Question Regarding Availability Of Liquid Forms For Certain Drugs

Jay asked

I'm doing some research for my 95-year-old father. I need to find out if any of his medications come in liquid form. He's currently taking the following: Coumadin, sotalol, metoprolol, Lasix, Crestor, montelukast, azithromycin, and rifampin. Do you know if any of these come in liquid form? Thank you.

Answer

Thanks for reaching out to us! We are more than happy to help.

I'll touch on each of the medications you mentioned in your question in regard to whether or not they are available in a liquid dosage form. To recap, the drugs in question are:

• Coumadin (warfarin)
• Sotalol
• Metoprolol
• Lasix (furosemide)
• Crestor (rosuvastatin)
• Montelukast
• Azithromycin
• Rifampin

An important note before we get going is that we need to differentiate between a liquid drug product that is available commercially and those that are not.

A commercially available drug product means that it is mass-produced by a pharmaceutical company and distributed to pharmacies.

Drugs that are not commercially produced in a liquid form can be often be compounded by a compounding pharmacy. There are many reasons why a particular drug may not be produced commercially in a liquid dosage form, but it mostly has to do with long-term stability.

Nevertheless, a compounding pharmacy may be able to make a one-month supply at a time of many drugs if you absolutely need a liquid formulation.

If that is the case, you may want to reach out to a local compounding pharmacy to see if they could make it for you (and whether or not it would be covered by insurance).

On to your list!

Coumadin (Warfain)

Coumadin, a blood thinner, is not available in a liquid dosage form.

However, it can be compounded by a specialty pharmacy. One study reported that a warfarin compound containing deionized water, glycerin, sodium phosphate, and strawberry alcohol concentrate was stable at room temperature for 30 days.

Most retail pharmacies would not be able to make a compounded liquid warfarin, so if this is something you need or want to look into, contact a compounding pharmacy.

Sotalol

Sotalol, an anti-arrhythmic, is available in a liquid dosage form, but only as a branded product. It is not available generically so you may find an issue with insurance covering it.

The branded product is called Sotylize 5mg/mL.

Metoprolol

Metoprolol, a 'beta-blocker' is not available in a liquid formulation but it is commonly compounded (much more so than warfarin).

It is important to note that metoprolol comes as both an immediate-release product (metoprolol tartrate) and an extended-release product (metoprolol succinate).

Compounded metoprolol suspensions are all going to be in the 'immediate-release' dosage form so if you are taking metoprolol succinate (the extended-release product), you may be out of luck.

Metoprolol can be compounded by most pharmacies (not just specialty compounding pharmacies).

In fact, there is a commercially produced product that is essentially a 'compounding kit' that pharmacies can utilize called 'First-Metoprolol'.

The resulting metoprolol tartrate solution from the kit is 10mg/mL and is stable for 60 days at room temperature.

In order to get this product, your doctor would write a prescription for the 'kit' and the pharmacist would use it to compound the drug immediately before dispensing to you.

Lasix (Furosemide)

Lasix (furosemide), a loop diuretic, is available in a liquid dosage form.

Several manufacturers make a furosemide 10mg/mL solution and if your insurance covers tablets, it should also cover the liquid dosage forms.

Crestor (Rosuvastatin)

Crestor (rosuvastatin), a cholesterol medication, in not available in a liquid dosage form.

However, you do have a few options.

Firstly, rosuvastatin is available in another branded product known as Ezallor. Ezallor comes as sprinkle capsules, which can be opened and sprinkled on food like applesauce prior to taking. While this isn't quite the same as a liquid, it can help ease administration.

Like many of the drugs I've talked about here, rosuvastatin can be compounded.

One study showed that a compounded rosuvastatin 20mg/mL solution is stable for 30 days at room temperature. Be sure to reach out to your local compounding pharmacy to inquire as to whether or not they can make this and if it would be covered under your insurance.

Montelukast

Montelukast, a medication used for allergies and asthma, is not available in a liquid dosage form.

It is, however, available as chewable tablets and as 'granules', which can be mixed with the following foods:

• Applesauce
• Carrots
• Rice
• Ice cream

Azithromycin

Azithromycin, an antibiotic, is available as a liquid suspension in two different strengths:

• 100 mg/5 mL
• 200 mg/5 mL

Unfortunately, these suspensions are stored in the pharmacy as powders, which are then mixed (i.e. reconstituted) by the pharmacist immediately prior to dispensing. Once reconstituted, they are only stable for 10 days.

If you are taking this antibiotic every day, it may not be practical to return to the pharmacy every 10 days for a refill.

Rifampin

Rifampin, an antibiotic, is not available in a liquid dosage form.

However, it can be easily compounded by most pharmacies as either a 10 mg/mL solution or a 25 mg/mL solution.

Studies show that compounded rifampin solutions are stable for 28 days at room temperature.