CreamTopicalNon sterile Rx only

Ivermectin 1%/Metronidazole 0.75% Topical (ExoBlue™)

Peptide and Zinc Hyaluronate Cream Base (ExoBlue™)

A compounded ivermectin 1% and metronidazole 0.75% cream in PCCA's ExoBlue base, prepared in Chino, CA to a prescriber's order. Not FDA approved.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

USP <795> compliant
USP <800> hazardous drug lab
PCCA member

At a Glance

Preparation details for Ivermectin 1%/Metronidazole 0.75% Topical (ExoBlue™)
Dosage form	Cream
Route	Topical
Active ingredients	Ivermectin, Metronidazole
Technology	Peptide and Zinc Hyaluronate Cream Base (ExoBlue™)
Strengths in literature	FDA approved ivermectin cream is 1%. FDA approved metronidazole gel and cream are 0.75% and 1%
Commercial product	No U.S. commercial product
Strength and directions	Per prescriber
Dispensing	Valid prescription

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Phone (909) 378-7301. Fax (909) 378-7071

Clinical Advantages

Multiple actives in one base
Custom strength available
Applied topically
Non sterile preparation

How It Works

What are ivermectin and metronidazole?

Ivermectin 1% cream, sold as Soolantra, is labeled for the treatment of inflammatory lesions of rosacea. It is for use on the skin only, and not for oral, eye, or vaginal use [1].
Topical metronidazole, sold as a 0.75% gel, a 1% gel, and a 0.75% cream, is labeled for the treatment of inflammatory papules and pustules, or inflammatory lesions, of rosacea. The labels say how it works in rosacea is unknown, but appears to include an anti inflammatory effect [2][3][4].

No FDA approved product combines ivermectin and metronidazole.

What ExoBlue is, and what compounding in it provides

ExoBlue is a topical base made by PCCA. PCCA calls it a cosmetic base for skincare and anti aging use. Its base page lists hormones, tretinoin, spironolactone, and tranexamic acid among the common drug types used in it, and does not name ivermectin or metronidazole. Mixwell prepares ivermectin and metronidazole in ExoBlue at the strengths the prescriber orders. PCCA describes ExoBlue as follows [5]:

A light blue, smooth cream. The blue color comes from its copper peptide
Built on a core system of acetyl hexapeptide 8, GHK copper peptide, zinc hyaluronate, and a Centella asiatica derived exosome and peptide complex
Designed to support overall skin conditioning and visible skin renewal
Described as enhancing hydration and supporting a balanced skin environment
Light and moisturizing, for use on oily, normal, or dry skin
Designed to maintain peptide stability and support consistent performance

Compounding puts both medicines in one cream, in this base, at strengths the prescriber sets, in place of two separate products. These are the manufacturer's descriptions of a cosmetic base. They are not findings by the FDA, and they are not claims about ivermectin or metronidazole.

When prescribers choose it

Dermatologists and primary care providers treating rosacea
Prescribers who want ivermectin and metronidazole together in one cream
Prescribers who want to set the strength of each ingredient

Clinical Details

What does the evidence show?

FDA approved ivermectin cream 1% is labeled for the treatment of inflammatory lesions of rosacea [1].
FDA approved topical metronidazole is labeled for the treatment of inflammatory papules and pustules of rosacea (0.75% gel and 0.75% cream) or inflammatory lesions of rosacea (1% gel) [2][3][4].
No FDA approved product combines the two or is made in ExoBlue, which its maker describes as a cosmetic base [5]. The FDA has not reviewed this preparation.

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Why it is compounded

Ivermectin and metronidazole are FDA approved as separate products [1][2][3][4]. No approved product combines them. A prescriber who wants both in one cream, at set strengths, orders it compounded.

Dosage forms and strengths

Strength of each ingredient set by the prescriber
ExoBlue base, a light blue cream
Quantities matched to the prescription

Dosing and duration are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds this cream in Chino, California under USP 795 standards for non sterile preparations [6]. Our pharmacist confirms the strengths and base with the prescriber before compounding. Batch records document every preparation, and finished creams ship across California.

Safety information

Ivermectin cream labeling says it is not for oral, ophthalmic, or intravaginal use. Its most common reported side effects are skin burning sensation and skin irritation, and contact dermatitis and allergic dermatitis have been reported after approval [1].

Topical metronidazole labeling says it has been reported to cause tearing of the eyes, so contact with the eyes should be avoided. The patient information for the 1% gel says not to use it in the mouth, eyes, or vagina [3]. The labels note that oral metronidazole has shown carcinogenic activity in rodents [3][4]. Oral metronidazole has been reported to increase the effect of warfarin and coumarin blood thinners, and the effect of topical metronidazole on prothrombin time is not known [2][4]. The 0.75% gel label contraindicates use in people with a history of hypersensitivity to metronidazole, parabens, or other ingredients of the formulation [2].

No FDA labeling states how much of either ingredient is absorbed from this combined cream, or how the base affects irritation. Tell your prescriber about any ingredient allergies. Mixwell can provide the ingredient list for your preparation. Patient selection, dosing, and monitoring are the prescriber's responsibility.

References

SOOLANTRA (ivermectin) cream, 1%. Prescribing information. DailyMed. DailyMed
Metronidazole gel USP (topical), 0.75%. Prescribing information. DailyMed. DailyMed
METROGEL (metronidazole) gel, 1%. Prescribing information. DailyMed. DailyMed
Metronidazole topical cream, 0.75%. Prescribing information. DailyMed. DailyMed
ExoBlue. Product information. PCCA. PCCA product page PCCA base technologies
United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

APIs and strengths
Base or vehicle
Quantity
Directions for use
Refills
Allergies or dye free needs

Call (909) 378-7301 Fax (909) 378-7071

Compounded in Chino, CA. Delivered across California.

Chino
Chino Hills
Ontario
Pomona
Diamond Bar
Rancho Cucamonga
Eastvale

Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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