Compounding = Custom Medication Services=Customized Solutions for Therapeutic Problems
- Customized solutions for therapeutic problems
- Unusual dosage forms
- Safe and effective medications
- Treatment of rare and unusual medical conditions
- Options not available with commercially available products
- Medications for humans and animal patients
What Is Compounding?
Compounding is a way for physicians or other healthcare professionals (including veterinarians) to order custom medications for their patients. The compounding pharmacist combines the necessary ingredients into the desired formulation prescribed by the doctor. This skill is called extemporaneous compounding, and is only practiced by qualified pharmacists educated in the art and science of compounding. The service, is best described as providing customized solutions to a wide variety of therapeutic problems.
Why do we need compounded medications?
There are many reasons that a patient may require that a product be created to best suit their medical needs. Here are a few examples of why a medication would need to be compounded:
- The dosage required by the patient is not available commercially (i.e. a cat requires a much lower dose of a medication than a human)
- The dosage formulation required by the patient is not available commercially (i.e. a patient cannot swallow pills, therefore the pharmacist make the medication into a liquid form)
- The medication is not available in the correct form and needs to be converted to one of the following: capsules, oral liquid, topical cream or gel, or suppository.
- The commercially available formulation may not be in a form appropriate for an animal (i.e. flavouring)
Although such products most often require a prescription from your physician, many physicians are not aware that such services are offered. In addition, since not all pharmacists offer this service, either the physician or the patient must be aware of such pharmacies.
To give you an idea of some products that we are presently preparing, the following is a partial list, with brief explanations about these items:
Topical Pluronic Lipogels
Many medications can be useful when applied to the skin for problems, which are localized to only one or a few areas. This requires that the active ingredient be released into the joint or muscle to cause some beneficial effect. For example, an anti-inflammatory medication can be prepared in this way to allow the application to the affected joint, without the exposure of the whole body to such medication. This is most useful when people cannot normally tolerate such medications in the oral form. The pluronic lipogel has proven to be more effective than traditional cream formulations.
In other situations, the absorption of a drug into the general circulation is the actual goal. There are however, many reasons why oral or rectal formulations may not be viable options. Therefore, a drug that can be absorbed into the bloodstream after topical application would be very valuable. An example is the drug scopolamine, which can be delivered directly into the blood stream after applying a small amount of the scopolamine lipo-gel behind the ear. Each application lasts from 8 to 12 hours and can be reapplied as needed.
For young children, the taking of medication can be difficult at the best of times, but even more troublesome if that medication is not available in a liquid form. This problem may also apply to adults with special problems involving the ability to swallow capsules or tablets. Making available tablet and capsule medications into liquids can solve many of these problems. For children, there exist many flavoring agents that can be added to make the liquid medicine palatable, for even the toughest taste critic.
Despite our best efforts, sometimes oral or topical route may not be viable options. For this reason, rectal and vaginal suppositories can be the most effective dosage forms. An example is the Triple Antinauseant Suppository, which contains three different antinauseant ingredients combined into each suppository. Where nausea is not controllable through usual methods, this product can be the answer. The ingredients of this product can be altered to give the most effective combination.
Natural Hormones or Bio-identical Hormone Products
The decision to supplement with estrogen and/or progesterone must be done after considering the risks and the benefits. Many women, who are now approaching menopause, look to alternatives to what has traditionally been a very unclear need to supplement with conjugated estrogens and progestins. Many women consider the use of nutritional and herbal supplements before considering hormone replacement treatment.
What is now available through compounding, are a number of estrogen, progesterone and even testosterone formulations that make use of pure, bio-identical hormone ingredients. What this means is that we can start with ingredients that match a woman’s own circulating hormone, so that the match is not just close, but exact. These hormones can be taken orally, sublingually, topically or intra-vaginally. Formulations can be single ingredient or combinations, each made to suit the needs of the woman and the symptoms requiring treatment.
For additional information, check out our summary pages for some general information about Bio-identical Hormone Replacement Therapy. For physicians and naturopaths, you can ask for a summary of some preparations that we have experience in compounding. This is by no means a comprehensive list and new products are added at least on a monthly basis. Remember, that our skill is creating those necessary solutions to therapeutic problems.
Customized Solutions for Animals
It is not just human patients who need our attention. Animals are often in need of drug therapy for a variety of medical conditions. The challenge for the veterinarian is not only finding the right medication for the particular medical problem, but the right dosage or format given the wide variety of animal species that are seen. There are certainly challenges to giving medications to a small bird that would not be seen when giving medication to your dog or cat. Animals come in all different sizes, shapes, colors, and temperaments, so why shouldn’t their medicines.
Veterinary medicine presents some interesting challenges not seen with the human patient. Sometimes it is just a matter of finding a particular flavour that will be acceptable, other times it is preparing a product that is not available commercially. Just like humans though, the challenges of finding a solution to a therapeutic problem in animals becomes a real opportunity for the compounding pharmacist to work with the veterinarian, the animal owner, and the animal patient. Solutions that we have been involved include the creation of a product that could be applied to a cat’s ear to deliver some needed medicine. The medication once delivered to the blood stream in that manner allowed the veterinarian to examine the cat without the normal need for physical restraint. Several drugs can be delivered transdermally and often it is a drug that helps to relax the animal that is best put in a dosage form that can just be gently rubbed on the animal’s ear, where fur is very short and blood supply is close to the skin surface.
These are just examples of ways that we can help. There doesn’t seem to be a limit on what can be done and each problem often brings its own unique solution. Call us or have your veterinarian contact us for more information.
For more information about the available services contact us at (403) 320-6500 or have your physician discuss your particular medication needs with us. We will also work with you and your physician to create customized solutions to therapeutic problems that do not have an “off the shelf” solution. Just have your physician call and discuss any therapeutic problem with one our pharmacists. We assure you that many good things come to be as a result of that single phone call. If your physician prefers, an e-mailed request will also be accepted. Be aware that all such discussions are considered to be private and confidential. Informal discussions and/or requests for information are treated in a similar manner.
Contact us at (403) 320-6500 and follow the menu instructions. For those in Canada but outside our local calling areas, please call us on our toll free number which is 1-800-320-1260. We are sorry, but our authorities and licenses do not allow us to ship to clients outside of Canada. For those residing in the United States, visit the website of the International Association of Compounding Pharmacists (IACP) at www.iacprx.org where you will find a service intended to locate a compounding pharmacy within your area.