What is Compounding
Compounding is the creation of a particular medication to fit the unique needs of an individual patient. To do this, a compounding pharmacy combines or processes appropriate ingredients in a laboratory environment, customized to specific patient needs. Demand for professional compounding has grown in recent years as both patients and doctors have realized that the strengths and dosage forms of commercially available medications are often unable or unsuited to meet the needs of many patients, and that they may have a better response to customized medications.
How can compounded medications benefit me?
There are several reasons why patients opt for traditional compounding. Many patients are allergic to ingredients in certain medications such as dyes or casein, are sensitive to standard drug strengths, or may have difficulty swallowing the pills or tablets that their medication comes in as standard. A compounding pharmacist can work with a patient in order to change the strength of a prescribed medication, alter the dosage form to make it easier to take, or even to add a flavor that makes it taste better. Medications can be prepared to use several unique delivery systems such as:
- Sublingual troches or lozenges
- Oral rinses
- Transdermal gels
Is prescription compounding safe?
Yes, compounding has been a part of pharmacy healthcare since its origins and is still used widely today. A compounding pharmacy must abide by state regulations, as well as section 503A of the Federal Food, Drug, and Cosmetic Act and is overseen by the state board of pharmacy.
Every day, women across the country experience a variety of symptoms associated with menopause and hormone imbalance. These include PMS, hot flashes, anxiety, mood swings, irritability, memory lapses and much more. Thankfully, modern medicines can help to relieve these symptoms.
Bioidentical Hormone Replacement Therapy (BHRT) is a cutting-edge solution to a matter facing women every day. It is an alternative to traditional synthetic hormone replacement (HRT) and uses a natural human-identical hormone. The term bioidentical means that the substance that replaces the traditionally utilized synthetic hormone is biologically identical to one made by your own body. These hormones include estrogens, progesterone, DHEA, testosterone, and pregnenolone. Hormone imbalances will vary from woman to woman and a one-size fits all hormone replacement therapy is not optimal. Unlike traditional hormone replacement therapy, the true value of compounded BHRT is that the hormones can be adapted to suit your individual body and hormone levels.
Bioidentical hormones are more readily absorbed by the body and by optimizing the dosage strength the side effects associated with traditional therapies are minimized. This means the hormones work the same way the ones in your body have all your life. BHRT helps women to avoid the typical symptoms of menopause and hormonal imbalance.
- Mood swings
- Hot flashes
- Night sweats
- Low libido
- Heart disease
- Weight gain
- Painful menstruation
- Fibrocystic breasts
Our compounding pharmacy has helped many women with hormone-related problems and we can help you. We offer private consultations with our specially trained pharmacists. Private consultations allow you to address concerns or questions about bioidentical hormone replacement therapy. We will work with you and your physician to test your hormone levels and to develop a customized hormone replacement plan that best suits you.
Veterinary compounding is a specialty service that helps veterinarians broaden their prescribing abilities and to offer dosage forms and strengths that can treat pets in a more effective manner.
Our pharmacist can prepare:
- Flavored medication
- Medication modified by size, strength and dosage form
- Unavailable medications
- Combinations of medications to improve compliance
Getting animals to accept medication can sometimes be a struggle, but a compounded medication can be flavored which may help a dog to accept a beef-flavored tablet or a cat to eat a liver-flavored chew.
Differing medication strengths
Many animal medications come in a standard size, even though different animals even of the same species can vary enormously. For example, with the average Maltese weighing under 7lbs whereas the average Labrador Retriever weighs 10 times as much. Compounded medications allow the veterinarian to scale the dose to suit a pet’s specific size and weight.
Many pets don’t like taking pills, however with veterinary compounding a
veterinarian is able to vary the dosage form depending on the medication.
Chewable treats, eardrops, liquid concentrations and transdermal medications
Men experience many hormonal changes during their lifetime. As men age, the
amount of testosterone produced by their body can decrease. Testosterone is the hormone responsible for sperm production, red blood cell production, muscle growth, libido, energy levels and male sex characteristics such as a deep voice and body hair.
Lowered levels of testosterone can be characterized by symptoms such as:
- Erectile dysfunction
- Loss of libido
- Declining muscle tone
- Irritability or mood swings
If you have been diagnosed with decreased levels of testosterone, then there are many compounded medications that may help you. In consultation with your doctor and our compounding pharmacist, we can customize hormone replacement medications. For example, a transdermal gel can be compounded to deliver testosterone which can be absorbed more readily than other dosage forms.
