Pharmaceutical Compounding

By Lynn Holt

It seems like centuries ago, but it has only been about 50 years since drug companies began manufacturing medications in ready to take formulations. Before that, pharmacists made – or compounded – all of the medication we consumed right in their pharmacies. Companies like Merck actually sold bulk chemicals to pharmacists who then compounded them into dosage forms. In the 1950s and ’60s, those companies began manufacturing pre-measured pills and liquids. By the 1970s, less than 5% of prescriptions ordered were for medications that had to be compounded by pharmacists. Compounding medications from bulk chemicals was a dying art. Most pharmacists’ jobs shifted from making medications to dispensing drugs and supplying information. Chain pharmacies began to put small, independently owned pharmacies out of business. But like most things in life, pharmacies and compounding have come full circle. We have found that pre-manufactured medications do not always meet every patient’s need. One person may be allergic to an ingredient in the product. Another person may not be able to swallow a pill, but the medication is not available commercially in liquid form. Your pet bird may need a medication only available in a dose made for an adult human. Compounding can fill these needs.

Technology has changed compounding like it has almost everything else in our lives. But much about compounding is just as it was at the turn of the century, when pharmacists worked in their shops with jars and bottles of every kind of chemical and mortars and pestles in every shape and size. Compounding pharmacists still use chemicals and mortars and pestles. They also use specialized flavorings (every flavor imaginable from banana crème to tutti-frutti) and electronic mortars and pestles (that run at up to 3000 rpms), and technology has given us many unique dosing options not available 50 years ago.

Today, compounding pharmacists can put medications in lollipops, gelatin troches, suppositories, rapid dissolve tablets, capsules, and creams. Women concerned about the safety of synthetic hormone replacement have been able to find relief through natural hormones compounded by their compounding pharmacist. One of the most exciting dosage forms are transdermal gels. These gels allow many medications to be absorbed through the skin instead of having to be swallowed. The applications for this are seemingly endless. For cats and dogs, you can avoid being bitten or scratched by applying the gel containing medication to the outer part of their ears. For a child or adult who is vomiting, medication for nausea can be rubbed on the skin to provide relief. For someone suffering knee pain, the medication can be applied directly to the knee, avoiding many side effects of non-steroidal oral medications such as stomach upset and bleeding. This dosage form can also be useful in hospice patients who are no longer able to swallow.

Hospice patients and older patients on multiple medications who have trouble swallowing may also have three or four of their medicines combined into one capsule, or even into a suppository, by their compounding pharmacist. Some babies need a common medication for acid reflux that is only available in capsule form. Countless parents have gotten a much needed night’s sleep thanks to the suspension their compounding pharmacist was able to make. Patients suffering from cold sores and fever blisters can benefit from a medicated lip balm made by their compounding pharmacist. Sometimes drug manufacturers discontinue a certain product, not for safety issues, but because demand for the product is low or it is not economically feasible for them to continue making the product. However, compounding pharmacists are able to compound the prescription for that discontinued medication.

The question arises: Can any pharmacy compound? The answer is yes … and no! By virtue of a pharmacy license, any pharmacist can compound. But pharmacy schools stopped teaching the art years ago when commercially available dosage forms took over the market. Most schools now focus on therapeutics and drug information. Therefore, most pharmacists do not have the training and background needed to properly and safely compound. Special equipment and chemicals are also needed and these are not available in most pharmacies. So what do you do if you need a compounded prescription for you or your pet? There are two designations to look for when deciding which pharmacy to use. Most compounding pharmacists are members of Professional Compounding Centers of America (PCCA) and the International Academy of Compounding Pharmacists (IACP). Ask about credentials or visit one of these organizations’ websites for referral to a pharmacy in your area.
And remember, compounding is not new. It is an art and science as old as the practice of pharmacy itself.

Lynn Holt is a compounding pharmacist and the owner of HealthFIRST Pharmacy, located at 2001 S. Main St. in Wake Forest. She may be reached at 569-0500.