Compounding

How can compounds help?

Above each kidney lies a small adrenal gland, which is responsible for making various hormones essential to health and vitality and helps the body respond to any kind of physical, emotional, or psychological stress. The outer portion of the adrenal glands (adrenal cortex) contain cells that make the hormones cortisol and aldosterone. Another gland found just under the brain, the pituitary gland, is responsible for making adrenocorticotropic hormone (ACTH). ACTH passes into the bloodstream, is carried to the adrenal glands, and stimulates the adrenal glands to make cortisol.

Cortisol has many functions which include:

• Blood pressure regulation
• Immune system regulation
• Helping to balance the effect of insulin by raising blood sugar level
• Helping the body to respond to stress
• Aldosterone helps to maintain the balance of salt and water in the blood and helps to control blood pressure

Cells in the inner part of the adrenal glands (adrenal medulla) make the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine), which have various actions throughout the body. There is a variety of reasons why the adrenal glands might not work as they should. Adrenal gland disorders, which cause your glands to make too much or too little hormone, may be caused by genetic mutations, tumors, infections, pituitary gland disorders, and certain medications.

The adrenal glands are an essential part of your body's responses to any kind of physical, emotional, or psychological stress.

Examples of physical stress:

• Severe or recurrent infection or illness
• Severe injury
• Surgery
• Nutritional deficiencies
• Insufficient sleep

Examples of emotional or psychological stress:

• Difficult relationships
• Death of a family member
• Problems at work

Adrenal fatigue, although not a proven medical condition and not recognized by any Endocrinology society, is believed by some healthcare providers to be caused by chronic exposure to stressful situations. Chronic stress may disrupt the adrenal gland's normal pattern of cortisol release which can lead to problems such as:

• Insulin resistance/diabetes
• Cardiovascular problems including arrhythmias, CHF, MI, atherosclerosis, hypertension
• Osteoporosis
• Dementia/memory loss
• Immune suppression
• Impaired thyroid function
• Decreased kidney function
• Exacerbation of skin conditions (acne, psoriasis, eczema)
• Gastrointestinal problems (GERD, Irritable Bowel Syndrome)
• Mood disorders and depression
• Increased risk of neurodegenerative diseases
• Sleep disorders
• Reproductive disorders
• Premature aging

Depending on the adrenal gland disorder with which you are suffering, you may require lifestyle advice to reduce stress and improve diet, exercise, sleep, and relaxation. In addition, nutraceuticals, supplements, and medications may be required to stop the excess or insufficient production of hormones. Your compounding pharmacist, working with your healthcare provider, can help you achieve optimal hormone balance.

Introduction

Many children with autism follow a special diet free of gluten and casein as well as other problem-causing ingredients. Some commonly used medications contain gluten, and some probiotics contain casein, which may pose a problem. Fortunately, your compounding pharmacist can prepare medications free of these problem-causing ingredients. Your compounding pharmacist will work closely with your child's pediatrician to provide the best treatment to meet your child's specific needs.

How can compounds help?

Getting your child to take their medication can be a struggle, as some kids might not have the easiest time swallowing capsules or taking unpleasant-tasting liquid. These difficulties can become even more challenging when your child lives with autism. With that being said, your pharmacist can prepare flavored syrups, suspensions, lollipops, popsicles, or gummy bears that contain the medication your child needs. Your compounding pharmacist can prepare formulations specifically geared towards children who may need additional considerations when receiving medication. If your child has any food or medication allergies, your compounding pharmacist can prepare medications that are free of gluten, casein, yeast, wheat, certain sugars, and dyes. Some children with autism may need specialized nutrition therapy or specific chelation therapies that can also be compounded by your pharmacist.

Introduction

Millions of individuals across the world suffer from chronic pain. Chronic pain can be a burden for both patients and their healthcare providers. Optimal pain management is essential for patients to lead productive, enabling lifestyles. Pain can arise due to a variety of different conditions, and as a result, healthcare providers have to use many different approaches for successful treatment.

How can compounds help?

Many medications that are traditionally used to manage symptoms of chronic pain can cause undesirable side effects. Opioid-related medications such as codeine, hydrocodone or oxycodone can be very intolerable in the gastrointestinal system. Treating pain topically is an alternative option to avoid these undesirable side effects. Many pharmacies are able to compound topical preparations that contain various medications to help control symptoms of pain. Because these formulations are applied topically, just enough of the medication is absorbed through the skin to help relieve symptoms at the site of the pain.

Introduction

If you or your family is experiencing any oral or dental issues, compounded medications just may be the solution. Compounded medications can be prepared in a variety of formulations to treat various oral and dental conditions. Your compounding pharmacist can work closely with your dentist to prepare medications unique to you and your needs. Compounded medications can often represent a unique way to make sure the visit to your dentist is as smooth as can be. These medications can provide personalized treatment, and the options are unlimited.

How can compounds help?

Many people feel an overwhelming sense of apprehension and fear at the thought of going to the dentist for a variety of reasons. In some cases, many people fear the noise of the dentist’s drill or fear the sharp instruments. Trips to the dentist do not have to cause you anxiety or discomfort. Your compounding pharmacist can prepare medications to help ease your anxiety and eliminate pain via topical anesthetics. Compounded medications may be prepared in a variety of formulations, which includes lollipops, throat sprays, lozenges, mouth rinses, gels, toothpastes, lip balms, and pastes to treat canker sores, dry mouth, oral pain, infections, and gum disease. Compounded medications can also be prepared for the treatment of Temporomandibular joint dysfunction (TMJ), fever blisters, and to suppress the gag reflex.

Introduction

Disorders of the skin can be a problem among patients of all ages. Common problems include: scarring, acne, rosacea, skin discoloration, psoriasis, and eczema. Numerous medications exist on the market to help with these conditions, but they can often be costly and many health insurance plans may not cover them.

How can compounds help?

