Most of the failures were again related to potency, ranging Lenvatinib from 68 to 268 % of the labeled dosage. The FDA concluded that the compounding processes used at pharmacies most likely caused the quality failures and reiterated that this rate of failure raises public health concerns for buy IWR-1 compounded drugs. Annual testing of randomly selected compounded drugs by the Missouri

Board of Pharmacy covering the years 2005–2009 showed failure rates between 11.6 and 25.2 %, with potency ranging from 0 to 450 % of the labeled dosage [26]. The Ohio State Board of Pharmacy performed similar testing of compounded drugs in 2007, which found potency results ranging from 27 to 87 % of the labeled dosage and 1,380 doses of fungally contaminated products. Thousands of the purportedly sterile compounded products that were examined had not undergone appropriate sterility testing [27]. Over the period 2008–2010, the Texas State Board of Pharmacy found an overall potency failure rate of 23 % for compounded drugs [28]. 4.2 Scientific Literature on the Quality of Compounded Drugs Azarnoff et al. [29] tested compounded nitroglycerin ointments (84,000 prescriptions in 2004) and found that 46 % failed basic tests for potency and content uniformity. Similar potency variations

Milciclib mouse were found in compounded diaminopyridine products, with assays ranging from 22 to 125 % of the labeled dosage [30]. Goldman investigated content variability of compounded sodium tetradecyl sulfate solutions and found that compounding pharmacies were using a lower-quality ingredient as a starting material, which produced significant concentrations of a highly toxic contaminant called carbitol [31]. Mahaguna et al. compared the

quality of compounded vaginal progesterone suppositories with that of the FDA-approved formulation. Only one of the ten pharmacy-compounded products met the labeled potency specifications. There were also large pH differences in the suppositories, and the products from one compounding pharmacy were microbially contaminated [32]. An investigation of the quality of compounded hydroxyprogesterone caproate (HPC) samples obtained from 30 compounding pharmacies across the US found that 27 % failed to meet potency standards, and 53 % had impurity levels exceeding those allowed in the FDA-approved version of Liothyronine Sodium the drug. Testing of the active pharmaceutical ingredient (API) used to compound the drug product revealed that one sample was glucose, and eight of the other nine API samples exceeded the impurity limits set for HPC used in the FDA-approved drug [33]. A subsequent FDA investigation confirmed instances of variable quality in compounded HPC and the API used to prepare it, which prompted the FDA to remind prescribers and patients that FDA-approved medicines provide a greater assurance of safety and efficacy than compounded drugs [10].