1. Lozenges, Troches, Sticks, and Suppositories
Practicum in Pharmacy Technician

2. Introduction
Lozenges, troches, sticks, and suppositories are all solid dosage forms that are prepared similarly using molds.
Each is designed to melt, soften, or dissolve at body temperature upon administration.

3. Types and Definitions
Lozenges and troches – are both dosage forms that are placed in the oral cavity, either onto the tongue or into the cheek pouch, and meant to disintegrate over time.
Chew troches have been developed and are intended to be chewed and swallowed, delivering medication in the gastrointestinal tract.

4. Types and Definitions
The terms lozenge and troche are often used interchangeably.
There is one distinct difference between the two.
Lozenge is never chewed and swallow; it is placed in the oral cavity to dissolve slowly over time.
Troches were intended to be used in the same manner; but is now available in a chewable form.
Either one may be used when the treatment is intended for either a local or systemic effect.

5. Types and Definitions
In the past, lozenges and troches, were used extensively to deliver antiseptics and anesthetics to the oral cavity for the relief for minor sore throat pain or irritations in the mouth.
Today, they are being compounded with the specific patient in mind for a variety of drug classes.
A few common drug classes prepared in lozenge or troche form include antimicrobials, analgesics, antitussives, corticosteroids, and decongestants.

6. Composition and Ingredients
Hard lozenges or troches are made of a hard candy base consisting of sugars and other carbohydrates, such as corn syrup.
They will have an adhesive agent such as acacia added.
Chewable troches are made from a gelatin base, resulting in a “gummy” product.

7. Preparation and Compounding Techniques
Many different molds are available for the compounding of lozenges and troches.
The mold must be calibrated for each formula.
This is done by filling a sample of 10 molds with the base only.
Always good to prepare molds beforehand by spraying them with nonstick cooking spray.
Hardy candy lozenges are prepared by heating the sugars and syrups to approximately 154*C.
Powdered ingredients are then added.
Followed by flavoring.
Then poured into the molds.

8. Preparation and Compounding Techniques
Another method is to pour out the mixture onto a prepared surface and stretch the mass into a ribbon.
The ribbon is then cut into equal pieces.
Extreme care must be taken to ensure that the pieces are of equal size and weight so that the correct dosage is contained within each piece.

9. Types and Definitions
Sticks- are prepared for the topical use of either medications or cosmetics.
They are a unique solid dosage form used in topical application of local anesthetics, sunscreens, antivirals, antibiotics, and cosmetics.
They may include a pharmaceutical active ingredient that serves to heal or protect.

10. Composition and Ingredients
Material used in preparing medicated sticks include waxes, polymers, resins, dry solids fused into a firm mass, and fused crystals.
3 Types of Sticks:
Hard Sticks – consist of crystalline powders that are fused by heat or held together with a binder such as cocoa butter.
Example: Styptic pencil
Soft Opaque Sticks – usually contain petrolatum, cocoa butter in their base; most are this type.
Example: Lip balm containing antiviral and a sunscreen
Soft Clear Sticks- made from sodium stearate and propylene glycol and usually contain water or alcohol.
Example: deodorant stick

11. Preparation and Compounding Techniques
It is imperative that a quality product is produced in order for the stick to be both acceptable and usable.
A stick should spread easily onto the application site without excessive greasiness.
Should be uniform throughout.
It is important that it does not crumble, crack, sweat.

12. Preparation and Compounding Techniques
The high melting point waxes must be blended with the low melting point waxes to produce a product that will melt or soften at body temperature.
To change the consistency of the final product, the percentage of wax with the highest melting point is increased or decreased so that its melting point is adjusted.
Lubricants are necessary to aid in the spreading of the medication.

13. Preparation and Compounding Techniques
Sticks are prepared using a mold.
Molds must be calibrated for each formula being prepared.
To calibrate fill 10 sticks with the base alone.
The powders to be used are mixed using geometric dilution.
The bases are melted at the appropriate temperature and the solid ingredients are added.
Coloring and flavoring agents are added last.
The mixture is poured into the molds.

14. Types and Definitions
Suppositories – are used to deliver medications via the rectum, the vagina, or the urethra.
They are to melt at body temperature, delivering the drug either locally or systemically.
The route of delivery and the patient will determine the shape and size of the suppository.

15. Types and Definitions
Rectal suppositories are conical or cylindrical in shape.
They are tapered at either one end or both ends for ease of insertion.
Adult suppositories typically weigh approximately 2 grams and are anywhere from 1 inch long to 1 ½ inches long.
Infant suppositories are usually about half the size of adult suppositories.

16. Types and Definitions
Vaginal suppositories are available in a variety of shapes.
They may be conical, cylindrical, globular, or ovoid in shape.
They usually weigh between 3 grams and 5 grams each.
They are typically made from water soluble bases to help minimize leakage.
They may be made of a gelatin capsule that will melt in bodily fluids.
One other form is the compressed tablet, know as an insert.

17. Types and Definitions
Urethral suppositories are pencil shaped with a 5mm diameter.
The length will depend on the gender of the patient.
Female is 50 mm in length and weigh approximately 2 grams.
Male is 125 mm in length and weigh approximately 4 grams.
Urethral suppositories are rarely prescribed.

18. Types and Definitions
Suppositories can be for either local or systemic effects.
The most commonly prescribed suppositories are for a local effect to sooth irritate tissues or to stimulate defecation.
Hemorrhoids, itching, infections, laxative.
Vaginal suppositories may result in an more systemic effect.
Circulatory system absorption (systemic) may be exerted through the urethra or rectum as well.
Usually given to pts who cannot swallow or when pH of the enzymes in the GI Tract will inactivate the medication.

19. Composition and Ingredients
Bases used in compounding suppositories should be stable and nonirritating.
They should melt or dissolve in the body cavity at body temperature.
The base will not interfere with the release or absorption of the active ingredient.
The most commonly used bases are Cocoa butter, glycerin bases, Fattibase, and Polybase.

20. Preparation and Compounding Techniques
Suppositories can be prepared in several ways, including hand molding or fusion.
Hand molding is performed when using cocoa butter as the base, as it has a low melting point and can be shaped and manipulated at room temperature.
When the mixture becomes a solid form, it can be shaped with the hands into a long cylinder and cut to desired length and the tip rounded.

21. Preparation and Compounding Techniques
Fusion is a method where the base is melted by using a water bath on a hot plate and poured into pre-calibrated molds.
Once the pouring process has begun it should not be interrupted, as a layered effect will occur, resulting in weakness that will cause the suppository to break.
The mold cavities should be slightly overfilled to allow for contraction during the cooling process.
Once cooled, the excess is trimmed using a razor or heated spatula.