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Mupirocin / Betamethasone Valerate Gel (WO6® Anhydrous)

Anhydrous Base

A compounded topical gel combining mupirocin and betamethasone valerate in WO6® anhydrous base, prepared to each prescriber's order for use on the skin.

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

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

Clinical Advantages

  • Multiple actives in one base
  • Custom strength available
  • Preservative free
  • Gluten free base
  • Applied topically

How It Works

What is Mupirocin / Betamethasone Valerate Gel?

Mupirocin / Betamethasone Valerate Gel (WO6® Anhydrous) is a compounded topical preparation that pairs a topical antibacterial with a corticosteroid. Both actives are blended into a water free gel base, so a prescriber can order the two medicines as one application on the skin.

How it works

  1. Mupirocin stops bacterial protein synthesis by inhibiting the bacterial isoleucyl tRNA synthetase enzyme [3].
  2. Betamethasone valerate is a topical corticosteroid that acts on inflammation where it is applied [5].
  3. WO6® is an anhydrous gel base, which matters because mupirocin tends to break down through hydrolysis and rearrangement when water, acid, or base is present [7].
  4. The patient applies a thin layer to the area and on the schedule the prescriber sets.

When prescribers choose it

  • Dermatology practices that want a corticosteroid and a topical antibacterial in a single gel
  • Allergy and immunology practices managing atopic dermatitis with localized bacterial involvement
  • Family medicine and pediatric practices simplifying a two tube regimen into one application
  • Prescribers whose patients prefer a light gel over a greasy ointment

Clinical Details

What does the evidence show?
  • A 2019 Cochrane review identified 14 studies comparing topical steroid and antibiotic combinations with topical steroid alone in eczema. Low quality evidence suggested the combination may produce slightly greater global improvement at 6 to 28 days (risk ratio 1.10, 95% CI 1.00 to 1.21; 3 studies, 224 participants) [1].
  • The same review found probably little or no difference in quality of life for children at 14 days, and it rated the long term antibiotic resistance data as very low quality [1].
  • UK guidance from NICE (2021) advises that people who are not systemically unwell should not routinely receive topical or oral antibiotics for secondary bacterial infection of eczema [2].
  • In the mupirocin ointment labeling, radiolabeled mupirocin applied to the forearm under occlusion for 24 hours produced no measurable systemic absorption [4].

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

No U.S. commercial product combines mupirocin with betamethasone valerate. Each is sold separately: mupirocin 2% ointment comes in a polyethylene glycol base [4], and betamethasone valerate 0.1% is available as a cream, ointment, and lotion [5]. A prescriber who wants both in one gel orders it from a compounding pharmacy.

Dosage forms and strengths

  • Mupirocin and betamethasone valerate strengths set by the prescriber
  • Anhydrous gel base formulated without preservatives or gluten
  • Application frequency and duration are the prescriber's decision

How Mixwell prepares it

Mixwell compounds this gel in Chino, California under USP 795 standards for non sterile preparations. USP 795 classifies preparations with water activity below 0.6 as nonaqueous, a category that allows longer default beyond use dates than water based preparations [6]. [ADD ONE DETAIL LINDA CONFIRMS, such as the dispensing container or storage instruction.] Batch documentation follows USP requirements, and finished preparations ship across California.

Safety information

Systemic corticosteroid absorption increases with larger treatment areas, prolonged use, and occlusive dressings, so prescribers consider area and duration [5]. Children may be more susceptible to HPA axis suppression because of a larger skin surface area to body weight ratio, and tight diapers can act as occlusion [5].

Prolonged mupirocin use may lead to overgrowth of nonsusceptible organisms, including fungi [4], and resistance has been reported with extended use [3]. Mupirocin labeling notes it is not formulated for mucosal surfaces, so this gel is for skin use only [4].

Patient selection, dosing, and monitoring are the prescriber's responsibility.

References
  1. George SMC, Karanovic S, Harrison DA, et al. Interventions to reduce Staphylococcus aureus in the management of eczema. Cochrane Database Syst Rev. 2019;(10):CD003871. doi:10.1002/14651858.CD003871.pub3
  2. National Institute for Health and Care Excellence. Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing (NG190). 2021. nice.org.uk/guidance/ng190
  3. [VERIFY VOLUME AND PAGES] Hetem DJ, Bonten MJ. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect. 2013. PubMed 24144552
  4. Mupirocin ointment, 2%. Prescribing information. DailyMed, U.S. National Library of Medicine. DailyMed label
  5. Betamethasone valerate cream, ointment, and lotion USP, 0.1%. Prescribing information. DailyMed, U.S. National Library of Medicine. DailyMed label
  6. United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.
  7. [VERIFY AUTHORS AND DOI] Clayton JP, et al. The chemistry of pseudomonic acid. Part 3. Rearrangement of pseudomonic acid A in acid and basic solution. J Chem Soc Perkin Trans 1. 1979:838 to 846.

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

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Compounded in Chino, CA. Delivered across California.

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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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Want to learn more about Mupirocin / Betamethasone Valerate Gel (WO6® Anhydrous)

Are you a healthcare provider or patient in Chino, Chino Hills, Ontario, Eastvale, Rancho Cucamonga, or Upland? Mixwell Pharmacy provides specialized pharmaceutical support throughout San Bernardino, Los Angeles, and Orange Counties. Contact our Chino laboratory to learn how we facilitate customized Mupirocin / Betamethasone Valerate Gel (WO6® Anhydrous)for practitioners across Southern California.

(909) 378-7301

Serving Los Angeles County, Orange County, San Bernardino County, Riverside County, Ventura County, and the Inland Empire