Specialized pharmacists fill in the gaps in manufacturers’ offerings 1 1
By Joseph Lorello
For anyone who’s ever had difficulty swallowing pills, been allergic to dyes or preservatives, or simply needed a dosage not commonly available from manufacturers, pharmaceutical compounding can be an ideal solution. For that reason, compounding – the use of pure, active ingredients to create an individualized medication for a patient – is again gaining in popularity in the United States.
When health care providers order compounded prescriptions (and only licensed medical professionals can do so), specially trained pharmacists work with them to create medication customized to meet the patients’ individual needs in terms of formulation, dosage and delivery system. The health care provider can then assess treatment results and alter the formulation as necessary going forward.
While unfamiliar to some, compounding has been around as long as pharmacy has been. Today, about 1 percent of the country’s prescriptions are compounded. That sounds like a small number until you consider that billions of traditional prescriptions are filled in the United States each year. Almost any type of medication can be compounded into products such as topical formulations, preservative-free medications, sublingual dosage forms and children’s dosages of adult prescriptions. Drug delivery methods include tablets, liquids, creams, suspensions and even medicated lollipops.
Some of the most common uses of compounding today are for women’s health issues, pain management and dermatology. Compound medications for pediatric conditions, such as pediatric attention deficit/hyperactivity disorder (ADHD), are also commonly prescribed today. In each of these cases, small changes in dosage can have significant effects and drug manufacturers typically market only limited strengths of each product. With compounding, physicians can tailor dosage levels and modify the strength and how a medication is delivered as they monitor the results.
One of the major women’s health treatments commonly prescribed as a compounded medication is bio-identical hormone replacement therapy (bHRT). Used to treat symptoms of declining estrogen levels such as hot flashes, sleeplessness and depression, bHRT is a compounded prescription that, coupled with nutritional and herbal supplements, can effectively address each individual woman’s symptoms. Since women’s hormonal issues are affected by a variety of factors including sleep, diet and thyroid health, a compounding pharmacist working closely with the patient and her clinician can provide options that will meet her personal needs.
Does that level of customization mean compounded medications are more expensive than manufacturers’ brands? Not necessarily. Some compounded prescriptions actually cost less than the average insurance copay. A patient concerned about cost can always speak to a compounding pharmacist and learn about what to expect.
While frequently an option, compounding isn’t appropriate for every prescription -manufacturers’ products work well for many patients and conditions. But for the patient who is allergic to certain ingredients, or requires a different method of drug delivery or dosage than manufacturers offer, compounding pharmacies can provide an excellent alternative. A growing number of patients are finding that caring, personal service and customized pharmaceutical solutions can make a real difference.
Joseph Lorello is a compounding pharmacist at Apothecary by Design in Portland, Maine.