Pain management is among one of the most essential duties of medicine today. Even if the underlying condition is being treated, uncontrolled pain can severely diminish a patient’s quality of life preventing them from working, or taking part in their usual roles in family and society.
Chronic pain has numerous causes, and therefore can be much more difficult to manage than acute pain from a specific injury or condition, and the customized treatment protocols offered by compounded treatments can meet the specific needs of each patient.
Our compounding specialists offer many unique options for pain management. Regardless of origin, and whether the pain is acute or chronic, our efforts are directed at meeting the specific needs of each patient. We work together with patients and their physicians to reach treatment goals.
Oral Dosage Forms Oral dosage forms can also be customized to meet the specific needs of each patient. For example, we can combine numerous compatible medications into a single dose to make medication management. Medicated lollipops, gummy bears, solutions, and suspensions can also be compounded with added flavors to suit.
Transdermal Dosage Forms Transdermal medications are medications that are absorbed through the skin. This is very useful for patients who are unable to take an oral medication or have an aversion to injections. Many types of medication can be compounded into a transdermal gel.
Rectal Dosage Forms Formulations can be delivered as suppositories, solutions and gels. In addition, there is a specialized delivery system which simultaneously applies the medication internally and externally.
Oral infections, pain or conditions such as chronic mucositis, may call for specialized treatments and drug delivery methods which may not be commercially available.
We work together with patients and their dentists to create non-commercially available formulations for dental care to increase treatment options helping to minimize patient anxiety and pain.
Mouthwashes and rinses are the most common dosage forms for dental patients. However, other options such as lollipops, gummy bears, troches, sprays, lip balm, oral gel and pastes can all be compounded.The following are some examples of the dental solutions that we can provide:
- Presurgical sedation
- Oral pain relief lollipops or lozenges
- Lip balms for viral lesions
- Topical anesthetics
- Crown preparation hydrocortisone gels
- Non-staining antibacterial rinses
- Oral sedation lollipops
- Lollipops for oral thrush
- Mouth rinses for chemotherapy-induced stomatitis
- Lozenges that help to suppress gag reflex
- Difficult to find or commercially unavailable medications.
Dermatology is the branch of medicine that deals with the skin and its diseases. Compounding can help the patient in a variety of ways including topical anesthetics, barrier creams for various applications, and all sorts of skin and wound care formulations that improve results.
If a patient is allergic to a medication then some preservatives, perfumes or emulsifying agents can be specifically removed and/or replaced by other ingredients with a low potential to cause allergies.
Active ingredients such as; dithranol, capsaicin, estradiol benzoate, thiabendazole, menthol, or polidocanol for example are not commonly found in commercial preparations. A customized version of the medication can be compounded to add such active ingredients.
The preparation’s strength can be customized to treat the patient with increasing or decreasing quantities of the active ingredient, which is especially useful in long-term care treatments. There are many treatments that can be improved by compounding including:
- Scar Management
- Plant irritations
- Warts and molluscum
- Anti-Wrinkle creams
- Skin bleaching creams
- Herpes virus
- Wrinkle creams
- Anti-oxidant aging creams/gels
- Contact and allergic dermatitis
- Fever blister meds
- Insect bite
- Viral infections
- Radiation/chemotherapy burns
- Skin cancer
After the skin has been damaged from a burn, trauma, or surgery, scars form as a normal part of healing.Everyone’s scars are different, and it can take up to a year for scars to heal completely. To speed scar healing and add additional therapy components like pain relief, we use a base (Pracasil from PCCA ) with a high concentration of silicones and compound it with additional medications, for example pain medication. This compounded medication simultaneously provides pain relief without the side-effects of an oral medication and speeds up scar healing.
Pediatrics is the specialized branch of medical care for infants, children, and adolescents. This is one of the most popular uses for compounded medications since getting a child to take medication can be problematic and commercial dosages have generally been designed for adults.
Commercial medications can often be bitter or unpleasant, and children may be resistant to receiving these medications.
With compounding, you can add a chocolate flavoring to a bitter tasting medication. Thereby improving the chance that a child will find the medication more appealing. For oral medications, a large variety of different flavors including:
- Mixed Fruit
Because there is a lack of suitable pediatric dosage forms, our compounding pharmacy can formulate alternative doses and dosage forms for your child, including syrups, lollipops, gummy bears, lozenges, or transdermal creams.
Allergic reactions are a symptom of the immune system adversely reacting to typically harmless substances. Common symptoms of an allergic reaction may include rashes, red eyes, sneezing, a runny nose, shortness of breath, or swelling.
