What is Compounding?

Compounding combines an ageless art with the latest medical knowledge and state-of-the-art technology, allowing specially trained professionals to prepare customized medications to meet each patient’s specific needs. Compounding is fundamental to the profession of pharmacy and was a standard means of providing prescription medications before drugs began to be produced in mass quantities by pharmaceutical manufacturers. The demand for professional compounding has increased as healthcare professionals and patients realize that the limited number of strengths and dosage forms that are commercially available are unable to meet the unique needs of many patients. These patients may have a better response to a customized dosage form that is “just what the doctor ordered”.

Compounding professionals can prepare

  • unique dosage forms containing the ideal dose of medication for each individual.
  • medications in dosage forms that are not commercially available, such as transdermal gels, troches, “chewies”, and lollipops.
  • medications free of problem-causing excipients such as dyes, sugar, lactose, or alcohol.
  • combinations of various compatible medications into a single dosage form for easier administration and improved compliance.
  • medications that are not commercially available.

Quality Compounding Maximizes Therapeutic Outcomes

The efficacy of any formulation is directly related to its preparation, which is why THE SELECTION OF YOUR COMPOUNDING PHARMACY IS CRITICAL. Ongoing training for compounding pharmacists and technicians, state-of-the-art equipment, and high quality chemicals are essential. Experience and ingenuity are important factors as well. When modifying a formula or developing a unique preparation, the compounding pharmacist must consider physical and chemical properties of both the active ingredient and excipients, solubility, tonicity, viscosity, and the most appropriate dosage form or device for administering the needed medication. Standard Operating Procedures should be in place and appropriate potency testing should be performed.

Compounding professionals can formulate suitable medications as sublingual drops, oral and nasal sprays, lollipops, rectal solutions and suppositories, and other customized dosage forms. Please contact doctor to discuss your needs and medication problems.

Veterinary

Pharmacists Helping Vets and Pets

Our specialty service should not be viewed as competition with local veterinarians; rather, compounding allows veterinarians to broaden their prescribing abilities and to offer [dosage] forms that are patient-specific in strength and formulation. Therefore, the goal of compounding for the veterinary patient is to enhance the veterinarian’s ability to treat patients in a more effective and efficient manner.

“Compounding can make medicating animals easier if the pharmacist prepares flavored chews that animals accept readily. For example, tranquilizing a feral cat with a liver-flavored chew eliminates the possibility of over- or underdosing. If a chew contains 10mg acepromazine and the dose fails to gain a response, a second flavored chew can be given to the animal. Furthermore, the amount of medication incorporated into the chews, capsules, [topical or transdermal], or liquid preparations can be formulated to the specific request of the veterinarian, thereby eliminating the need to cut-up tablets and divide the contents of commercially prepared capsules… As manufacturers decide that certain products are no longer economically rewarding to market, the list of commercially prepared veterinary medication becomes smaller. At present, the armamentarium of medications available for animals is less than perfect. Cherry-flavored amoxicillin or orange-flavored cephalexin may not be [appealing to a cat or monkey]…”

Veterinary Forum October 2002, (pp. 62-65)

Our compounding pharmacy can prepare:

  • Flavored medication
  • Medicine in ideal size, strength, and dosage form
  • Unavailable medications
  • Combinations to improve compliance
  • Novel devices and delivery systems

Compounding is actually a means to an end. We work together with veterinarians and their clients and patients to solve medication problems by compounding specialized medications that meet the unique needs of each animal – pets, exotics, horses, or zoo animals. Let us know how we can help you and the animals in your care.

Dentistry

Upon a prescription order, we can compound:

  • lip balms for viral lesions
  • topical muscle relaxants/analgesics
  • topical anesthetics
  • non-staining antibacterial rinses
  • oral sedation in lollipops and freezer pops
  • lollipops for oral thrush
  • mouth rinses for aphthous ulcers or chemotherapy-induced stomatitis
  • mouth rinse to stop oral bleeding during dental procedures for patients who take anticoagulants
  • dry socket preparations
  • “mucosal bandages” to cover ulcerated, infected, or tender mucosa
  • lozenges that help to prevent gagging
  • and many more unique preparations and novel delivery systems

Medications are manufactured in a limited number of strengths and dosage forms that will satisfy the needs of most patients due to stability concerns, and the cost of stocking and distributing numerous formulations of each drug. Using pharmaceutical grade chemicals and specialized equipment not found in most pharmacies, we can compound medications in doses and dosage forms that are not commercially available. We want to optimize the care of every patient. Just let us know what you need!