Preparations such as gels, creams, lotions, and ointments can be compounded to help manage dermatological ailments. Pharmacists will work with medical providers such as dermatologists to provide a customized topical preparation specifically designed for treating your condition at an affordable cost.

Introduction

Many individuals suffer from ailments that affect their endocrine system, which regulates a variety of body functions. Thyroid gland dysfunction is a common condition that may be present in people. Supplementation of thyroid hormone is an option to treat symptoms that may arise from this dysfunction.

How can compounds help?

Oftentimes, a very exact dose is needed to help patients. Commercially available products are made up of synthetic thyroid hormones, which may not work in some people. Natural thyroid hormones, T4 and T3, can be compounded in specific doses for patients. Sustained release formulations are also an option to provide consistent hormone levels throughout the day. Talk to your endocrinologist today to learn if compounded thyroid supplementation may be right for you.

Introduction

If you have been diagnosed with fibromyalgia, chances are you are familiar with muscle pain and debilitating fatigue. There is no cure for fibromyalgia, but certain medications can help manage the symptoms. When treating fibromyalgia, treatment must be individualized, which may include alternate dosage forms, combined formulations, and strength variations. Your compounding pharmacist can prepare medications that can be integrated into a comprehensive treatment program for your fibromyalgia. Treating fibromyalgia includes treating the cause of the condition, if known. With that being said, your compounding pharmacy can provide treatment options that may address the cause of fibromyalgia.

How can compounds help?

If hormone imbalance is the cause of the condition, your compounding pharmacist can prepare a custom hormone treatment to address your specific imbalance.

If you have a nutritional deficiency, it may worsen your condition. To resolve this, your compounding pharmacist can prepare vitamins, minerals, and specific supplements unique to you and your needs.

Are compounded prescriptions covered by insurance?

Some health insurance plans cover compounded medications. Check with your insurance company to see if you have coverage. Many pharmacies are able to bill insurance companies directly for compounded medications. If unable to bill your insurance company, you may submit a claim form to your insurance company to reimburse you directly. Depending on the nature of the product, these medications may be just as affordable as your conventional prescriptions. Pharmacies are also willing to work with patients who wish to pay out-of-pocket on pricing.

How does my medical provider play a role in compounding?

Many medical providers are aware of the practice of compounding, and they may work with your local compounding pharmacy to provide the right medication for you. Talk to your pharmacist or doctor today if you feel that a compounded prescription may be a better way to manage a health condition for you or your family member.

What is "compounding"?

In general, compounding is a practice in which a licensed pharmacist, upon a physicians' prescription order, combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient. A health care provider will prescribe a compounded drug when commercially available products do not meet your needs. Preparing a paste or suspension from crushed tablets is one example of compounding. Likewise, adding flavoring to a medication is also compounding.

What makes compounded medications different from commercially available medications?

Mass-produced, commercially available drugs are manufactured by drug companies for the general population with no specific patient in mind. Compounded medications are ordered by a physician and individually prepared by a compounding pharmacy in the exact strength, dosage and formulation to meet your unique medical needs. For example:

• Oral liquids can be compounded for those patients who have difficulty swallowing tablets and capsules.
• Ingredients such as dyes, preservatives, or gluten are sometimes excluded from medications due to allergies or other sensitivities.
• Custom flavor enhancers or sweetening agents can be added to mask bitter or otherwise unpleasant oral products for human and veterinary patients.
• Multiple medications can often be combined into a single dosage or made into sustained-release capsules.
• Cellulose capsules are available for patients who do not want to take a gelatin capsule.
• Many medications can be formulated into topical preparations (gel, creams, lotions, sprays, and foams) to allow direct absorption through the skin and to avoid certain unwanted side effects.
• Troches (dosage form that dissolves under the tongue), lollipops, and suppositories are other medication forms that may be prepared to meet your unique needs.

Does a compounding pharmacist have special training?

All pharmacists are taught in pharmacy school how to properly compound medications, and many compounding pharmacists have advanced training after pharmacy school graduation. Compounding pharmacists utilize their unique pharmacy skills, knowledge, and creativity to work with you and your prescriber to prepare medication in a dosage form that has been customized to your particular needs.

Is a prescription required for a compounded medication?

Yes, a prescription order from a physician is required for the pharmacist to compound your medication to meet your specific needs.

Can a regular pharmacy compound my prescription?

A compounding pharmacy ensures the quality of its products by using specialized equipment, high grade chemicals, and advanced techniques. Other pharmacies generally do not have the time, equipment, chemicals, or specialized training and techniques to appropriately prepare your customized medications.

Introduction

Compounded preparations, in formulations ranging from oral solutions to rectal suppositories, can help patients with a variety of gastrointestinal disorders and improve quality of life.

By working closely with your compounding pharmacists, your practitioner can prescribe medications for the following gastrointestinal conditions: 

• Anal fissures
• Burning Mouth Syndrome (BMS)
• Canker sores
• Indigestion
• Inflammatory Bowel Disease / Crohn's Disease
• Leaky Gut Syndrome (LGS)
• Nausea
• Opioid-induced constipation (OIC)
• Ulcer wounds
• Ulcerative Colitis

How can compounds help?

Opioids, widely used in the treatment of acute and chronic pain, are sometimes limited by their numerous adverse effects, the most common being opioid-induced constipation (OIC), an often debilitating side effect of therapy. Bulk-forming laxatives (eg, psyllium, methylcellulose), which are considered safe in most cases of constipation, can be harmful to patients with OIC. These agents are not likely to relieve symptoms of OIC and may even be detrimental, as they are associated with abdominal pain and increase the risk for intestinal obstruction, and they are generally not recommended. Compounding pharmacists are often called upon to prepare medications to either prevent or reverse OIC.

Indigestion, characterized by upper abdominal fullness and/or pain, heartburn, nausea, and belching, is frequently caused by gastroesophageal reflux disease (GERD) or gastritis. When antacids alone or other treatments fail, a "G.I. cocktail," a general term for a mixture of liquid antacid, viscous lidocaine, and an anticholinergic drug, may provide relief for indigestion.