One of the most beneficial uses of compounded medicines is for patients who suffer from allergic reactions to ingredients found in common commercial drugs. A compounding pharmacy is able to break a medication down into it’s base compounds, recreating it with the same active ingredients either removing/replacing the offending substance or making the medication into something safer and less likely to cause an allergic reaction. For example a compounding pharmacy may also be able to combine anti-allergens, such as antihistamines, into a medication if needed.
Podiatric medicine is the branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle, and lower extremities.
Penetrant enhancers can be added to topical medicines to improve absorption and compatible medications can be combined into a single dose.
Compounding can be of great help in the treatment of many podiatric conditions:
- Inflammation and Pain
- Diabetic Neuropathy
- Non-Surgical Nail Removal
- Nail fungus (Onychomycosis)
- Decubitus ulcers
- Transdermal anti-inflammatory agents
- Skin softeners & moisturizers
- Transdermal treatments for neuropathy
- Keratinolytic agents
- Wound Care
- Plantar fasciitis (Heel Spurs)
- Anti-fungal foot powders
- Muscle & joint pain
Palliative care is the treatment of patients whose disease or condition is non-responsive to curative treatment. It focuses mainly on providing relief from symptoms, pain, and mental stress.
Because palliative care is so unique to each individual patient, it benefits enormously from compounded medicines that can address the patient’s specific needs and care plans while allowing the caregiver to do their job more efficiently.
While every individual is unique, common symptoms and problems include:
- Pain Management
- Nausea and Vomiting
- Severe Constipation
- Decubitus Ulcers
- Shortness of Breath
Our compounding specialists can compound medications which can help with all the above problems, and in a range of forms tailored to suit the patient such as:
- Extended-release capsules
- Gummy bears
- Insulin resistance
- Chronic fatigue syndrome
- Autoimmune disease
- Iron deficiency
- Heart problems
- Eye problem
- Brittle bones
- Red, swollen skin
- Thyrotoxic crisis
Low Dose Naltrexone, also known as LDN, is an increasingly popular treatment option for autoimmune conditions, fibromyalgia, pain control and even cancer.
Naltrexone was developed in 1965 and oral Naltrexone (50mg) was approved to treat alcohol use disorders 1984. Naltrexone reduces both the rewarding effects of alcohol and craving for it. Endorphins are opiate-like molecules produced naturally in the body and are important regulators of cell growth, and therefore the immune system. Naltrexone works by causing the body to increase its production of endorphins and by making the body’s cells more receptive to the available endorphins.
A low dose of Naltrexone (LDN) takes advantage of Naltrexone’s impact on the
body’s endorphins but does so for a short period before being metabolized. This method of autoimmune support boosts the natural defenses of one’s own system by helping to increase endorphin production. The elevated levels of endorphins in turn assist in regulating cell growth and immunity.
LDN is used to treat conditions such as:
- Autoimmune diseases
- Chronic fatigue syndrome
- Crohn’s disease
- Central nervous system disorders
- thyroid-related conditions
- Alzheimer’s Disease
- Multiple Sclerosis
If you have been diagnosed with an autoimmune disease or cancer and are looking for support, many patients with autoimmune conditions report significant improvements in their symptoms. Patients report improvement in fatigue, pain and mood after taking LDN.
This is done most commonly by taking a dose before bed, LDN then blocks the
production of endorphins for several hours thus prompting your body to
increase production and the resulting increase in available endorphins benefits the body’s immune system.
LDN is easy to administer and virtually free of side effects. The exact low dose differs by patient and condition. Typically, the dose is in the range of 0.5mg to 3.5mg. Achieving an optimal strength for your body and condition is critical.
Allergic reactions are a symptom of the immune system adversely reacting to
typically harmless substances. Common symptoms of an allergic reaction may
include rashes, red eyes, sneezing, a runny nose, shortness of breath, or swelling.One of the most beneficial uses of compounded medicines is for patients who suffer from allergic reactions to ingredients found in common commercial drugs.
A compounding pharmacy is able to break a medication down into it’s base compounds, recreating it with the same active ingredients either removing/replacing the offending substance or making the medication into something safer and less likely to cause an allergic reaction. For example a compounding pharmacy may also be able to combine anti-allergens, such as antihistamines, into a medication if needed.
Drug shortages are unfortunately still common. Shortages can occur for many
reasons including quality, production delays, and discontinuations.
The FDA publishes a list of drug shortages on its website.
In order to minimize the impact on physicians and patients, FDA allows
compounding pharmacies to compound commercial medications that have been discontinued or are on shortage. If your medication is on the FDA drug shortage list, please call us.