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It is unfortunate that more companies don't continue to manufacture older products - I guess if they're not highly profitable, nobody want anything to do with them. Even the generics won't make them. I would chalk this up the FDA - prohibitively expensive to go through the audits on drugs that don't make money. I kind of blame the FDA for this. They should take on a grandfather policy. Instead we get stuck with herbalists and homeopathic medicines...
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I can't imagine supporting GMP or whatever other audit costs on things like soluble morphine sulfate or codeine phosphate, USP tablets would consume vast resources, or indeed on Tuinal, amyl nitrite, USP crushable inhalant ampoules, B&O (Belladonna & Opium suppositories, USP), and all that other stuff, would be some prodigious expense compared with an NDA.

Yet there will be the patient that needs them, and Lilly carries more of these quasi-orphan drugs or drugs in these forms than anyone else I know of except for the compounding pharmacists that want to dive really deep and order in USP/NF pure forms things like Cocaine Hydrochloride, crystalline, USP from Merck et al.

Good example of a needing Pt.: HS buddy of mine, father Hx massive liver damage due to Hep infected blood; he had to count up the number of grams of protein he had every day to make sure he didn't go over his limit and go into hepatic coma. Dx: extreme hepatic damage, Prognosis: not hopeful. It was a tragic case, fortunately he had a doctor that took chemistry in school.

Without going into all his numerous and consequent symptoms and problems, pain was a problem. Lilly's little soluble codeine tablets were his blessing; APAP/codeine or anything with acetominaphen would have meant adios amigo, or anything else remotely threatening to the liver would have been the end. He was so on the edge that he was allowed one or maybe two hot dogs a week because more than that, the fragmentary proteins and God only knows what else they have in hot dogs would have put him over the edge; as it was he was also on lactulose syrup to reduce danger from excessive nitrogenous levels in the blood by the GI / hepatic pathway and of course Lasix (furosemide, Hoercst <- I can never spell their name right, nor pronounce it) to counter the edematous problems. Hot dogs were his favorite thing to eat.

But I remember that little brown bottle, original Lilly, that looked like it was 100 years old, with codeine phosphate, soluble tablets, USP in it and marvelling at how tiny they were to hold a whole grain (which used to be 64 mg...rrrgh.. now 60. Metrics, you gotta hate them.) They looked little larger than saccharin tablets (Sherwin-Williams, US paint maker, used to be the world's largest maker of saccharin sodium, bet you didn't know that). [Makes you wonder what they make it out of...]

Patients with kidney stones or acute, intractable lower GI problems would stand in line to swear to B&O. Preop patients would do the same for Tuinal, as well as pt.s with intractable insomnia (of limited duration, like 5 days.) The USAF flight surgeons still issue an amphetamine compound and a barbiturate (probably Tuinal) for pilots of single-pilot fighters and bombers for long flights, to keep them awake, and to put them down when they finally safely arrive or return from overseas.

And I remember aerosol Mercurochrome in the red rubber coated glass bottles and ethyl chloride packed much the same way with the Lilly name on it (different color bottle).

And of course I'm leaving out hundreds of medications that because of their preparation, or even identity, nobody else makes or supplies but Lilly. And patients still depend upon them. The old drugs that nobody cares about anymore, but that might be the precise medicine for a particular patient with a given indication.

(Well, I might make an exception in Mercurochrome's case but...)

In particular, Lilly and Merck have stood virtually alone in supporting compounding pharmacists and their need for medicines in their pure form. I know this from pharmacy audits I have personally done over the years. Of course, the number of pharmacists able to understand, let alone be able to execute and fill, a compounded prescription order has greatly shrunk from what it was 10, 20, 30 years ago. I suppose, in a sadly fortunate way, the number of physicians able to properly write a compounded prescription order has diminished even more rapidly, or God knows what we'd be looking at.

I wonder how an Rx. for Brompton's Cocktail would go over anywhere in the US outside a hospice-associated pharmacy. (Well, they'd have to substitute something for the diacetylmorphine [Heroin] in any case, that is DEA Class I in the USA, meaning ixnay. Methadone would work (which Lilly makes).] (Heroin can be used only in experimental, controlled, limited situations, as any Schedule I drug may be.)

Another Pt. I know has intractable back pain and takes a compounded liquid prescription (disGUSting, banana flavored) that's methadone and hydroxyzine (Vistaril, Atarax) as a synergist. He wouldn't be able to get this medicine here in Montana if it were not for Lilly. There are a few other companies that deal with methadone but usually in concert with drug rehabilitation programs, not as a primary pain management agent. But out in the boondocks, compounding pharmacists, the few we have, count on Lilly and Merck one or two of the fine chem companies.

I do not recall seeing compounding-quality substances from anyone else; of course most of these things were in the pharmacy safe or hidden elsewhere. During audits, estimating the remaining contents of a bottle of crystalline cocaine hydrochloride had its moments. (Like, "I don't want my fingerprints on this, let alone open the bottle.")

And any respectable compounding pharmacist would have a microbalance and appropriate volumetric measuring equipment, not the flasks of red and green water in the front window. A laminar flow hood would be nice too.

Eli Lilly & Co, and Merck, deserve due credit for supporting the vanishing number of compounding pharmacists, and especially in Lilly's case, in continuing to inventory drugs rarely called for beyond belief.

It would not overly surprise me to see if Lilly still had standardized digitalis leaves, powdered, USP, somewhere, and I would be proud to know they did.

RSH.
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