Whether you are suffering from opioid-induced constipation or indigestion, or another gastrointestinal condition, your compounding pharmacist may be able to prepare medications unique to you and your needs and get you feeling better in no time.

Introduction

Hormonal imbalances can occur at any age and affect both men and women. The primary hormone in men is testosterone. As age increases, testosterone levels decline and can lead to a condition known as andropause, or more commonly “low-T.” Testosterone deficiency may lead to decreased concentration, lethargy, loss of libido, erectile dysfunction, and depression among other side effects.

How can compounds help?

There are several effective products that exist on the commercial market to help with symptom management. If you have low testosterone and if the current available treatment options are not a good fit for you, your compounding pharmacist can work with your medical provider to create a testosterone formulation for you. These medications may be for oral or topical use. With proper monitoring and dosage adjustments, compounded testosterone formulations can help control symptoms associated with low-T in a safe manner.

Serious side effects have been reported with testosterone, including the following:

• Blood clots in the legs or lungs. Contact your healthcare provider if you notice pain or swelling in the legs, redness of the legs, difficulty breathing, or chest pain.
• Possible increased risk of heart attack. Seek immediate medical attention if you experience symptoms of a heart attack. Symptoms include:
• Chest Pain
• Feeling of Pressure in the Chest
• Shortness of Breath
• Discomfort in the Neck, Back, Shoulder, or Arms
• Nausea/Vomiting
• Dizziness or Lightheadedness
• Sweating
• Possible Increased Risk of Stroke. Seek immediate medical attention if you experience symptoms of a stroke. Symptoms include:
• Sudden Numbness or Weakness on One Side of the Body (can be in the face, arm, or leg)
• Sudden Confusion
• Difficulty Speaking
• Sudden Change in Vision
• Sudden Trouble Walking (may experience loss of balance or coordination)
• Possible Increased Risk of Prostate Cancer. Your healthcare provider will check for prostate cancer before and during treatment with testosterone.
• Edema With or Without Heart Failure. Contact your healthcare provider if you notice swelling of your ankles, feet, or body.

This is not a complete list of testosterone serious side effects. Ask your doctor or pharmacist for more information.

Compounding requires a relationship between patient, physician, and pharmacist. Together, they will work to provide an alternative treatment option when and if the current available treatment options are not the best fit for you.

Introduction

Hormonal imbalances can take place at any age and affect both men and women. Many women experience side effects when dealing with menopause and hormone imbalance. Unstable hormone levels can lead to chronic symptoms and disorders that can disrupt daily activity. Some of these symptoms include but are not limited to: unexpected weight gain, hot flashes, migraines, depression, difficulty sleeping, loss of libido, and fatigue.

The primary hormone of importance in females is estrogen, which exists in three different forms in the body: estrone (E1), estradiol (E2), estriol (E3). Other important hormones include progesterone (P4), testosterone, and dehydroepiandrosterone (DHEA). These substances may help restore natural balance in the body and may help alleviate chronic symptoms arising from imbalance.

How can compounds help?

There are several effective products that exist on the commercial market to help with symptom management. Compounding allows for a more personal and tailored dose for you. In addition, compounding offers a variety of dosage forms that will best fit you. By working with your medical provider, compounding pharmacies can create various formulations that may include any combination E1, E2, P4, E3, DHEA, and/or testosterone to help manage your symptoms with the lowest possible dose to alleviate symptoms for the shortest period of time.

Complete medical histories will be taken and evaluated to create a product that will help you manage any issues you might be experiencing. The amount of these hormones will be limited to mimic how they naturally exist in your body to ensure safety. Formulation examples include topical and vaginal creams, oral capsules, and orally dissolving or sublingual tablets. With sufficient monitoring, formulations can be adjusted to help relieve your most bothersome symptoms.

Compounding is a relationship between the patient, physician, and pharmacist. Together, they will work to provide an alternative treatment option when and if the current available treatment options are not the best fit for you.

Introduction

In preparing medications for Hospice patients, compounding pharmacists seek to respect the dignity and individuality of each patient and meet each patient's individual needs in pain and symptom management for end-of-life care. The primary goal of treatments in this area is to keep patients comfortable. Compounded preparations can be used to treat a variety of underlying conditions related to hospice and palliative care.

How can compounds help?

Patients in hospice care often have difficulty in swallowing. Therefore, other routes of administration must be used. Other formulations that can be prepared may include skin, rectal, and sublingual preparations. Compounding pharmacists can prepare medications to treat a variety of issues such as pain, nausea, vomiting, dry mouth, constipation, oral thrush, and secretory issues. Some patients may require inhalations to help with breathing problems. In these cases, compounding pharmacists can prepare special inhalation treatments. Wounds can also become an issue for hospice patients (i.e., bed sores). Depending on the pain and odor associated with the wound, treatment options will vary. Talk to your pharmacy staff today for more information regarding medications for all these ailments.

Introduction

If you are having difficulty conceiving, your compounding pharmacist may have just the solution. Medications are common treatments for infertility. However, these treatments are complex, expensive, and are not likely to be found at most retail pharmacies, making it more difficult to receive the treatment you may need. Your compounding pharmacist can prepare specialized fertility medications to increase your chance of conceiving. In addition, your compounding pharmacist can provide comprehensive counseling and education services regarding a wide variety of fertility medications. Compounding pharmacists can offer support materials including medication and injection teaching guides for each specific treatment. They can also work with insurances to help you gain optimal medication coverage.

How can compounds help?

It can be very difficult for many couples to cope with infertility. Your compounding pharmacist may provide the hope you need. They can prepare specialized fertility medications that can increase your chance of conceiving. These fertility treatment options may include specific hormones and/or medications that help regulate or induce ovulation. With that being said, these prepared medications can result in multiple births. Your fertility specialist and pharmacist will work closely together to ensure you receive the most appropriate medication for your situation and have the best chance for conceiving.

