Pharmacy compounding is the art and science of preparing personalised medications for patients. Compounded medications are “made from scratch” – 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 customise a medication to meet the patient’s specific needs.
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.
Fortunately, compounding has experienced a resurgence as modern technology and innovative techniques and research have allowed more pharmacists to customise medications to meet specific patient needs.
Trained compounding pharmacists now can personalise medicine for patients who need specific:
- Dosage forms
- Ingredients excluded from medications due to allergies or other sensitivities
The TGA approval process is intended for mass-produced drugs made by large manufacturers. Because compounded medications are personalised for individual patients, it is not possible for each formulation to go through the TGA’s drug approval process, which takes years to complete and is prohibitively expensive, often costing hundreds of millions of dollars.
However, every compounding pharmacy must comply with the regulations set by the State Board of Pharmacy of the state in which the pharmacy is located. Each State Board of Pharmacy has the power to set and enforce regulations for compounding in its state, just as traditional pharmacies are regulated. The ingredients used by compounding pharmacies to make compounds come from TGA-registered and inspected facilities.
Compounding enables prescribers and pharmacists to meet the special needs of patients. One of its most important benefits is to those patients who have difficulties with commercially available medication. With the prescriber’s consent, pharmacists can custom-prepare medications in a variety of unique dosage forms, including:
- Oral liquids
- Troches or lollipops
- Topical preparations
- Eye and ear drops
- Nasal sprays
- Sterile injections
The result? A way to take medicine that helps increase patient compliance.
Custom flavouring is available for most oral medication forms, and unique delivery systems may be employed to help give medication to finicky patients. Many medications can be taken through a flavoured lollipop. Infants especially benefit from alternate delivery devices such as pacifiers or baby bottles. These devices, which are provided in child-proof packaging, allow parents to dispense prescription medicine easily and accurately.
Medication can be compounded into customised capsules, especially in cases where an alternate strength is required or to omit potential allergens or irritants, such as dyes, preservatives, or gluten. To lessen the number of doses to be taken, multiple medications often can be combined into a single dosage or made into sustained-release capsules. Vegetarian capsules made from cellulose are available for patients who do not want to take a gelatine capsule.
Many medications can be compounded as oral liquids for those patients who have difficulty swallowing tablets and capsules. Some patients may have problems tolerating the taste of a commercially available liquid, but a compounding pharmacist can make a pleasant-tasting, custom-flavoured oral solution or suspension which can be administered easily and accurately. Some medications may be available as effervescent powders, which are mixed with water to make a fizzy drink.
Troches and lollipops are used to keep drugs in the mouth when local action is needed there. Troches also may be placed under the tongue and allowed to dissolve, which allows the medication to enter the bloodstream quickly and easily. Some troches can be chewed and swallowed by a patient who cannot or will not take a capsule or tablet. These dosage forms can be enhanced with natural sweeteners and pleasant-tasting flavours, making them ideal for geriatric and paediatric patients.
Topical methods of delivery also are widely used because they allow the absorption of medicine directly through the skin, and may help avoid potential side effects such as stomach upset or drowsiness. Topical medications often are prescribed for pain management, inflammation and nausea/vomiting. They are easy to use and are effective in delivering the medication as needed. Topical medication forms include:
- Creams and lotions
- Stick applicators, such as lip balms
Patients who cannot take medications orally are ideal candidates for compounded suppositories. Available in various shapes depending on the route of administration, suppositories can be given rectally, vaginally or urethrally. By melting or dissolving into the body cavity, they allow the medication to pass quickly into the bloodstream. They can be used for bio-identical hormone replacement therapy (BHRT), to fight nausea, or to treat local conditions such as haemorrhoids, infections, or inflammation.
A compounding pharmacist working closely with you and your physician can prepare medication in a dosage form that has been customised to your particular needs.
Ask our pharmacist today about alternate dosage forms and compounding.
One of the greatest challenges in prescription medication is a simple fact: some patients just don’t like taking medicine. From a child who can’t stand the taste of a cough syrup to a cat who absolutely refuses to take an antibiotic, taking medicine rarely is a pleasurable experience.
It doesn’t have to be that way. Each patient is unique, with certain likes and dislikes. Others have difficulty swallowing a pill, and might respond better if the pill were compounded into a liquid suspension instead. A distinctive solution to these issues is a flavoured medicine.
A prime advantage of compounding is its ability to customise medication. What’s the easiest way to customise it? Flavour! Compounding pharmacists have access to many flavours and flavour combinations which can enhance the taste and colour of a medication to make it easier to swallow.
A child who has difficulty taking a prescription because the taste is a prime candidate. He or she won’t mind taking medication that tastes like bubblegum, watermelon, or even chocolate. Most PCCA flavours are sugar-free and some are even dye-free, which benefits patients who are sensitive or allergic. And working closely with a physician, your compounding pharmacist can even change the form of the medication. What if a child’s medicine came in the form of a lollipop or a gummy treat?
Many adults also may benefit from flavoured medication. As people age or battle a chronic illness, taste preferences can change. Often, sweet flavours can become unbearable, or bitter flavours may cause nausea. In these instances, your compounding pharmacist can alter or mask certain flavours in order to make medicine more palatable – without changing the strength or effectiveness of the medicine itself. When flavouring antibiotics, for instance, careful consideration is given to the measurement of pH in order to maintain the medicine’s stability. Whether you prefer a distinct flavour – or no flavour at all – compounded medications may be of benefit to you.
Cats, dogs, exotic pets and even zoo animals also are prime candidates for flavoured medication. Cats don’t like pills, but they do like fish. Dogs may not appreciate a squirt of traditional medication into their mouths, but they’ll gladly take it if it tastes like chicken.
Working closely with a pet owner and a veterinarian, a compounding pharmacist can custom-flavour a medication to fit the tastes and preferences of any kinds of animal. There are beef, cheese, chicken and liver flavours for dogs; fish for cats. Horses prefer alfalfa, cherry, apple, carrot and molasses. Even birds, rodents and reptiles have flavour preferences that can be met by a compounding pharmacist.
Like humans, some animals may require alternate medication forms such as pastes, custards, or traditional pet biscuits and treats. Cats are notorious for eating right around a pill disguised in food, but the right combination of flavour and appearance can take the struggle out of medicating your pets. Click here for more information on veterinary compounding.
Do you have a flavouring challenge that could be solved through compounding? Ask our compounding pharmacist about custom flavouring.