Pharmacy compounding is an established tradition which allows a physician to prescribe a very specific medication, prepared by a pharmacist, for a patient’s individual needs. Years ago, compounded medications provided the majority of prescription drug care for the population. Today, the vast majority of medications are mass-produced by pharmaceutical drug companies. They aim to treat a specific medical condition for a large segment of people. Problems can arise when a patient has a medical condition that can’t be treated by one of these mass-produced products, or they might be allergic to a dye or filler in a commercial tablet. Patients may not be able to take the medication if the capsule is too large, or the dose is too high, which is common in pediatric cases. These are the situations where a compounding pharmacist can play a vital role in helping the physician find an appropriate treatment for their patient.
Compounded medications are ordered by a licensed physician, nurse practitioner, veterinarian or other prescriber, and mixed by licensed compounding pharmacists in a safe and carefully controlled environment. Pharmacists are the only health care professionals trained in chemical compatibilities, making them the only ones qualified to compose alternate dosages. Each state requires instruction on the art of pharmaceutical compounding be included as part of the core curriculum in their pharmaceutical programs. In addition, it's important for compounding pharmacists to seek additional, continual training on their trade to stay current on the latest information and techniques.
The basis of this profession has always been the patient-physician-pharmacist relationship, also known as the “triad” relationship. Prescribers might recommend compounded medications for reasons including, but not limited to, the following situations:
- The manufacturing of a medication may be discontinued by a pharmaceutical company due to lack of profit or other setbacks. A compounding pharmacist might order the ingredients for that discontinued medication in blulk and compound the product into a particular dosage for the patient.
- Patients may need a particular medication or nutritional supplement that is available commercially, but of which they have an allergy to a particular preservative, dye or binder. A compounding pharmacist can likely compound that particular product without the offensive ingredient.
- Compounding pharmacists can create custom dosage forms or uniquely flavored products for special situations such as pediatric or veterinary patients. Compounded items are in greater demand for these groups, as the mass-produced market is lacking.
- A compounding pharmacist may be able to combine several medications a patient is taking into one dosage form to increase compliance. The same situation may apply to a patient taking several nutritional supplements.
- Some patients cannot take certain medications due to side effects such as upset stomach or systemic side effects like drowsiness. A compounding pharmacist can prepare the medications in a transdermal cream that can be applied directly to the site of the pain to avoid the unwanted side effects. Examples of this include compounding anti-inflammatory medications such as ketoprofen or ibuprofen into topical dosage forms, or compounding neuropathic pain agents such as gabapentin, amitriptyline, lidocaine, or a combination of all three into a topical cream.
This article by no means covers all of the capabilities of a compounding pharmacist, but hopefully it offers a glimpse at how they can help those frustrated with their current methods. I encourage you to seek out a compounding pharmacist in your area to learn more about ways they can assist in your health care.