Compounding is a safe and legal practice.

Compounding has been an essential part of pharmacy practice for centuries. Many regulatory bodies are aware of the practice of compounding and have set rules with which pharmacies must be compliant. The Food and Drug Administration allows products to be compounded as long as licensed practitioners have written a prescription for a specific patient to be filled at a licensed pharmacy. In addition, many state boards of pharmacy require additional regulations to be followed. Depending on the category of products made by your pharmacy, their compounding lab and procedures must be either USP 795 (for nonsterile) and/or USP 797 (for sterile) compliant.

Introduction

Mesotherapy treatment is a nonsurgical cosmetic solution aimed at diminishing problem areas in your body such as cellulite, excess weight, body contouring, and face/neck rejuvenation, just to name a few. The technique uses very fine needles to deliver a series of injections of various medications, vitamins, hormones, enzymes, and herbal extracts into the mesoderm, the layer of fat and connective tissue under the skin. The theory is that when these small amounts of medication are injected into the mesoderm, underlying fat is melted. It is administered via numerous injections containing various types of FDA-approved medicines, vitamins, and minerals.

Mesotherapy has been around in other countries for many years but has more recently become very popular in the United States. Mesotherapy involves injecting medication, vitamins, minerals, herbal extracts, and enzymes into the subcutaneous tissue to treat medical conditions and for cosmetic procedures. Mesotherapy has been mainly advertised as a procedure for anti-aging and body sculpting. Mesotherapy can also be used for facial and skin rejuvenation as well as for other cosmetic procedures. Your compounding pharmacist can prepare specific formulations unique to you and your needs.

How can compounds help?

Mesotherapy has been reported to be used for pain management for several disorders, such as arthritis, tendonitis, and neuralgia, and to improve circulation for certain vascular diseases. Mesotherapy has been gaining popularity for cosmetic procedures ,which may include skin rejuvenation, scar revision, hair loss prevention, and body sculpting. However, mesotherapy is most widely used for weight loss and in the reduction of cellulite. Mesotherapy has been promoted as a non-invasive alternative to liposuction.

Introduction

Before the 1950s, when Allergan and Alcon began marketing and widely distributing prescription ophthalmic drops, almost all ophthalmic drops were compounded. That has all changed as commercially available drugs for ophthalmic use have exploded in recent years. But for many patients with unique ophthalmic needs, commercial products are just not suitable.

At times, the demand for a particular drug outpaces its availability. Sometimes patients can't tolerate the commercial products, usually due to the preservatives. Commercially available antibiotic ophthalmic products are often not concentrated or strong enough to treat a severe infection. Some compounded antibiotic ophthalmic preparations (topicals and intraocular injections) are prepared from commercially available injections, but the stability of the drug in the solution or vehicle may only be 14 days refrigerated. For these and many other situations, a custom compounded pharmaceutical is an important option.

How can compounds help?

Compounded eye medications can be prepared to treat a variety of eye conditions such as infections caused either by bacteria, a fungus, or a virus. Compounded medications can also be used to treat glaucoma, age-related macular degeneration (AMD), and ulcers. Your pharmacist can also compound preparations to dilate the pupil or serve as anesthesia for certain eye procedures.

Your compounding pharmacist can work with you and your prescriber to customize a medication to meet your specific ophthalmic needs.

Preparation Examples:

• Combination Antimicrobial Drops
• Combination Glaucoma Drops
• Treatment for Dry Eye Disease
• Cataract Formulations
• Cyclosporine Ophthalmic Drops for Both Animals and Humans
• Phenylephrine Ophthalmic Drops
• Preservative-free Preparations that are not Commercially Available
• Acetylcysteine 5% and 10% Ophthalmic Drops
• Atropine 0.01% Ophthalmic Drops
• Cefazolin 50mg/ml Ophthalmic Drops
• Ceftazidime 50mg/ml Ophthalmic Drops
• Fortified Tobramycin 14mg/ml and 15mg/ml Ophthalmic Drops
• Fortified Vancomycin 25mg/ml and 50mg/ml Ophthalmic Drops
• Cyclosporine (Preservative-Free) 0.5%, 1%, and 2% Ophthalmic Drops
• Dexamethasone (Preservative-Free) 0.025%, 0.05%, and 0.1% Ophthalmic Drops
• EDTA 1%, 2%, and 3% Ophthalmic Drops
• Progesterone 0.05% / Testosterone 0.05% Ophthalmic Drops
• Tretinoin 0.01% Ophthalmic Drops and Ophthalmic Ointment

Customized ophthalmic preparations are sterile, free from foreign particles, and compounded specifically for instillation into the eye. To ensure the quality and safety of these compounds, sterile preparations are made in a cleanroom and laminar flow isolator that meets or exceeds each of the standards set by the United States Pharmacopeia (USP) chapter 797.

Introduction

Many medications are not available in child-friendly dosage forms. The most common factors that influence medication compliance among children include taste and appearance. The commercial market does not produce many formulations of medications that are easy to use in the pediatric population.

How can compounds help?

Compounding is an option for helping children get the medications they need in a suitable form. Many medications that may not be available in liquid forms can be compounded into solutions, suspensions, and syrups. In addition, gummy bears, freezer pops, lollipops, and topical creams are examples of formulations that may be more child-friendly. Many of the oral alternatives can be flavored to help with medication administration in children.

Introduction

If you are like most people, you tend to take your feet for granted and forget just how important the feet are to your health and how they may be affected by other medical conditions you may have. With poor foot health, simply moving around, going to work, or performing normal activities can be quite challenging. Many patients suffering from medical conditions like arthritis and diabetes often suffer from foot ailments. Fortunately, podiatric physicians can help. Podiatry is the branch of medicine that deals almost exclusively with the foot, ankle, and lower leg. 

How can compounds help?

Compounded formulations provide innovative solutions to challenging medical situations involving the treatment of foot and leg issues.

