September 22, 2018
Health & Fitness
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Compounding? What’s That?

Marcus LaChapelle
Marcus LaChapelle's picture
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June 27, 2018

Lately at the pharmacy counter, I have been talking about compounding. Pharmacy compounding is the art and science of preparing personalized medications for patients and their pets. As the Professional Compounding Centers of America explains, “Compounded medications are made based on a doctor’s prescription in which individual ingredients are mixed together in the exact strength and dosage form required by the patient.”

Compounding dates back to ancient times and has been a role of pharmacists since the first pharmacies were started. Ancient compounders used their knowledge of the medicinal properties of the animals, plants, molds, fungus and bacteria in their environment to make various antidotes and ointments. During the 1800s, pharmacists specialized in the raising, preparation and compounding of crude drugs. The compounding pharmacist often extracted these crude drugs using water or alcohol to form extracts and concoctions. With the isolation of medications from the raw materials or crude drugs came the birth of the modern pharmaceutical company.

Initially, pharmacists were relieved to have modern manufacturing doing the hard work of preparing compounds. Pharmacists’ work shifted from compounding the medications to dispensing pre-manufactured dosage forms. However, large manufacturing operations take a one-size-fits-all approach by only manufacturing certain strengths or dosage forms. In the field, doctors and pharmacists know that every patient is unique and the manufactured product may not fit every patient because of strength, form, flavor, or inactive ingredients. Compounding allows a doctor and pharmacist, working together, to customize a medication for a unique individual patient.

The popularity of compounding gave rise to larger-scale operations that service patients and doctors nationwide. These large-scale, mail-order pharmacies blurred the line between compounding and manufacturing. A large-scale compounding pharmacy would prepare a large batch in anticipation of many orders. The large batch would be divided and given to several patients and mailed all over the country. Errors made in these large-scale operations gave compounding a bad name and forced the Food and Drug Administration (FDA) to increase its oversight. The FDA has stepped up its enforcement to stop compounders from becoming unlicensed manufacturers. This enforcement effort is not intended to stop the practice of compounding but to ensure it keeps its roots. In a small compounding pharmacy, a prescriber’s customized prescription for an individual patient can be compounded in a single batch by a pharmacist trained in compounding.

Compounding is an art passed down from generation to generation. In this way, the traditions of the past are incorporated into today’s pharmacy compounding. Compounding has its own language that has been passed down over the years. Pharmacists triturate tablets in the mortar and levigate powder into paste on the counter.

Current compounding includes even more customized capabilities. In hormone compounding, local doctors use lab tests to test patient hormone levels and prescribe a specific dose based on the lab results. In podiatry, nail samples can be tested for bacterial or fungal presence and then used to create customized prescriptions that target the specific bacteria or fungus found. In veterinary medicine, a medication that would be otherwise difficult to give to a pet can be masked in a chicken or tuna flavor suspension. Other popular compounded medications include allergen-free capsules, nasal sprays, mouth rinses, skin creams or ointments.

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