All-Purpose Nipple Ointment (APNO) Compounded in Etobicoke

Sore, cracked, or burning nipples can derail breastfeeding faster than almost anything else. For many new moms in Etobicoke and across the Toronto west end, the answer their lactation consultant or family doctor recommends is APNO — All-Purpose Nipple Ointment, a compounded prescription created right here in Toronto by pediatrician Dr. Jack Newman. Here is what APNO is, why it works, and how to get it filled at a local compounding pharmacy in Etobicoke.

What Is APNO and Why Was It Developed in Toronto?

APNO stands for All-Purpose Nipple Ointment. It was developed by Toronto pediatrician Dr. Jack Newman, founder of the International Breastfeeding Centre, to address the most common causes of nipple pain in breastfeeding mothers — bacterial infection, inflammation, and yeast (Candida albicans) overgrowth — in a single combination cream rather than three separate products.

The classic APNO formula combines three active ingredients:

  • Mupirocin 2% — a topical antibiotic that targets Staphylococcus aureus and other bacteria that commonly live in cracked or damaged nipple skin.
  • Betamethasone 0.1% — a topical corticosteroid that reduces the redness, swelling, and inflammatory pain that contribute to most of the discomfort mothers feel.
  • Miconazole 2% — an antifungal that addresses Candida, a frequent contributor to deep, burning nipple pain that does not respond to antibiotics alone.

Because no commercial product combines all three ingredients in the correct base, APNO must be prepared by a compounding pharmacy from a prescription. It is one of the most familiar compounded medications in Canadian community pharmacy practice, particularly in the GTA where Dr. Newman's work originated.

Why APNO Is Only Available Through a Compounding Pharmacy

A regular retail pharmacy cannot hand you a tube of APNO off the shelf — it does not exist that way. Mupirocin, betamethasone, and miconazole are sold as separate commercial products, each in different bases (creams, ointments, and powders). Combining them at the right ratios, in a single stable ointment vehicle, is the work of a licensed compounding pharmacy.

At Humber Bay Compounding Pharmacy in Etobicoke, our compounding lab follows Ontario College of Pharmacists (OCP) and NAPRA standards for non-sterile compounding. Each tube of APNO is prepared using pharmaceutical-grade ingredients, measured to the prescriber's exact concentrations, and labeled with clear instructions for the patient. We also confirm the prescription with your prescriber if anything needs clarification before we compound — because for a breastfeeding mom in pain, accuracy matters more than speed.

The result is a single ointment that addresses several overlapping causes of sore nipples at once, instead of asking a sleep-deprived new mom to coordinate three separate products at every feed.

How to Get APNO Filled at Humber Bay Compounding Pharmacy

Here is what the process typically looks like for moms in Etobicoke, Mimico, New Toronto, The Queensway, and the rest of Toronto's west end:

  1. Get a prescription. APNO requires a prescription from a physician, nurse practitioner, or midwife. Family doctors, pediatricians, and midwives in the GTA are familiar with the standard APNO formulation and can write for it directly. Many lactation consultants will recommend you bring the prescription to a compounding pharmacy that prepares APNO regularly.
  2. Send the prescription to us. Your prescriber can fax it to 647-351-2323, or you can bring the original to the pharmacy. We are located at 2240 Lake Shore Blvd W, Unit C107, inside the Lake Shore medical clinic in Etobicoke.
  3. We compound it fresh. APNO is prepared in-house in our compounding lab. Same-day or next-day turnaround is typical, depending on prescription volume that day.
  4. We counsel you on use. Before you leave (or before delivery), a pharmacist will review how to apply the ointment, what to expect, safety considerations during feeds, and when to follow up with your prescriber if pain is not improving.

If getting to the pharmacy is difficult during the early weeks postpartum, ask us about local delivery options when you call. More information about our compounding services is available on our compounding pharmacy FAQ page.

Frequently Asked Questions About APNO

Do I need a prescription for APNO?

Yes. Two of the three active ingredients — mupirocin and betamethasone — are prescription-only in Canada. You will need a written or faxed prescription from your physician, nurse practitioner, or midwife before we can compound APNO.

Is APNO safe to use while breastfeeding?

Dr. Newman's standard guidance is that APNO is applied sparingly after feeds and is not wiped off before the next feed. The amount transferred to the infant is very small, and the formula has been used in breastfeeding mothers for decades. Always confirm safety with your prescriber and let your pharmacist know about any allergies or other medications you or your baby are taking.

How long does APNO take to work?

Many mothers notice some improvement within a few days, though timing depends on the underlying cause of the nipple pain. APNO works best when it is used alongside — not instead of — addressing latch, positioning, and any other root causes of pain with help from a lactation consultant or your healthcare team. If pain is not improving, follow up with your prescriber.

The Bottom Line for Toronto Moms

Breastfeeding pain is common, treatable, and not something a new mom should be told to simply push through. APNO remains one of the most established compounded treatments for sore nipples in Canada — and getting it filled is straightforward when you work with a local compounding pharmacy that prepares it regularly.

Have questions about compounded medications? Contact Humber Bay Compounding Pharmacy at 647-348-2323 or visit us at 2240 Lake Shore Blvd W, Unit C107, Etobicoke. We're your local compounding specialists in Toronto's west end.