• Topical, transdermal therapy can decrease systemic exposure and significantly reduce the risk of undesirable side effects of certain medications such as drowsiness, gastrointestinal upset, or bleeding.
• Compatible medications can be combined into a single formulation for ease of administration.
• Some compounded formulations solve nail removal problems. For example, urea plasters, a non-surgical treatment for nail removal, are less costly, essentially painless, and reduce the risk of infection or hemorrhage.

The following list is just a few of the conditions for which your pharmacist, working closely with your podiatrist, can prepare customized formulations to meet your unique needs:

• Warts
• Nail Fungus
• Heel Spurs
• Plantar Fasciitis
• Poor Circulation
• Wound Care
• Toenail Removal
• Dry Skin
• Inflammation/Arthritis
• Swelling
• Blisters
• Calluses
• Diabetic Neuropathy
• Neuropathic Sprains
• Neuritis
• Muscle Spasm
• Athlete's Foot
• Sprains
• Tendonitis
• Iontophoresis/Phonophoresis

Introduction

So you're going to have a baby! Whether you are pregnant or are planning to get pregnant, you will want to ensure you keep your baby safe and healthy during the pregnancy as well as post-delivery. Your body goes through many physical changes during and after pregnancy. Compounded medications can safely treat many issues that may arise during pregnancy as well as post-delivery. Talk to your compounding pharmacist to find out how they can help you and your baby journey off to the best start.

How can compounds help?

Many issues may arise whether it is stretch marks, not producing enough breast milk, and/or sore and cracked nipples during breastfeeding. Compounded medications can help many issues that may arise during pregnancy as well as post-delivery. Compounded medications can ease your transition after your delivery to help you start feeling like yourself in no time. Compounded medications can also provide customized medications to meet you and your baby's needs while being safe for your baby.

Introduction

Compounding for proctology is the preparation of customized medication for conditions related to the anus and rectum. Conditions that involve the anus or rectum typically will cause discomfort and pain. In addition, many available topical and systemic treatments may simply be inadequate in treating the condition. Fortunately, your pharmacist can prepare customized medications to manage your condition, and in turn, help to manage your discomfort and pain.

Hemorrhoids

Hemorrhoids (also called piles) are swollen, engorged veins within the lining of the anal canal or lower rectum. They are either inside the anus or under the skin around the anus. Internal hemorrhoids normally don’t cause much discomfort. External hemorrhoids, on the other hand, are typically painful. Both types of hemorrhoids can bleed when they are irritated.

Traditionally, hemorrhoids are associated with aging, pregnancy, chronic constipation, diarrhea, straining during bowel movements, and prolonged sitting on the toilet. These conditions interfere with blood flow to and from the area, causing it to pool and enlarge the vessels.

While bleeding, anal itching, and pain are common symptoms, some people with hemorrhoids have none of these symptoms and only learn of their hemorrhoids during routine physical examinations or colonoscopy screenings. Symptoms, when they do occur, usually go away within a few days.

Simple, self-help, and over-the-counter measures can ease pain and promote healing. Increased fluid and fiber intake, either by eating plenty of fruits and vegetables or with fiber supplementation, draws water into stools, making them softer and easier to pass.

Over-the-counter topical therapies such as pads infused with witch hazel (Tucks), as well as soothing creams that contain lidocaine, hydrocortisone, or other ingredients like phenylephrine (Preparation H) are available to help you find relief. Compounded prescription preparations are sometimes necessary for more severe or thrombosed hemorrhoids.

Anal Fissures

An anal fissure is a tear in the anus. Passing hard stools, constipation, and chronic diarrhea can cause stretching and tearing of the anus. Other factors include pregnancy, childbirth, complications of Crohn's disease, ulcerative colitis, or a sexually transmitted infection such as anal herpes infection.

Anal fissures cause sharp, stinging pain that can be severe and tends to worsen when you pass a bowel movement and then for an hour or so after. The pain is often accompanied by bleeding during bowel movements. In most people, this skin damage will heal quickly without any problems. However, fissures sometimes become chronic because after the first tear, bowel movements reinjure the area. Some people seem to have a higher than normal pressure in the anal canal from muscle spasms of the internal anal sphincter (the muscle around the anus). Increased anal canal tone and sphincter spasm is believed to decrease blood flow to the anal region and slow the healing process. For this reason, the most effective medications for anal fissures work by increasing blood flow to the region and relaxing muscles to reduce spasms.

Compounded topical treatments such as nitroglycerin, nifedipine, and diltiazem can be prepared by your compounding pharmacist. These medications work by dilating the blood vessels around the anus and/or by causing relaxation of the internal anal sphincter. Blood is able to flow to the area more easily to promote faster healing.

How can compounds help?

Your compounding pharmacist can prepare medications in a variety of formulations to treat and manage conditions like hemorrhoids, anal fissures, idiopathic proctodynia (pain syndrome affecting the perianal region), and/or inflammatory bowel disease such as Crohn’s disease.

In addition, your compounding pharmacist can prepare medications to manage pain post hemorrhoidectomy, which is a surgery to remove internal or external hemorrhoids. If you are receiving radiation therapy for pelvic malignancy, you may experience radiation proctitis, which is a known complication. If this is the case, your compounding pharmacist can formulate a customized treatment for you.

Introduction

If you are looking to quit smoking but have tried and did not like or did not find success with any of the nicotine replacement therapies on the market, your compounding pharmacist may have the solution. Nicotine replacement therapy uses products that supply low doses of nicotine. These products do not contain the toxins found in smoke. The goal of nicotine replacement therapy is to decrease cravings for nicotine and ease the symptoms of nicotine withdrawal.

Commercially available smoking cessation aids, such as nicotine gum, lozenges, patches, inhalers, and sprays, are used to help people stop smoking without exposing the user to the harmful tars and carbon monoxide in cigarette smoke. They not only curb the craving for tobacco, but in the case of gum and lozenges, also satisfy the oral fixation associated with nicotine addiction. While these products are very helpful for some, patches may cause skin irritation at the site of application and do not allow for increased dosage during stressful events of the day. Nicotine gum may cause headaches and heart palpitations, and other side effects, if chewed in the way regular gum is chewed.

