vehicle from 3/4th
Add to measure
Add other liquid ingredient

Make up the volume with remaining

vehicle
 INDIFFUSIBLE MIXTURES

 Indiffusible solids are insoluble in vehicle.

 N o t evenly distribute throughout the vehicle on shaking or not
distribute in vehicle for sufficiently long time.
 E x . Acetyl salicylic acid, Quinine salicylate, calomel,
Phenacetin, chalk powder.
 Suspending of drug is required.
suspending agents are added in formulation.
 SUSPENDING AGENTS
 Compound Tragacanth Powder:
 I t content 20% acacia, 15% tragacanth,
 I n the proportion of 2g/100 ml of themixture.
 I t is used when the vehicle is other than water or chloroform
 Tragacanth mucilage:
 I n the proportion of 1/4th of the volume of the mixture
 I t is used when the vehicle is waterorchloroform water.
 METHOD OF DISPENSING
Solid’s + Tragacanth powder (2%)

Triturate the powder with a portion from ¾ of

vehicle
Smooth cream is formed
Add remaining portion of vehicle from 3/4th.

Examination

Add other liquid ingredient + soluble ingredients Make up the

volume with remaining vehicle

 Solid’s +Tragacanth Mucilage(1/4th)

Triturate
Smooth cream is formed
Add 1/2 of the vehicle.

Examination

Add other liquid ingredient + soluble ingredients Make up the

volume with remaining vehicle

 EXAMPLE
Rx
Ppt chalk powder -----------30 grain.
Catechu tincture ------------ 20 minim.
Cinnamon water ------------ 1 fl.oz.
 Direction:
Secundis hora sumenda
 Method of Preparation:
Method of dispensing using tragacanth powder
 PRECIPITATE FORMING LIQUIDS

Certain liquid preparations contain resinous matter.

when mixed with water, the resinis precipitated
- which may adhere to sides of bottle or
- form a clotted precipitate.
This will not re-diffuse upon shaking.
 T o prevent this, suspending agentis used.
 E x . resin extract, tincturesetc.
 METHOD OF DISPENSING
Solid’s + Tragacanth powder (2%)

Triturate the powder with a portion from ¾ of vehicle

Smooth cream is formed
Add precipitate forming liquid in the centre of cream

Add remaining portion of vehicle from 3/4th.

Examination

Add other liquid ingredient + soluble ingredients Make up the

volume with remaining vehicle

Solid’s + Precipitate forming liquid + Tragacanth
Mucilage(1/4th)

Triturate
Sooth cream is formed
Add 1/2 of the vehicle.

Examination

Add other liquid ingredient + soluble ingredients

Make up the volume with remaining vehicle

 MIXTURE CONTAINING SLIGHTLY SOLUBLE LIQUID

 T h e insoluble portion ofslightly soluble liquids is not readily

diffusible.
 S o a suspending agent such as tragacanth powder or tragacanth
mucilage are needed to dispense such mixtures.
 E x . Paraldehydeliquid
 METHOD OF DISPENSING

Paraldehyde + tragacanth mucilage in bottle

Shake vigorously
Dissolve syrup and liquid extract of glycyrrhiza in
water.
Add to
Bottle Content
Shake vigorously
Make up the volume by adding water
 FORMULATION
Drug: Antibiotics , antipyretics, analgesic, etc
Vehicles: following vehicles are used.
Water:
 purified water

Aromatic water: Multiple use, e.g. chloroform water, Cinnamon
water, etc.

Medicated vehicle: Infusions, ex. Senega infusion as expectorant.
Adjuncts: Adjuncts are generally used to improve the Safety, efficacy
and palatability.
Chemical Stabilizers: e.g. Antioxidant: Ascorbic acid (0.1%), Sodium
metabisulphite
 (0.1%) etc.
Preservatives: Chloroform (o.25%), Benzoic acid (0.1%) Methyl paraben,
propyl
 paraben, etc.
Coloring Agents:
E.g. Coal tar dyes.
Flavoring Agents: The following flavoring agents are commonly used
in mixtures.

Aromatic water Syrup and Glycerol.

Spirit lemon to cover the taste of alkaline citrates.
Orange
 syrup and compound orange spirit.


 STORAGE

 Mixtures are dispensed in plain glass bottles with uniform

internal diameter.
 The mixture should be dispensed and supplied to the patient for not
more than 3 days to prevent deterioration.
 The bottle should be fitted with a suitable cork which ensures
its easy removal and to prevent spilling of Mixture.
POWDERS
 Definition
Powders are the mixture of finely divided drug
or chemicals in dry form.

They are used for internally & externally.

They are available in crystalline or amorphous form.

There is a relationship between particle size of powder & dissolution,

absorption & therapeutic effect of drug.
 Advantages of Powders
 Powders are more stable than liquid dosageform.
 The chance of incompatibility are less as compared to liquid dosage form.

 The onset of action of powdered drug is rapid as compared to other solid dosage form e.g.
tablet, capsules. Due to smaller particle size of powder, it get dissolved easily in body fluids.
 Larger quty. of powdered drugs can be administered to the patient orally by dissolving or mixing
the powder in the suitable liquid.
 Small children or elderly patient can easily take the powdered drug as such or dispersed in water
orany other liquid.
 Powders are more economical as compared with other dosage form because not required any
special machinery or technique.
 Powders are more easy to carry than the liquid dosage form.
 Disadvantages of Powders
 Drugs having bitter, nauseous & unpleasant taste cannot be dispensed in
powdered form.

 Deliquescent & hygroscopic drugs cannot be dispensed in powder form.

 Drugs which get affected by atmospheric conditions are not suitable

for dispensing in powder forms.

 The dispensing of powder is a time consuming.

 CLASSIFICATION OF POWDERS

1. Bulk powder for internaluse.

2. Bulk powder for externaluse.

3. Simple & Compound powder for internaluse.

4. Powders enclosed in cachets &capsules.

5. Compressed powders (Tablets)

 Dispensing of Powders Involving Special Problems

 Volatile Substances:
- Certain vegetable powder contains volatile oil.

- Toprevent the loss of volatile oils, these vegetable drugs must be powdered lightly in a
mortar.

- Also, menthol, camphor & essential oils takes place

incorporation in powder.

- Final product pack with double wrapping.

 Dispensing of Powders Involving Special Problems

 Hygroscopic & deliquescent powders:

- Absorb the moisture from atmosphere are called hygroscopic
powders.
- Absorb the moisture from atmosphere & convert into solution are called
deliquescent powders.
- E.g. ammonium chloride, ammonium citrate, pepsin,
phenobarbitone, sodium iodide etc.
- Such substance are usually provide in granular form in order to exposé less
surface area to atmosphere & avoid convert into fine powder.
- Such powder should be double wrapped.
 Dispensing of Powders Involving Special Problems

 Efflorescent powders:

- Some crystalline substance liberates water of crystallisation wholly or partly on

exposure to humid atmosphere.
- e.g. citric acid, caffeine, ferrous sulphateetc.
- So, this problem overcome by mixing or incorporate with
inert substanceor using anhydrous slat.
 Dispensing of Powders Involving Special Problems

 Eutectic mixture:
A eutectic mixture is defined as a mixture of two or more components which usually do not
interact to form a new chemical compound but, which at certain ratios, inhibit the crystallization
process of one another resulting in a system having a lower melting point than either of the
components
 Liquids:
- In some prescription the liquid medicaments are also incorporated with powders.

- In that case, if liquid Quantiity is small, it may be triturated with equal amount of
powder, then the reset of the ingredients are incorporated in small proportions with
continuous stirring.
 Dispensing of Powders Involving Special Problems

 Potent drugs:
- The substance having a max. dose of less than 60 mg & poisonous substances are called
potentdrugs.
- It should be difficult to weigh on dispensing balance.
- For that, firstly potent drugs incorporated with diluents such as lactose before weigh.
- e.g. Dispense following powder in 5 powderpackets
- Rx,
Codeine phosphate 10 mg
In that case, weigh 100 mg of codeine phosphate & 900 mg of lactose mixed with ascending
order with help of spatula.
Out of 1 gm of triturate, weigh 100 mg of each powder contains 10 mg of codeine phosphate
& pack in powder paper.
 Dispensing of Powders Involving Special Problems
 Granular powders:
- Some solid medicaments required to administered in orally in large dose & its not
possible to convert into tablet or capsule bec. a large number of them will be required to
take single dose.
- And these medicaments are difficult to dispense in powder form bec. Its bitter, nauseous
& unpleasant taste.
- In this case, solid medicaments mix with sweetening, flavoring & coloring agent with
suitable granulating agent to moisten the powder to make coherentmass.
- Then, pass through sieve no. 10 to make granules & dry in hot air oven at 600C & after
drying pass through sieve no. 20 & pack into wide mouth containers.
- E.g. Nowadays, antibiotics like erythromycin, ampicillin etc are available in granular
powder bec. They are unstable in liquid form.
 Effervescent granules:
- These type of medicament granules are prepared for internal use.
- In that, medicaments mixed with citric acid, tartaric acid & sodium bicarbonate with
sweetening agents also present.
- When contact with water they release of carbon dioxide to mask the bitter & saline taste
of drug.
- Also, carbon dioxide stimulates the f low of gastric juice &
helps in the absorption ofmedicaments.
 INDRODUCTION
 Incompatibility is defined as a change resulting and an undesirable
product is formed, which may affect the safety, efficacy appearance
and stability of the pharmaceutical product.
 Incompatibilities occurs during
▪ Packaging
▪ Compounding
▪ Dispensing
▪ Formulation
▪ Storage
▪ Manufacturing
▪ administration of drugs
 DEFINITION
 It is defined as when two or more ingredients
of a prescription are mixed together , the
undesired changes that may takes place in
the physical, chemical or therapeutic
properties of the medicament is termed as
incompatibility.”
Incompatibilities occur during:-
• Compounding
• Formulation
• Manufacturing
• Packaging
• Dispensing
• Storage
• Administration of drugs

