Oral Suspensions Template

Prescription Template

400 Taché Ave, Winnipeg, MB R2H 2A4
Phone: (204) 233-3469   Fax: (204) 231-1739

Patient

SexMF

Common Compounded Suspensions

Check one

Standard concentrations we prepare regularly. Most are compounded in a ready-to-use suspending base; sugar-free and flavour options are available on request.

Sulfamethoxazole 40 mg / trimethoprim 8 mg per mL
Acyclovir 40 mg/mL (200 mg/5 mL)
Valacyclovir 50 mg/mL
Omeprazole 10 mg/mL (alkaline base)
Metformin 100 mg/mL (sugar-free)
Montelukast 2.5 mg/mL
Azathioprine 50 mg/mL
Chlorthalidone 12.5 mg/mL
Propranolol 1 mg/mL
Atenolol 2 mg/mL (sugar-free)
Nadolol 2 mg/mL
Sotalol 5 mg/mL
Flecainide 20 mg/mL
Clobazam 2 mg/mL
Baclofen 5 mg/mL
Trihexyphenidyl 0.4 mg/mL
Clonidine 0.025 mg/mL
Clonidine 0.1 mg/mL
Guanfacine 0.25 mg/mL
Quetiapine 25 mg/mL
Sertraline 5 mg/mL
Escitalopram 5 mg/mL
Trazodone 25 mg/mL
Glycopyrrolate 1 mg/mL

Or Any Other Medication

We can suspend most tablets and capsules

Write the drug and either a target concentration or the mg dose — we will confirm the standard concentration and stability with you before preparing.

Drug Concentration
mg/mL, or dose

Directions

Give mg = mL (frequency) (route/notes)

An oral syringe and the measured concentration are dispensed with every suspension. Patient instructions: tachepharmacy.com/instructions/compounded-oral-liquids

Quantity mL Refills

Prescriber
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