Contemporary Compounding in the Community Practice Setting

Medivision.com presents a segment from our 1 hour educational video "Contemporary Compounding in the Community Practice Setting", featuring Art Matthys, RPh; William Letender, MS, RPh; Dave Mason, RPh and Loyd Allen, PhD. The full length video is available on DVD or VHS from www.health-e-mall.com and covers the following topics: -Definitions of the pharmacy, manufacturing, compounding and triad, and areas where pharmacists can solve non-compliance problems using compounding services; -Lists the unique dosage forms that are available to healthcare professionals, and the factors that exempt pharmacists from the Federal Food and Drug and Cosmetic Act; -Demonstrates how pharmacists meet the unique needs of patients at their practice sites; -Demonstrates the value of compounding services in terms of patient compliance and patient needs; -Identifies areas of practice that could potentially benefit compounding; -Illustrates a course of action to take when filling a compounded prescription .

Pharmacy compounding is the practice of preparing personalized medications for patients, in which individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs.
With the advent of mass drug manufacturing in the 1950s and ‘60s the pharmacist’s role as a preparer of medications 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 and compounding has recently experienced a resurgence as modern technology, innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs. Trained pharmacists can now personalize medicine for patients who need specific strengths, dosage forms, flavors or ingredients excluded from medications due to allergies or other sensitivities.

Two particular areas in which compounding has shown particular benefits are preparations for pain medications and pediatric prescriptions. 

Pain is the most common symptom for which individuals seek medical help. Many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia 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 come to accept these conditions as part of daily life, but they may find a better solution through pharmacy compounding.
Pharmacy compounding can provide alternate methods of delivery to make the medication easier; instead of a capsule or tablet, pain medications often can be compounded as dosage forms such as topical gels, creams or sprays that can be applied directly to the site of the pain and absorbed through the skin. Other delivery options may include a custom-flavored troche that dissolves under the tongue, a nasal spray, or a suppository.
These dosage forms may bypass the gastrointestinal tract, providing optimal results with less GI irritation and help patients who have difficulty swallowing pills. On many occasions, multiple medications can be combined into a single dose providing greater convenience for the patient. And because patients vary in size, symptoms and pain tolerance, commercially available medications sometimes may not provide the appropriate dosage strength for an individual patient; through compounding a prescriber and pharmacist can customize the dosage to the exact amount the patient requires and find a dosage form that best suits the patient’s needs.

Pediatric patients are especially suited for custom compounded prescriptions. For various reasons, commercially manufactured drug forms sometimes may not meet the needs of every child. Compounding can benefit young patients in a variety of ways.
Many children refuse medication because of its texture or color, or simply because they know it is medicine. But compounded medications may often be transformed into colorful, pleasantly flavored dosage forms  dispensed in childproof packaging. Compounding pharmacists can enhance the taste and color of a medication without changing the medication’s effectiveness, and utilize custom delivery forms such as
lollipops, gummy treats, topical gels or effervescent drinks. Some compounded medications can be administered using special pacifiers or bottles for infants.