 The incompatibilities may be detected by changes in

the physical, chemical, and therapeutic qualities of
the medicine.
 TYPES OF INCOMPATIBILITIES:-
 The incompatibilities occur when the components of a
medicine interact in such a way that properties of that
medicine are adversely affected.
Physical incompatibilities

Chemical incompatibilities

Therapeutic incompatibilities
 PHYSICAL INCOMPATIBILITIES
❑ When two or more than two substances are combined
together, a physical change takes place and an unacceptable
product is formed.
❑ Interaction between two or more substances which may lead
to change in color, odor, taste, viscosity and morphology. It is
also called as pharmaceutical incompatibility.
❑ Manifestations of physical incompatibility:-
❑ The following list outlines the various ways
incompatibility between or among drug agents may be
manifested.
 PHYSICAL INCOMPATIBILITIES
A. Insolubility:-insolubility of prescribed agents in vehicle
B. Immiscibility:-Immiscibility of two or more liquids
C. Precipitation:-It occurs due to solvent is insoluble when it
is added to solution
D.Liquefaction:-Liquefaction of solids mixed in a dry state
(called eutexia)
 PHYSICAL INCOMPATIBILITIES
• A. Insolubility:-insolubility of prescribed agents in vehicle:
 It means the inability of material to dissolve in a particular solvent system.
The majority of incompatibilities is due to insolubility of the inorganic as well
as organic compounds in particular solvents.
 The following factors affect the solubility of prescribed agent in vehicle and
may render it less soluble.
➢ Change in pH
➢ Chemical reaction
➢ Surfactant
➢ Complex formation
 PHYSICAL INCOMPATIBILITIES
 Any change in previous factors may lead to precipitation of drugs
and change in their properties.
 Substances like chalk, acetyl salicylic acid, succinyl sulphathiazole,
zinc oxide, and calamine are the common examples of in diffusible
solids.
 Some tinctures containing resins or chlorophyll may provide
precipitation when added to the aqueous system.
 PHYSICAL INCOMPATIBILITIES

