Compounding is like cooking from scratch. We take a doctor’s prescription for a medicine that is not commercially available and turn it into a capsule, tablet, cream, suppository, eye drop, or injection that is made just for you or your pet.
In David Miller’s grandfather’s day this would have meant reading a prescription in Latin with several ingredients and turning it into a powder paper (an envelope filled with powder, often horribly smelly or foul-tasting).
Today we use all available science to accurately measure the ingredients and check for vital biochemical markers such as tonicity, sterility, and stability. The art of compounding still rules in that we want an elegant finished product, but we must do this within the strict rules of good science. Of course, it helps if it tastes good too.
A Brief History of Compounding
At one time, nearly all prescriptions were compounded. With the advent of mass drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms, and most pharmacists no longer were trained to compound medications. However, the “one-size-fits-all” nature of many mass-produced medications meant that some patients’ needs were not being met. Community pharmacists who have experience with compounding techniques are now less common, but there is still a need for custom compounded preparations.
The Most Common Types of Compounded Medications
Pediatric Compounding: Compounding for children poses its own set of problems. Children either won’t or can’t swallow a commercial preparation because of its taste or because it is only available in tablet form. Also, children are not small adults; there are special factors to be taken into consideration when calculating a pediatric dose. We work closely with the doctor to formulate the right dose in a form the child will take.
Changing the Dosage Form: Many adult patients also have difficulty swallowing pills. We can offer alternate dosage forms for some medications including liquids, suppositories, and transdermal gels.
Gluten or chemically sensitive patients: In many cases we can formulate gluten-free or dye-free versions of medications.
Patients who absorb or excrete medications abnormally: Often changing the route of administration can affect how well a patient absorbs medication. A patient with a short or compromised bowel may do better with a liquid dosage form. Other patients may benefit from having a medicine that bypasses the gut altogether and will use a transdermal gel or oral lozenge or drops.
Patients who need drugs that have been discontinued: Sometimes manufacturers stop making drugs because of low demand. If the medication is deemed safe by the FDA, we can compound these medications for the small number of patients who may need them.
Drugs that are back-ordered by the manufacturer: We do not compound in large batches, but we can compound some drugs for individual patients that cannot be supplied by a manufacturer for as long as a need persists.