Wound Care

Per a prescription order, a formulation can be compounded to contain the proper combination of active ingredients, in the most appropriate base, to treat a specific type of wound. We customize medications to meet each individual’s specific needs.

For example, the choice of cream, ointment, or gel can be clinically significant. Each time a wound needs to be cleaned, there is the potential for disruption of new tissue growth. Gels, which are more water soluble than creams or ointments, may be preferable for wound use because a gel can be rinsed from the wound by irrigation. Another useful dosage form is the “polyox bandage” – which can be puffed onto a wound and will adhere even if exudate is present. A polyox bandage can be compounded to contain the active ingredient(s) of your choice.

Sports Medicine

Athletes, coaches, trainers, team physicians, physical therapists, and even the “weekend warrior” are faced with problems including inflammation and muscle spasms. We work together with these individuals and other health care professionals to customize medications which meet specific needs. Our compounding specialists can help to solve medication problems using customized preparations that contain the most appropriate ingredients in the best vehicle to most efficiently provide the needed drug to the affected area. Please contact our compounding pharmacist for more information.

Podiatry

Podiatrists and other health care professionals encounter numerous problems that may be helped with compounded medications.

We commonly prepare unique formulations that prescribers develop to meet specific needs of their patient population, or “tried and true” formulas acquired during professional training. Penetrant enhancers can be added to improve the extent of absorption of topically applied medications. Numerous compatible medications can be combined into a single dosage form for ease of administration. Also, a synergistic effect can be achieved when certain medications are used concomitantly.

Pediatrics

We work together with practitioners, children, and their families to customize medications and meet specific needs.

Children pose many challenges when it comes to medication: they may resist having to take a medication, dislike the taste or texture, have difficulty swallowing solid dosage forms, and are fearful of injections.

The limited pediatric market for most drugs may be the leading reason for the lack of investment in drug development for this population by the pharmaceutical industry. Most medications are not labeled for pediatric populations, and when a medication is not approved for use in infants and children, it usually is not available in a suitable pediatric dosage form. Fortunately, our compounding pharmacy is able to help. We can compound oral medications into pleasantly flavored suspensions, solutions, concentrates, freezerpops, “gummy bears” or lozenges, in colors that entice the child to take the medication. A palatable formulation is more likely to improve compliance and minimize spillage or waste during administration. Lollipops are an ideal alternative to “swish and swallow” medications that need to be retained in the mouth for a prolonged period of time. Most drugs can be compounded into transdermal gels that can easily be applied to an appropriate site, such as the child’s wrist, for absorption through the skin.

Professional compounding is not just diluting existing medications, or mixing powders with bases. We must consider physical and chemical properties of each active and inactive ingredient in order to prepare an effective and safe customized medication with the desired taste, color, fragrance, viscosity, uniformity, texture, and stability. The efficacy of any compounded medication is influenced by the technique and equipment used in preparing the formulation, the purity and quality of the ingredients, choice of vehicle (base), and proper use of additives such as penetration enhancers.

Dermatology

Compounding professionals can prepare individualized therapies for a myriad of dermatologic problems. Compounding pharmacists continue to improve both the aesthetic and therapeutic aspects of customized medications, offering alternatives and advantages for dermatology. We can compound medications into cosmetically appealing creams, topical sprays and powders, as well as create customized oral dosage forms (such as flavored troches or lozenges) and various preparations for other routes of administration. Compatible drugs can be combined into a single dosage form to simplify a medication administration schedule and improve compliance. USP approved chemicals can be utilized to enhance the absorption of topically applied medications. We commonly prepare unique formulations that physicians develop to meet specific needs of their patient population, or “tried and true” formulas acquired during medical training.

Palliative Care

Palliative Care is “the active total care of patients whose disease is not responsive to curative treatment.” The goal of palliative care is the achievement of the best possible quality of life for patients and their families.

Symptom Control involves therapies for pain management, nausea & vomiting, dry mouth & stomatitis, excessive pulmonary secretions/death rattle, radiation mucositis and proctitis, and wound care.

Hormone Therapy for Women

Structural differences exist between human, synthetic and animal hormones. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. There are significant differences between hormones that are natural to humans and synthetic or horse preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer. Naturally-occurring substances can not be patented, so scientific studies are less numerous on natural hormones.

Natural hormones include estrone (E1), estradiol (E2), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone. Our compounding pharmacists work with patients and practitioners to provide customized hormone therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman’s specific needs. Hormone therapy should be initiated carefully after a woman’s medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and adjustments are essential.