 Causes: - Chalk powder is not soluble in water.It gets precipitated when

added to aqueous medium.These precipitates are found indiffusible in
nature which results in physical incompatibility.
 Remedy: - Use of suspending agents is necessary to
suspend the precipitated chalk particles.
 Generally 2% W/V of compound tragacanth powder is recommended as
suspending agent.
 PHYSICAL INCOMPATIBILITIES
B. Immiscibility:-Immiscibility of two or more liquids
❑ When two such ingredients are combined resulting in a non-
homogenous product, such ingredients are called immiscible to each
other and the phenomenon is called immiscibility.
❑ This manifestation appears clearly in emulsions, creams,
lotions, some types of ointments.
❑ Separation in two phases is noticed in this
pharmaceutical dosage form.
❑ Storage must be in room temperature to prevent separation
 PHYSICAL INCOMPATIBILITIES
B. Immiscibility:-Immiscibility of two or more liquids
 The following factors lead to immiscibility
 Incomplete mixing
 Addition of surfactant with
 Unsuitable concentration
 False time of addition
 Unsuitable for the type of emulsion
 Presence of micro – organisms
 Some bacteria grow on constituents of mixture. E.g.:- Gelatin Arabic gum
 PHYSICAL INCOMPATIBILITIES
B. Immiscibility:-Immiscibility of two or more liquids
 Others produce enzymes which oxidize the surfactant.
 Temperature
 Oils and water are immiscible with each other which shows
physical incompatibility
E.g.:- Castor oil emulsion
Rx
Castor oil – 15ml
Water – 60ml
 PHYSICAL INCOMPATIBILITIES
B. Immiscibility:-Immiscibility of two or more liquids
 Causes: -In this prescription castor oil is immiscible with water due to high
interfacial tensions, which is a sign of incompatibility.
 Remedy:-To overcome this type of incompatibility emulsification is
necessary with the help of an emulsifying agent.
 The corrected prescription is
Ex: Castor oil emulsion
Rx
Castor oil – 15ml
Acacia – 2% W/V
Water– upto 60ml
 PHYSICAL INCOMPATIBILITIES
C. Precipitation:-It occurs due to solvent is insoluble when it is added to
solution.
 PRECIPITATION: Solubilized substances may precipitate from it
solution if a non-solvent for the substances is added to the solution.
 E.g.:- Resins are insoluble in water
 Alcoholic solution of resins + water =precipitated resins.
 Aqueous dispersions of hydrophilic colloids (polysaccharide mucilage
+ high concentration of alcohol or salts) =precipitated colloids.
 PHYSICAL INCOMPATIBILITIES
C. Precipitation:-It occurs due to solvent is insoluble when it is
added to solution.
 a) High concentration of electrolytes causes cracking of soap emulsion by
salting out the emulsifying agents.
 Vehicles (one or more organic liquids) use to dissolve medicaments of
low solubility; water soluble adjuvant practically inorganic salts may be
precipitated in such vehicles.
 When tinctures containing resinous matter are added in water, resin
agglomerates forms indiffusible precipitates.
 This can be prevented by slowly adding the undiluted tincture with
vigorous shake. Suspension or by adding
 PHYSICAL INCOMPATIBILITIES
C. Precipitation:-It occurs due to solvent is insoluble when it is added to
solution.
E.g.:- Lotion of compound tincture of benzoin
Rx
Tincture benzoin compound – 5g
Glycerin – 10ml
Rose water upto 100ml
 Causes: - Tincture benzoin compound contain resins.This change in
solvent system results in an unavoidable precipitate.
 Remedy: - Addition of tincture with rapid stirring yields a fine colloidal
dispersion. So there is no need of any suspending
 PHYSICAL INCOMPATIBILITIES
D. Liquefaction:-Liquefaction of solids mixed in a dry state (called eutexia) :
 When certain low melting point solids are mixed together, a liquid or
soft mass know as eutectic mixture is produced.
 This occurs due to the lowering of the melting point of the mixture to
below room temperature and liberation of hydrates.
 If such conditions take place, compounding such powders becomes difficult
since the ultimate mixture turns to liquid.
 The medicaments showing this type of behavior are camphor, menthol,
phenol, thymol, chloral hydrate,
D.Liquefaction:-Liquefaction of solids mixed in a dry state (called
eutexia) :
 Causes: - This mixture is a physical incompatibility because both the ingredients
in the prescription are liquefiable of mixed together.
 Remedy:-These substances can be dispensed by any one of the following method.
 Triturate together to form liquid and mixed with an absorbent (light kaolin,
magnesium carbonate) to produce the following powder.
 The individual medicaments is powdered separately and mixed with an adsorbent and
then combined together tightly and filled in a suitable container.
 CHEMICAL INCOMPATIBILITIES
Reaction between two or more substances which lead to change in
chemical properties of pharmaceutical dosage form. As a result of this a
toxic or inactive or product may be formed
 Occurrence:- These reactions may be
noticed by
 Chemical incompatibilities
occur, due to the chemical ❑ Precipitation
properties of drugs and additive
❑ Effervescence
like,
 PH change ❑ Decomposition
 Oxidation-reduction reactions
❑ Color change
 Acid-base hydrolysis

 Double decomposition ❑ Explosion

 CHEMICAL INCOMPATIBILITIES : TYPES
 Based on chemical interactions
 Tolerated incompatibility: - In this type incompatibility, the
chemical interactions can be minimized by changing the order of
mixing, the solutions in dilute forms, but no alteration is made in
formulation
 Adjusted incompatibilities: - In adjusted incompatibility the
chemical interaction can be prevented by addition or
substitution of one of the reacting ingredients of a prescription
with another of equal therapeutic value .
 E.g.: substitution of caffeine citrate with caffeine in sodium
salicylate and caffeine citrate mixture
 CHEMICAL INCOMPATIBILITIES : TYPES

