What Is A Compounding Pharmacy
A compounding pharmacy is a special kind of pharmacy that specializes in the preparation of medications by mixing raw ingredients. Compounding pharmacies specialize mainly in the preparation of medicines that are customized to meet the needs of specific patients. This includes preparing medicines for patients who have allergies to certain ingredients found in mass-produced drugs; liquid versions of solid medicines to make them easier to swallow; flavored medicines for children; cream or gel-based versions of a medication for topical application (as well as other delivery methods); medicines that have been discontinued by a manufacturer; or medicines of a different dosage or concentration than that which is typically available.
We commonly receive compounded prescriptions for: bioidentical hormones ( menopause, andropause); pain relief remedies (neuropathic, joint & arthritic, fibromyalgia, back, neck, knee, foot, muscle); dermatologic conditions (fungal infections, warts, acne, wounds, psoriasis, eczema, radiation burn, scarring, skin and diabetic foot ulcers); dental problems (canker sores, pain syndromes, infections); as well as specialized veterinary medications (transdermal gels, creams, capsules, liquids, eye drops, ear drops and suppositories).
Compounding pharmacies allow for more flexibility, options and customization than are typically available from pharmaceutical companies. Some common forms of compounding are discussed further in the following paragraphs.
Pain Management Compounding
Many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia, migraine headaches, and other nerve and muscle pain, but they can also result in unwanted side effects such as drowsiness, dizziness or stomach irritation. Many patients taking these medications may find a better solution through pharmacy compounding. These dosage forms may bypass the gastrointestinal tract, providing results with less GI irritation, and help patients who have difficulty swallowing pills, removing yet another source of aggravation.
Bio-Identical Hormone Replacement Therapy (BHRT)
Hormone therapy designed specifically for your body
Bio-Identical hormones are those that have the same chemical structure as the hormones in the human body. The body recognizes them and allows them to mimic the function of the hormones the body produces on its own. The advantage of compounded BHRT is that it can be adapted specifically to fit each individual’s body and hormone levels.
BHRT for women is used to treat menopause symptoms, peri-menopause, and post-menopause. BHRT can also be used to treat a variety of conditions that women of all ages my experience, including: irregular menstrual cycle, moodiness, weight gain, vaginal dryness, sleep disturbances, hot flashes, night sweats, decreased libido and painful sexual intercourse. These conditions affect millions of women. As the number of women seeking hormone-related treatment has grown, so has the mass production of pills, patches and creams by the drug industry. Each woman’s body is different and has its own unique needs, but commercially manufactured products tend to be “one-size-fits-all,” and do not always account for the differences between individuals. Researchers have long held that there are significant differences between hormones that are natural to humans (bio-identical) and synthetic preparations. Molecules are added to a natural substance to create a synthetic product that can be patented by a manufacturer. This patented drug can be profitable to mass-produce and therefore a drug company can afford to fund the research as to the medication’s use and effectiveness. However, bio-identical substances cannot be patented, so scientific studies are less numerous on these natural hormones.
Many patients and medical professionals are often given a very one-sided view of hormone replacement therapy and are unaware of the availability of bio-identical alternatives. As a result, many women who should substantially benefit from bio-identical hormone replacement never have the opportunity. Lack of information, fear and bias are a few of the reasons women in general remain uniformed and often times misinformed about their options for Hormone Replacement Therapy. Published research describing the differences between natural bio-identical and synthetic HRT is now more abundant, but studies of BHRT will probably never be as plentiful as those dealing with patented synthetic hormones.
How to start a BHRT regimen
Our compounding pharmacists work hand and hand with the prescribing healthcare provider. We receive a prescription to do a BHRT consultation with the patient, obtaining all necessary information. We then assist the healthcare provider in helping interpret the results of serum or saliva tests which measure a patient’s hormone levels. The healthcare provider, compounding pharmacist and the patient can use the results of these diagnostic tools to help determine a course of treatment which will give the patient the exact amount of hormones their body needs. Along with the healthcare provider, we can help a woman start and maintain a bio-identical replacement regimen that brings her hormones back into balance and closely mimics what her body has been doing naturally for years. We can prepare hormones in a variety of strengths and dosage forms, including: capsules; topical or vaginal creams and gels; suppositories; and sublingual troches. Once the therapy is begun, the pharmacist will continue to work with the woman and her provider to make sure the BHRT is working correctly, adjusting the dosage if necessary, and ensuring that the medication is just right for her body.
Bio-identical hormones include the three estrogens: estrone (E1), estradiol (E2) and estriol (E3); progesterone, testosterone and dehydroepiandrosterone (DHEA).