How can compounds help?

Nicotine lollipops, which require a prescription, can help control cravings because they provide an alternative source of nicotine and can help to satisfy the "hand to mouth habit" by keeping your hands busy, much like a cigarette. This quality is missing in the commercially available products.

Because nicotine lollipops do not contain the toxins found in cigarette smoke, you are not subjecting yourself to the same risks associated with smoking. As you begin to step down your usage, you gradually wean your body off the nicotine until you no longer desire nicotine.

Whether you have been smoking for a very long time or for only a few years, kicking the habit can be hard. With the right plan, however, you can break the addiction and manage your cravings to live a rewarding, smoke-free life. When choosing a nicotine replacement therapy, you should choose a form that fits your lifestyle and is based on your habit. If you feel like the nicotine lollipop may be a great option for you, talk to your compounding pharmacist today.

Introduction

Participating in any sport or fitness activity, at any level, can result in injury that may require a variety of treatments. Whatever the injury, compounded medications are available in different strengths as well as unique dosage forms to provide a personalized treatment. Compounded medications can help you get back into the game much faster and are not just for professional athletes but are available to everyone.

How can compounds help?

Compounded medications can treat pain, inflammation, muscle spasms, bacterial/fungal infections, and neuralgia. In addition, compounded medications can help treat excessive sweating, can be used for pregame rubs, and can be used with iontophoresis and phonophoresis technologies, which are used to enhance drug penetration through the skin. Many oral medications that are traditionally used to manage sports injuries, such as non-steroidal anti-inflammatory drugs (NSAIDs), can cause undesirable side effects that can negatively affect athletic performance. However, these medications, if used topically, can ease inflammation and pain, with fewer undesirable side effects. In short, compounded sports medicines offer the ability to supply key ingredients in strengths and delivery systems that most effectively provide relief and recovery.

What types of formulations can be made?

Capsules, creams, ointments, gels, troches, suppositories, solutions, suspensions, syrups, sublingual tablets/drops are all examples of non-sterile products. Any product used for injection or inhalation are examples of sterile formulations.

What types of illnesses can compounded medications help treat?

Contemporary compounding has been providing solutions to help with many areas including, but not limited to: Chronic Pain Management, Hormone Replacement Therapy, Endocrine Disorders, Veterinary Conditions, and Dermatological Conditions.

Introduction

Compounding for urology and urogynecology is the preparation of customized medications for conditions affecting the urinary tract, reproductive systems in men, as well as vulvar pain, pelvic floor disorders, and other issues that may affect women. For many of these conditions, medications that are found on the market may not meet the unique needs of every individual patient. Fortunately, your compounding pharmacist can prepare medications in a variety of different formulations to offer the best treatment for you.

In the following instances, a compounded medication therapy may be indispensable:

• Preservative-free medications are required.
• Certain dyes, sugars, alcohols, or lactose must be avoided.
• Combination products or other special formulations are desired but are not commercially available.
• Normally commercially available product is backordered or discontinued.
• Alternative dosage form or strength outside of what is commercially available is necessary.
• Allergy or side effect to a commercially available product.
• Commercially available treatments have failed.

How can compounds help?

Compounding for Common Urological Conditions

The following common conditions can be treated with custom compounded preparations:

• Erectile Dysfunction
• Peyronie's Disease
• Post Surgical Penile Functioning
• Kidney Stones
• Vaginal Atrophy
• Benign Prostate Enlargement
• Bladder Control (Incontinence)
• Bladder/Urinary Tract/Prostate Infections
• Bladder/Kidney/Prostate/Testicular Cancer
• Bladder Irrigation/Intravesical Solutions
• Cystoscopy Procedures

Customized Delivery Forms for Urology

Your medication can be compounded into many formulations including:

• Intracavernosal Injection Solutions
• Intravesical Solutions
• Vaginal Gels/Creams
• Topical Gels/Creams
• Oral Liquids
• Rapid-Dissolve Oral Tablets
• Urethral Gels and Inserts
• Bladder Irrigation Solutions
• Sterile Injectables
• Suppositories
• Troches
• Vaginal Suppositories

Your compounding pharmacist is ready to work with your physician to develop a dosage form to fit your unique needs.

Introduction

Giving a pet medication can be a struggle. Compounded medications are a simple solution for pet owners who have difficulty giving their pets medicine. We understand that your pets are a very important part of your family. A pet can suffer from a variety of medical conditions, and because animals differ in their bodily systems across species, treating conditions can be difficult.

How can compounds help?

Together with veterinarians, pharmacists can provide compounded medications to expand the amount of treatment options available for veterinary conditions. Medications can be made in oral liquid, topical, and animal treat forms. These medications can be flavored to appeal to animals, making them easier to administer.

Introduction

For those with weight loss goals, compounded weight-loss medications may be the solution. Your pharmacist can compound a variety of preparations to help you achieve and maintain your ideal body weight goals. Being overweight or obese increases one's risk for many health conditions such as diabetes, hypertension, and heart disease. Losing weight can significantly improve these health conditions and in turn improve overall quality of life. Your pharmacist will work closely with your doctor to determine the best treatment options for you and your weight loss goals. With a prescription from your doctor, your compounding pharmacist can prepare customized medications to help you lose weight. These medications should be taken in conjunction with a diet and exercise plan.

How can compounds help?

