As I mentioned in my introductory article, I was a pharmacist who loved compounding before I retired and began writing more seriously. And, as I compounded products for women that were unavailable in Canada, I became increasingly interested in women’s health issues. But, before I describe what I learned while using compounding to solve women’s health problems, I wanted to explain just what compounding is and how patients and practitioners can benefit from this specialized skill of pharmacists.
What is pharmaceutical compounding?
Compounding is the art and science of making a medication from individual components, sometimes referred to as making medicines “from scratch.” The science is making sure the product contains exactly what was ordered and that it remains stable for the entire time it will be used. All pharmacists are taught to do this accurately as part of their basic training. The art is creating a product that looks good, is easy to use, and feels or tastes good (as applicable).
The result is essentially personalized medicine… medicine made to suit the individual. Since the beginning of time, this is what pharmacists have done: a doctor would diagnose the condition and write an order for what the patient needed. The pharmacist would then create the treatment in a form the patient could use.
But, although compounding medications was pharmacists’ original role, eventually, pharmaceutical companies took over the manufacture of most medicines. Pharmacists’ role evolved to ensuring there are no drug interactions, repackaging suitable quantities, instructing patients in proper use, solving medication problems, and answering any drug-related questions.
How does compounding affect your health?
Today, pharmacists only compound medicines to create something that does not exist commercially, even if it could be compounded less expensively. We create compounds to solve problems. A few examples are patient allergy to a non-drug ingredient (for example, lactose or a colouring agent), difficulty swallowing (preparing a liquid from a tablet), or to change the route of administration (making an anti-inflammatory drug into transdermal form).
Some pharmacists delve deeper into this essential activity of pharmacists, developing the ability to create highly specialized medicines in specific specialty areas. They work closely with doctors and patients, and often read scientific papers and attend conferences for inspiration and information. Some of these compounds can be quite complex and rigorous standards have been developed to ensure the quality of the final product. These pharmacists who perform higher-level compounding are referred to as compounding specialist pharmacists. But remember that all pharmacists and pharmacy technicians are trained in calculations and techniques for preparing accurate basic compounds.
Compounding can create unique medicines to treat pain, improve end of life care, balance hormones, facilitate complex nutritional protocols, and help our animal friends. Pets or zoo animals might need tiny doses that cannot be accurately measured or very large doses that are difficult to administer with existing commercial medications.
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Occasionally these original medicines are so successful that pharmaceutical companies become interested in manufacturing them. An example is transdermal anti-inflammatories, some of which are still compounded, although diclofenac gel is now manufactured commercially. Another example is testosterone for women, which has been compounded by pharmacists since before I became a pharmacist in the 1970s. Note that, as far as I am aware, there are no commercial testosterone products designed for women available in North America currently, although I understand that a low-dose patch for women is in development.
Even the most basic of compounds can benefit from the input of a compounder. For example, pharmacists are often asked to mix two creams together so the patient can benefit from both ingredients with a single application of the product. However, practitioners often do not realize that each cream dilutes the other resulting in half strength of both active ingredients.
Here’s an example: Mixing 15 grams of clotrimazole 1% and 15 grams of hydrocortisone 1% together creates 30 grams of clotrimazole 0.5% and HC 0.5% cream. But any pharmacist can add 1% hydrocortisone powder to clotrimazole 1% cream, resulting in full strength of both active ingredients. The practitioner simply needs to ask for what they want in the final preparation, and let the pharmacist determine the best way to create it!
So, when available medications are not suitable for a patient or the person has special requirements due to allergies, swallowing or other problems, consider calling your local compounding pharmacist. They may have suggestions and, if not, I expect they would be willing to research a solution to the problem for you. Compounding pharmacists have formed international networks to share ideas and help each other solve patient problems and compounding challenges and have specialized equipment to facilitate the creation of a quality compounded medication. They are an excellent resource!
What is Compounding? PCCA (Professional Compounding Centers of America) https://www.pccarx.com/aboutus/whatiscompounding.aspx
Jeannie Collins Beaudin is a recently retired Canadian community pharmacist with 40 years of experience, including specialization in compounding pharmacy, and hormone assessment and management. In addition to publishing her book, Can I Speak to the Hormone Lady? Managing Menopause and Hormone Imbalances in 2018, she has written articles and blogs for Pharmacy Practice + Business since 2006, peer reviewed educational programs for Canadian pharmacists since 1998 and publishes a weekly health blog found on her website.
Editor’s Note –The views expressed in the nurse influencer posts are those of the contributing authors. NPWH does not sanction the content of these posts.