Estrogens are responsible for normal growth and development of female sex organs. They maintain secondary sex characteristics and protect against bone loss and heart disease. The three main estrogens produced in female humans are:
Estrone – E1 – (10-20% of circulating estrogens) is the primarily estrogen produced after menopause
Estradiol – E2 – (10-30% of circulating estrogens) is the most potent and major secretion product of the ovary. Estradiol is the primary estrogen of ovarian origin and the major form of estrogen in premenopausal women.
Estriol – E3 – (60-80% of circulating estrogens) is thought to be protective against breast cancer. Estriol has been shown to be clinically effective for the treatment of menopausal symptoms as well as postmenopausal problems. Estriol is produced in very large amounts during pregnancy and may be protective against breast cancer.
Progesterone is necessary during pregnancy for maintenance of the uterine lining, it prepares the breasts for lactation, and it increases bone mass and density. Progesterone is a term that is used incorrectly in the description of natural and synthetic substitutes. Synthetic progestins have been developed because they are longer lasting, more potent and patent able. One example is medroxyprogesterone acetate, the most commonly used progestin. This progestin has serious side effects including migraine headache, weight gain, mood swings, depression, irritability, acne, menstrual irregularities, and fluid retention. However, Bio-identical progesterone has never been shown to have any serious side effects.
Androgens, such as testosterone and DHEA:
These hormones enhance libido, enhance bone building (increase calcium retention), provide cardiovascular protection (lower cholesterol) and improve energy level and mental alertness.
Androgens are hormones that are important to the integrity of skin, muscle and bone in both males and females, and have an important role in maintaining libido. DHEA is an androgen precursor from which the body can derive testosterone.
Goals of Bio-Identical HRT:
Alleviate the symptoms caused by the natural decrease in production of hormones by the body
Give the protective benefits, which were originally provided by naturally occurring hormones
Re-establish a hormonal balance
Natural Testosterone Replacement for men:
On average, a man’s testosterone levels begin to decline at a rate of 1% per year after the age of 40. Most men have more slow and subtle hormonal decline, experiencing symptoms including: weakness, fatigue, reduced libido, osteoporosis, heart disease, irritability and insomnia. Blood or saliva testing is necessary to determine an individual’s testosterone levels and to establish the need for testosterone replacement therapy. Testosterone replacement therapy is only recommended for men whose testosterone levels are low. When hormones are replaced or restored back to physiologic levels considered normal for younger males, men may experience dramatic reversal of the changes caused by aging. We can work with the patient and healthcare provider to determine if any testosterone replacement is needed and if so, determine dosage and strength.
Our pharmacy knows that skin wounds, such as pressure sores, are a common health concern. That's why we offer custom compounding solutions to patients with hard-to-heal wounds. We offer custom-compounded medications that can be applied to the wound. These medications are designed to: stimulate new tissue growth; reduce pain and discourage bacterial overgrowth. We also can compound other medications which may be applied to the area surrounding the wound to increase blood flow to the wound area. With a healthcare provider's prescription, we also can make these medications available to patients who do not have wounds, but suffer from poor circulation to their extremities.
Our pharmacy features a "sterile room," which enables us to compound injections, intravenous solutions, and ophthalmics.
Medicine for Children
Pediatric medicine is one of our specialties. We all know how difficult it can be to administer medications to children. Many antibiotics, taken orally, have a horribly bitter taste. As a compounding pharmacy, we are able to add flavorings to these medications to make them more palatable and thus easier for the child to take.
- Preservative and Sugar Free Formulations
- Veterinary Formulations
- Lip Balms
- Otic Solutions
- Suspensions & Insufflations
- Creams, Ointments, Sprays, Powders & Lotions
- Dental Preparations
- Pain Formulations
- Rectal Enemas
- Nausea Formulations
- Vaginal Creams
- Injectables, Suppositories & Transdermal Gels
- Ophthalmic Specialties
- Nasal Sprays & Solutions
- Pediatric Formulations
- Sublingual Troches & Tablets
- Discontinued Combinations
Is compounding safe?
The U.S. Food and Drug Administration (FDA) has stated that compounded prescriptions are ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and are compounded by a licensed pharmacist. The bulk drug substances used in a compounded medicine must qualify for use in compounding either via FDA-approved lists or via a listing in the U.S. Pharmacopoeia National Formulary (USP/NF), published by an independent standard-setting organization. Previously marketed drugs that have been found to be unsafe or ineffective have been removed from the market may not be compounded. Each compounding pharmacy is regulated by the state board of pharmacy and must follow strict facility and quality control standards to ensure that their products are safe and that each batch is consistent.
Our goal is to deliver the highest quality custom pharmaceutical compounds to people and their pets. Because our formulations are focused on unique and specific needs we deliver them with highly personalized service, right down to individual patient consultation and follow-up.