Date:

29/04/2024

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 1% Naltrexone Powder
  • 2% Diphenhydramine Powder
  • 5% ML Glycerin
  • 2.5% Hydrocortisone Powder
  • 2% Lidocaine Powder
  • 87.5% Xematop

Quantity:

SIG:

Refills:

Prescribing Doctor Name: