Compounding

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What is Compounding?

Simply stated, compounding is the art of making customized medication products by hand. Compounding provides an innovative way for pharmacists to customize medications to fit the needs of their patients. The art of compounding utilizes modern medicine while still holding true to the roots of the profession of pharmacy. Many compounds are specialized medication combinations or compounded in other forms that are not otherwise commercially available. Your pharmacist is trained in compounding a wide variety of ointments, gels, syrups, suspensions, suppositories, capsules and other formulations that can make medications easier to take, address any special health problems, or just simply get you feeling better, faster.

Compounded medications are generally safe and effective for most patients who have talked to their doctor about their health and how a compounded medication can help them. Medications are compounded and dispensed to patients only upon receipt of a valid patient-specific prescription. Compounding requires a relationship between the patient, physician, and pharmacist. Together, they will work together to provide an alternative treatment option when and if the currently available treatment options are not the best fit for you.

Compounding services can be divided into three categories:

Simple Compounding

Simple compounding is the making and fixing of commercially available medical products, or raw chemical powders, from one strength or form into another strength or form, that is not commercially available. For example, a tablet can be crushed and used to make a suspension. Raw medicinal chemicals can be turned it into a capsule, cream, ointment, suppository, or syrup. Commercially available creams can be mixed together to make a combination specific for patients. Also, flavoring a medication is considered compounding.

Hazardous Compounding

Much like simple compounding except for the fact that the products made are considered Hazardous Substance's to the worker who is manipulating the powders and chemicals. The Hazardous Substances are listed on a data base called the NIOSH list for health care workers (National Institutes of Occupational Safety and Health). This list of drugs can pose hazards to the health care worker who manipulates or administers the drug, and as such must take precautions to protect the worker from deleterious/harmful effects due to exposure. Specific to compounding, the act of crushing pills, capsules, or manipulating raw powders that can be inhaled or that can affect the skin due to contact calls for a special Hazardous Materials laboratory, employee training, protective gear, and special ventilation. Chemo therapeutic agents, radioactive drugs, and most commonly any and all bioidentical hormones such as testosterone, progesterone, estrogens, estradiol, estriol, thyroid hormones, liothyronine, and levothyroxine are all considered Hazardous materials. These new safety requirements have caused many pharmacies to make a major investment to be able to safely compound these products. Many pharmacies, that once used to compound these products, no longer do so due to the capital investment, or physical limitations of their current facility. Willow Bend Pharmacy used to compound Bio-Identical Hormones. However, new federal regulations limit our ability to continue that service due to space limitations at our current facility. If we ever build a new facility in the future, we will include a hazardous materials lab and once again offer this service.

Sterile Compounding

Sterile Compounding involves making and preparing medications in a sterile environment in such a way that the end product is sterile and able to be administered into the body free of pathogens and contaminants. These products can be hazardous materials like testosterone injection or commercially available products like IV solutions. The emphasis in sterile compounding is less on worker safety and more on patient safety. The design flow of the laboratories needed are directly opposite of what is needed in Hazardous Compounding. Sterile compounds can be administered to the eye, ear, nose, or be injected or infused into the body or body cavities to include the spine, bladder, or venous system.

As you can see, to be a well-rounded compounding pharmacy, a facility would need three work areas and two complete labs. Few pharmacies have both, and fewer are nationally certified (2% of compounders). National certification is not a requirement but I would seek out the services of certified pharmacies over non-certified if I was needing a sterile injection. Because of the cost and space requirements, pharmacies that offer these complex services can be very busy. Also, the medications are typically expensive and have poor insurance coverage. At big box chain pharmacies some pharmacists will do simple compounding to include flavoring syrups for children, mixing two creams together, mixing three suspensions together as mouthwash, or preparing a compound from a commercial kit.At our pharmacy we do simple compounding. Simple compounding can sound like the easy stuff, but it can be complex and require specialized equipment. We can make capsules, suspensions, creams, ointments, or solutions for both humans and pets. I can list a variety of formulations that we have made but if you're looking for a specific product, it's easier to give me a call and ask if we can make it. If I cannot, I will direct you to several pharmacies locally that have the product equipment and expertise. We make about 2-4 simple compounds a day. Simple compounded products also have little to no coverage by insurance. However simple compounds can be cheaper than the hazardous or sterile compounding products due to the lower overhead.

Some of the compounded products we offer:

Tamiflu Suspension

It's been a bad influenza season. The flu is rampant, and the media is reporting every death due to the flu right now. Because of this, the primary treatment (Tamiflu capsules and the the Tamiflu suspension) is in high demand. The capsules are plentiful but the pediatric suspension always seem to be in short supply. No worries! We can turn the adult strength capsules into a tasty diluted suspension for your child when this happens. Nursing mothers who get cracked raw nipples from breast feeding can find relief with Triple Nipple Ointment, Newman's Nipple Cream, Triple Cream: All three of the above names refer to the same formulation. It consists of a steroid cream/ointment, an antifungal agent, and an antibiotic ointment.

Pet Capsules and Suspensions

Gabapentin capsules, Gabapentin suspension, Budesonide capsules, and Aspirin capsules. The smallest strength of gabapentin capsule available as a manufactured drug is 100mg. Gabapentin is used in dogs to control pain, but at a much lower dose. So we use the raw gabapentin powder and formulate it into 25 and 50mg capsules. We offer the smallest capsule size available to help your pet swallow the capsule or to hide in food. We also offer a pill gun to aide, and make it even easier for you to give your pet a pill. We also make other drugs like budesonide and aspirin in these small dose capsules. For comparison, these capsules are about the size of Bendadryl capsules

Methimazole Ear Cream/Gel For Cats

Methimazole is used to treat overactive thyroid in cats. It is applied to the ear and rubbed in. We dispense our pet gels in a small, convenient pump that delivers a full dose directly onto your pet's ear in one easy pump. This makes for easy administration, storage, as well as dose accuracy. Amitriptyline gel can also be dispensed in this pen device.

Questran and Aquaphor Ointment

This formulation combines the moisturizing ointment aquaphor, with a cholesterol medication called Questran to bind the bile acid salts in the feces that can cause blistering diaper rashes in young babies who have diarrhea from disease or antibiotic therapy.

Suspensions for G-Tube

We make glycopyrrolate and baclofen suspensions for several special needs patients with have G-tubes. These drugs help with drooling and spasms associated with certain conditions. Medications administered via G-tube can contribute greatly to quality of life of the patient. Ask us about ANY medication that needs to be made into a G-tube administered suspension!

So there you have it, these are just some examples of solutions to medication problems we have solved. Simple compounding isn't always simple, easy or cheap. It covers a wide range of medications, and applications. Give us a call if you have a question about any formulation and maybe we can help you out. 214-473-8682