Your compounding pharmacist can prepare a variety of medications that can help you lose weight. Your pharmacist will work closely with your doctor to determine the best option for you. Common weight loss treatments include:

• Oral appetite suppressants, which can be prepared in a variety of combinations.
• Customized phentermine capsules and lollipops are commonly prescribed alone or in combination for appetite suppression.
• Specific vitamin injections that help regulate appetite while assisting with the metabolism of fats and carbohydrates into energy.
• Injections that help release fat deposits in the body.
• Human chorionic gonadotropin (HCG) preparations.
• More recently, human chorionic gonadotropin (HCG) has gained popularity. Initially approved by the FDA for the treatment of female infertility and hormone treatment in men, many physicians believe it can be used for weight loss. HCG should be used in conjunction with a diet and exercise plan and should only be taken under the direction of a physician. You can only get HCG with a prescription from a physician. Don't be fooled by fake HCG supplements sold online. Many websites state they sell HCG, but doing so without a prescription is illegal.

Introduction

Treating a wound or a serious injury is often a complex activity as it involves many different bodily processes to make sure a wound heals quickly and safely, without leaving lasting health issues. Specialized medications and compounded preparations may be used to aid in the treatment of many types of wounds as well as be used post surgery. Customized medication becomes important when treating wounds; the choice of medication as well as the formulation used (e.g., creams, ointments, gels) affects proper healing.

How can compounds help?

There are a variety of compounds that can be prepared as either creams, gels, or ointments that include special combinations of ingredients that can promote healing, remove dead tissue, relieve pain, and increase blood flow to the affected area. In some cases, a medicated wrap or bandage may be a great option for wounds healing on active parts of the body like the legs or arms.

Introduction

Chronic pain can be very difficult to manage in many patients. Many of the traditional oral drugs used for pain treatment, such as opioids, NSAIDs, and anticonvulsants, can have unwanted systemic side effects. These classes of medications, among others, can be just as effective in managing pain when used topically. Using a multimodal approach to treating symptoms of chronic pain has also been shown to be efficacious, which can be easily accomplished using a topical formulation.

Treatment Options

Classes of medications that can be used topically include: NSAIDs, Alpha II Agonists, AMPA-Na+ Channel Blockers, GABA Agonists, NMDA-Ca2+ Channel Blockers, Tricyclic Antidepressants.

Advantages:

• Avoid first pass hepatic metabolism
• Avoid GI tract
• May improve compliance
• Increased drug concentration at site of pain
• Decreased systemic side effects

Disadvantages:

• Most common side effect is rash
• May not be suitable for large areas
• Absorption may vary from patient to patient depending on the stratum corneum barrier

Introduction

Each patient's dermatological condition is unique which can create a challenge for practitioners in regards to finding treatment options. Compounding pharmacists have the ability and experience to compound individualized therapies for numerous dermatological conditions including scarring, acne, rosacea, skin discoloration, psoriasis, and eczema.

Treatment Options

Treating these conditions often requires a multidisciplinary approach. Depending on the specific illness, a variety of drugs can be compounded into topical creams, lotions, gels, pastes, and ointments. Common agents used to compound formulations include calcium channel blockers (for circulation), anti-inflammatory agents, antihistamines, antipruritic agents, local anesthetics, and many other classes of drugs.

Dermatological Conditions

Some of the conditions we help treat include:

• Acne
• Alopecia
• Athlete's Foot
• Anesthetics
• Chemical Peels
• Diaper Rash / Incontinence
• Eczema
• Fever blisters
• Head Lice / Scabies
• Hyper-pigmentation Molluscum
• Nail fungus
• Peels
• Psoriasis
• Poison Ivy
• Pruritus
• Radiation burns
• Rosacea
• Scarring and Keloids
• Shingles
• Sun Protection / Photoaged Skin / Wrinkles
• Vitiligo
• Warts

Introduction

Many men can experience andropause or low-T as they age. As a result of declining free testosterone levels in the body, males can exhibit a variety of debilitating symptoms. Decreased concentration, lethargy, loss of libido, erectile dysfunction, and depression are commonly seen in men with low-T. Low-T is often characterized by total testosterone levels falling below 300 ng/dl. Testosterone supplementation can offer a solution for these patients.

Treatment Options

Compounded topical and oral preparations are options to help patients with low-T. Many preparations are commercially available such as AndroGel, Testim, and Striant. Injectable testosterone may not provide normal physiological serum levels for patients. In addition, patients may need specific dosing adjustments that may not be managed with these products. A compounded preparation could be an alternative if patients are having issues or concerns with commercially available therapy. Studies have shown that there is increased mortality specifically among patients with cardiovascular risks or history of cardiovascular issues. Complete medical histories should be taken and evaluated to ensure patient safety.

Introduction

Many women have difficulties coping with chronic conditions stemming from menopause. These conditions can often be complicated to manage. Symptoms arise from deficiency or dominance of estrogen, progesterone, or testosterone. Hormone replacement therapy involves three main forms of circulating estrogen: estrone (E1), estradiol (E2), estriol (E3). Other important hormones include progesterone (P4), dehydroepiandrosterone (DHEA), and testosterone (T).

Treatment Options

Studies have shown that combinations of E1, E2, E3, P4, and DHEA have been effective in treating various vasomotor symptoms that may be associated with menopausal hormone imbalance. Formulations include topical and vaginal creams, oral capsules, and orally disintegrating tablets. Various ratios of these hormones exist in the female body, and in order to mimic these ratios, formulations often have to be compounded to contain some proportion of the three estrogens. Triestrogen or TriEst is a common name given to formulations containing E1, E2, and E3, while biestrogen or BiEst is a common name given to formulations containing E2 and E3. BiEst generally contains 80% estriol and 20% estradiol, while TriEst contains 80% estriol, 10% estrone, and 10% estradiol. A prescription written for 2.5 mg of BiEst will actually contain 2 mg of estriol (E3) and 0.5 mg of estradiol (E2) if using a conventional 80:20 ratio.

Introduction

Compounded preparations can improve therapeutic outcomes, reduce side effects, and reduce the stress and discomfort associated with end-of-life care. Compounding medications for hospice patients is essential when other therapies fail or commercially manufactured medications are unavailable. If your patient requires alternative dosage forms, has allergies or side effects to commercially available products, or requires the use of multiple therapies combined into one medication, compounding pharmacists have the ability to customize compounded medications to meet these needs.