 Based on nature of chemical reaction

 Immediate incompatibilities: - If the chemical reaction
takes place, immediately after combining the prescription
ingredients, they are called immediate incompatibilities.
Hence, they should be dispensed only after correction.
 Delayed incompatibility: - When the chemical reaction
proceeds at a very slow rate and no appreciable visible
change occurs which may develop on keeping the product for
along time are called delayed incompatibility.
 CHEMICAL INCOMPATIBILITIES : TYPES
 Based on the prescriber
 Intentional:- When the prescriber knowingly prescribes the
incompatible drugs.
 Unintentional :- When the prescriber prescribes the drugs
without knowing that there is incompatibility between the
prescribed drugs.
 Generally reaction between strong solution proceed at a faster rate
and the precipitates are formed are thick and do not diffuse readily.
 Reaction between the dilute solutions proceeds at a slow rate and the
precipitates formed are light and diffuse readily in the solution.
 Hence the reacting substances should be diluted as much as
possible before mixing.
 CHEMICAL INCOMPATIBILITIES : TYPES
 Precipitate yielding interactions
 The precipitates so formed may be diffusible or indiffusible. The method A or B
is followed indispensing the prescription yielding diffusible and indiffusible
precipitates respectively.
 The preparation should contain a thickening agent if the precipitate is non-
diffusible.
 Method A:
 This method is suitable for diffusible precipitates following steps are carried out.
 Divide the vehicle into two portions.
 Dissolve the reactants in separate portions and mix the two portions by slowly
by adding one into other with
 CHEMICAL INCOMPATIBILITIES : TYPES
 Method B:
 This method is suitable for indiffusible precipitates following
steps involved:
 Divide the vehicle into two portions.
 Dissolve the one of the reacting substance in one portion.
 Place second portion of vehicle in mortar and incorporate
suitable amount of compound.
 Tragacanth powder (2g/100ml of preparation) with constant trituration until a smooth
mucilage is produced.
 Add and dissolve the other reacting substance to the mucilage.
 Add the solution of first reactant to the mucilage slowly with
constant stirring.
 A secondary label ―SHAKE THE BOTTLE BEFORE USE‖ should be fixed on the container
whenever method A or method B is followed in dispensing the prescription.
 CHEMICAL INCOMPATIBILITIES : TYPES
Alkaloid incompatibility:-
1. Alkaloidal salts with alkaloid substances
2. Alkaloidal salts with soluble iodides
3. Alkaloidal salts with tannins
4. Alkaloid salts with salicylates
5. Alkaloid with soluble iodides and bromides.
Soluble salicylates incompatibility:-
1.Soluble salicylates with ferric salts
2.Soluble salicylates with alkali bicarbonates
3.Soluble salicylates and benzoates with acids.
Soluble iodides incompatibility:-
1.Oxidation of iodides with potassium chlorate
2.Oxidation of iodides with quinine sulphate.
 CHEMICAL INCOMPATIBILITIES : TYPES
 Chemical incompatibility causing evolution of carbon dioxide
gas:-
1.Sodium bicarbonate with soluble calcium or magnesium salts
2.Bismuthsubnitrate and sodium bicarbonate
3.Borax with sodium bicarbonate and glycerin.

 Miscellaneous incompatibilities:-
1.Soluble barbiturates with ammonium bromide
2.Potassium chlorate with oxdisible substances
3. Incompatibility of emulsifying agent
4. Color stability of dyes
5. Incompatibilities of liquorices liquid extract
 CHEMICAL INCOMPATIBILITIES : TYPES
Eg-1: strychnine hydrochloride mixture
Rx
Strychnine hydrochloride solution -6ml
Aromatic spirit of ammonia -4ml
Water up to - 120ml
 Causes:-

 The quantity of strychnine hydrochloride is more than its solubility in

water (1:7000).
 The aromatic spirit of ammonia contains negligible mount alcohol.
 Remedy: - Strychnine hydrochloride gets precipitated yielding
diffusible precipitate, hence
 CHEMICAL INCOMPATIBILITIES : TYPES
 E.g-2.:Quinine hydrochloride mixture
Rx
Quinine hydrochloride -0.12ml
Sodium salicylate -4g
Water -100ml
 Causes: - When quinine hydrochloride combined with the sodium
salicylates it forms quinine salicylates which is an indiffusible
precipitate.
 Remedy: - Hence follow method B for precipitate yielding
interactions.
 THERAPEUTIC INCOMPATIBILITY