Treatment Options

Compounded preparations can be used to treat a variety of underlying conditions related to hospice and palliative care including:

• Chronic Pain
• Nausea/Vomiting
• Diarrhea
• Skin Infections
• Breakthrough Pain
• Constipation
• Skin Ulcers
• Anxiety

The following delivery forms may be available:

• Topical Gels/Creams
• Transdermal Gels/Creams
• Topical Ointments
• Oral/Sublingual Drops
• Capsules
• Flavored Oral Suspensions
• Suppositories
• Rapid Dissolve Tablets
• Lollipops
• Lozenges/Troches

Introduction

Many medications are not available in child-friendly dosage forms. The most common factors that influence medication compliance among children include taste and appearance. The commercial market does not produce many formulations of medications that are easy to use in the pediatric population.

Treatment Options

Compounding pharmacies are able to provide clinicians with a variety of options of medication dosage forms for their pediatric patients. Common preparations are seen in liquid and topical forms. Freezer pops, gummy chews, and lollipops can be made containing different medicines depending on patient need. These medications can also be flavored according to patient preference.

Examples:

• Omeprazole suspension for reflux which is commonly seen in infants
• Topical diaper rash formulations using cholestyramine

Introduction

After pregnancy, many women are faced with unexpected bodily changes including stretch marks, lactation failure, or sore and cracked nipples during breastfeeding. Treating these issues often becomes complicated as many medications can harm the baby in utero or postpartum through breastfeeding. Compounded medications may be the best solution as they can be customized to meet both the mother’s and the baby's needs.

Treatment Options

Compounded medications can help treat many issues that may arise during pregnancy as well as post delivery. In regards to stretch marks, although there is no proven way to prevent stretch marks, certain topical products can be prepared to try to improve the elasticity and appearance of the skin. For some women, breastfeeding is not an option. Problems with milk letdown, which is the inability to lactate due to not having enough of the hormone oxytocin, is a fairly common problem. If this is the case, oxytocin nasal spray can be compounded to facilitate lactation. As a result, you can give your patient the best chance to be able to breastfeed.

With breastfeeding comes the possibility of sore and cracked nipples. Special ointments can be compounded to soothe sore and cracked nipples. In addition, if a fungal infection develops, certain topical antifungals can be prepared for the infant and mother. Miconazole oral gel, clotrimazole oral gel, and gentian violet preparations can be applied to the mouth of the infant. Miconazole oral gel and clotrimazole oral gel can also be applied to the mother’s nipple(s).

Introduction

Sports medicine, for athletes ranging from weekend warriors to world-class Olympians, has proven to be another area where pharmacy compounding has shown to be very useful. For example, compounded medications can be used to treat sports-related pain, inflammation, muscle spasms, bacterial/fungal infections, and neuralgia. In addition, compounded medications can help treat excessive sweating, can be used for pregame rubs, and can be used with iontophoresis and phonophoresis technologies, which are used to enhance drug penetration through the skin. Compounded medications allow personalized treatment, and the options are unlimited as formulations are customizable in terms of dosage, method of administration, the number of active ingredients, absorption, and more.

Treatment Options

Many preparations are commercially available to help manage pain, inflammation, and muscle spasms, but they can cause undesirable side effects. However, these medications, when used topically, can provide better therapeutic benefit with fewer unwanted side effects.

Treatment options may include:

• Topical NSAIDS such as ibuprofen
• Topical anesthetics such as LET gel (lidocaine, epinephrine, tetracaine)
• Medications for iontophoresis and phonophoresis such as steroids, dexamethasone, NSAIDS, local anesthetics, salicylates, and individual substances such as zinc oxide, iodine, acetic acid, and calcium chloride
• Medications used for pregame rubs such as emu oil and antispasmodic drugs
• Medications for excessive sweating
• Nutritional supplements
• Rehydration drinks

Introduction

Veterinary medication therapy often poses unique challenges. Many medications can be compounded to help with administration and treatment of conditions in a variety of animals. Compounded preparations are always prepared from FDA-approved animal or human drugs. These preparations are prepared and evaluated in a manner consistent with current potency, purity, and stability standards. Compounding pharmacies want to work with veterinarians to create specialized, effective formulations for their patients.

Treatment Options

Depending on the animal and condition, various medications can be compounded into oral liquids, topical preparations, and animal treats.

Examples include:

• Topical methimazole gel for treatment of hyperthyroidism
• Phenobarbital and potassium bromide oral liquid for epilepsy
• Methocarbamol suspension for rhabdomyolysis in horses
• Antibiotic and antifungal liquid formulations for infections with appropriate flavoring to help with administration

Introduction

As a provider, when treating wounds or serious injuries, you want to ensure you properly treat the wound in order to obtain the best outcomes. Customized medication becomes important when treating wounds because the choice of medication as well as the formulation used (e.g., creams, ointments, gels) will affect the healing process.

Treatment Options

Examples of compounded medications for wound care may include:

• Topical antibiotic solutions to be used during the healing process
• Papain/Urea Ointment for wound debridement
• Topical Phenytoin for ulcer healing

Topical compounds may include any of the following ingredients: Misoprostol, Metronidazole, Phenytoin, and Lidocaine.

Compounds may be made in a variety of combinations and may depend if there is pain and odor associated with the wound. 

When writing a prescription for a compounded medication the following information should be included:

1. Patient identification (name, date of birth, address)
2. Date
3. Drug allergies
4. Indicate prescription is to be compounded
5. Generic name of all active ingredients
6. Strength or dose of medication (for example: %, milligram, grams)
7. Formulation desired (cream, gel, troches, capsule, suppository, ODTs, etc.)
8. Quantity desired and/or days supply needed
9. Directions for use
10. Medical condition being treated
11. Refills, if any.

If you have any specific questions regarding formulations, do not hesitate to contact our pharmacy.

Questions?

Contact our pharmacists with questions. We're happy to answer any questions and discuss suitable options to meet your patient's needs.