 It is the modification of the therapeutic effect of one

drug by the prior concomitant administration of
another. It may be as a result of prescribing certain
drugs to a patient with the intention to produce a
specific degree of pharmacological action, but have
restore or intensity of the action produced is
different room that intended by the prescriber.
 THERAPEUTIC INCOMPATIBILITY
 MECHANISM:
It is divided into two groups. They are
➢ Pharmacokinetic: absorption, distribution, metabolism and excretion.
➢ Pharmacodynamics: These are related to the pharmacological activity of the
interacting drugs.
E.g., Synergism, antagonism, altered cellular transport, effect on the receptor site.
 Therapeutic incompatibilities occurs due to following reasons

a. Error in dosage
b. Wrong dose or dosage form
c. Contra-indicated drugs
d. Synergistic and antagonistic drugs
e. Drug interactions
 THERAPEUTIC INCOMPATIBILITY
 ERROR IN DOSAGE
 Many therapeutic incompatibilities result from errors in writing or
interpreting the prescription order.
 The most serious type of the dosage error in the dispensing is overdose of a
medication26.
E.g., Atropine sulphate capsules
Rx
Atropine sulphate - 0.005g
Phenobarbitone - 0.015g
Aspirin - 0.300g
 Causes:- In this prescription, the quantity of the atropine
sulphate in each capsule is more than its recommended dose.
 Remedy:- The prescription is referred back to the prescriber to correct the overdose of
the atropine sulphate.
 The recommended dose of atropine for a single capsule is 0.25
to 2mg.
 THERAPEUTIC INCOMPATIBILITY

WRONG DOSE OR DOSAGE FORM

 There are certain drugs which have quite similar names and there is
always a danger of dispensing the wrong drug.
E.g., Prednisone and Prednisolone
Digoxin and Digitoxin
 Some times many drugs are available in the different dosage forms and
hence, if the dosage form is not clearly mentioned on the prescription,
it becomes necessary to seek clarification from the prescriber.
 The responsibility of the pharmacist becomes to check the prescription
intensively and if he finds these types of errors he should immediately
consult the prescriber for the clarification.
 THERAPEUTIC INCOMPATIBILITY
PRESCRIBING CONTRA-INDICATED DRUGS
 There are certain drugs which may be contra- indicated in a particular
disease or a particular patient who is allergic to it.
 Corticosteroids are contra-indicated in the patients having peptic
ulcers
 The penicillin and sulphur drugs are contra- indicated in the patients
who are allergic.
 Vasoconstrictors are contra-indicated in hypertensive patients.
 Barbiturates and morphine should not be given to the asthmatic patients.
 THERAPEUTIC INCOMPATIBILITY

E.g., Sulphadiazine capsules

 Causes:-Ammonium chloride is a urinary acidifier. It causes the
deposition of the Sulphonamide crystals in the kidney.
 Remedy: - Before prescribing such substances a doctor must be careful.
 If he does not, a Pharmacist shows his caliberto point out such type of the doctor’s
error.
 Such must Immediately be referred back tothe concerned doctor and get
corrected.
 PRESCRIBING SYNERGISTIC OR ANTAGONISTIC DRUGS
 When two drugs are prescribed together, they tend to increase the activity of each
other which is known as SYNERGISM.
 When two drugs are prescribed together, they tend to decrease the activity of each
other which is known as ANTAGONISM.
E.g.,
 A combination of aspirin and paracetamol increases the analgesic activity.

 A combination of penicillin and streptomycin increases the antibacterial

activity.
 Amphetamines show its antagonists effect with the barbiturates.
 E.g., Amphetamine sulphate syrup
 Causes:-In this prescription, there is a combination of two sympathomimetic
drugs There by causing additive effect.
 Remedy:- The prescription is referred backto the prescriber for necessary
corrections.
 DRUG INTERACTIONS
 The effect of one drug is altered by the prior or simultaneous
administration of another drug. The drug interaction can usually be
corrected by the proper adjustment of dosage if the suspected interaction
is detected.
 E.g., Tetracycline capsule - 250mg capsules
 Direction: Take one capsule every 6 hours with milk.
 Causes:-Tetracycline is inactivated by calcium present in milk.
 So, it should not be taken with milk.
 Remedy: In this prescription, the therapeutic incompatibility
is unintentional.
 So, the prescription is referred back to the prescriber to change the direction