Compounding is the pharmaceutical practice of producing customized medicine for specific needs. It provides solutions for those who are allergic to basic ingredients found in common medications, treatment to people who need a special doses or to those who require a rare drug that isn’t readily available in the market.

Compounded medication is a great option for people with 

• Allergies to preservatives, dyes, or fillers.
• Difficulty swallowing capsules or tablets (i.e. geriatric or pediatric patients).
• Sensitivity to standard drug strengths (i.e. renal patients).
• Dosage forms that are not commercially available.
• Difficult to dose patients (i.e. children and pets).

Because compounding requires expensive specialized equipment and extensive training in modern compounding techniques, most pharmacies do not compound.

With commercially available medications, the drug is produced with no specific patient in mind. It limits the prescriber to matching the available product to the patient. Whereas, with compounded medications, the formula matches the patient’s needs. The drug can be prepared in the most effective dosage, strength, and delivery form.

Compounded medications do require a prescription from a doctor. Compounding pharmacists have the unique opportunity to develop a special relationship with the patients they serve, working with the doctor to solve problems that manufactured dosage forms do not address.

Bioidentical hormone replacement therapy (BHRT) seeks to restore hormonal balance and typically involves estrogen, progesterone, testosterone, DHEA, and cortisol. BHRT involves individualized supplementation with hormones that are identical to the ones normally produced by a human body. These hormones are derived from plant sources and synthesized to create hormones that molecularly mirror what a human naturally makes. No two people have the same hormonal profile, so BHRT allows medical practitioners and pharmacists to tailor the replacement regimen and elevate a patient’s hormones to her/his normal levels.

Hormones fluctuate as early as a woman’s mid-thirties. Progesterone levels, for example, plummet by age 35, leading to a stage of life called perimenopause, which occurs during the 5-15 years preceding menopause. With menopause comes a significant drop in estrogen levels. Such hormonal imbalances, if left uncorrected, contribute to osteoporosis, increased risk for cardiovascular disease, and diminished quality of life because of hot flashes, night sweats, decreased sex drive, and other unpleasant symptoms.

Men’s testosterone levels decline gradually over a lifetime and the effects become readily apparent during mid-life with declining vitality, decreased muscle mass, waning sex drive, and increased risk for cardiovascular disease.

Regardless of age or sex, high-stress lifestyles contribute to cortisol imbalance. Such adrenal dysfunction interferes with the action of most other hormones and contributes to weight gain, fatigue, and other ill effects.

Because bioidentical hormones cannot be patented, drug companies have little to offer. Our compounding pharmacy we can readily assist in meeting BHRT needs. Working with the medical practitioner and the patient, we will custom make BHRT components to suit each individual hormonal profile.

Any form of hormone replacement can be contraindicated in certain patients. Please consult with your medical practitioner before proceeding with any hormone regimen, including over-the-counter products. BHRT is not recommended for every patient and can carry significant side effects if prescribed and/or taken in an unbalanced manner. These effects can include blood clots, strokes, and certain kinds of cancer, among others. Balance is the key to successful BHRT — balance between hormones and balance in lifestyle and nutrition. BHRT is not a cure-all. But when utilized in tandem with good nutrition, regular exercise, and stress reduction, patients have reported that BHRT can significantly contribute to overall good health.

• Making any strength of a medication when specific doses are not commercially available.
• Preparation of a medication that has been withdrawn from the marketplace due to economic concerns, not safety.
• Creating a concentrated liquid or a rectal suppository for those who cannot or have trouble swallowing.
• Allergy-free medications preparations for those who may have sensitivity to dyes, preservatives, or fillers.
• For children, compounding pharmacists can formulate flavored liquid medications.
• For patient compliance, compounding pharmacists may combine many medications into one dosage form.
• For animals, compounding pharmacists may create flavored medications or prepare unique dosage forms.

Lozenges / Troches
Lozenges or troches are a popular dosage form used to keep drugs in the mouth when local action is desired. They also can be placed under the tongue and allowed to dissolve for sublingual delivery, which allows the medication to enter the bloodstream quickly and easily. Lozenges and troches can be enhanced with natural sweeteners and pleasant flavors, making them ideal for geriatric and pediatric patients.

Unique Oral Delivery Systems
As many patients often have a difficult time taking medicine, a number of dosage forms can be custom-made for easier ingestion. Many medications can be ingested as flavored lollipops or frozen popsicles. Others can be taken as chewable gummy treats. Infants especially benefit from alternate delivery devices such as pacifiers or baby bottles, which are wonderful for dispensing medicine easily and accurately.

Capsules
Medication can be compounded into individually customized capsules, especially in cases where an alternate strength is required or in order to omit potential allergens or irritants. To reduce the number of doses to be taken, multiple medications often can be combined into a single dosage form or made into delayed-release capsules.

Transdermals
Transdermal methods of delivery are also widely used because they allow the absorption of medicine directly through the skin. Gels, emulsion creams, sprays, and lip balm applicators are easy to use and are effective at getting medicine into the bloodstream quickly. Transdermal medications are often prescribed for pain management, inflammation, and nausea/vomiting. In many cases, transdermals are used to help avoid potential side effects such as an upset stomach or drowsiness.

Suspensions
Many medications aren’t available in liquid form for patients who have difficulty swallowing tablets and capsules. Other patients may have problems tolerating the taste of a commercially available liquid. Through compounding, a pharmacist can make a naturally sweetened, pleasant-tasting oral solution or suspension that can be administered easily and accurately. Solutions and suspensions are also used in compounding eye drops, ear drops, sterile injections, or nasal sprays.

Suppositories
Patients who cannot take medications orally are prime candidates for compounded suppositories. Suppositories can be given rectally, vaginally, or urethrally. They pass quickly into the bloodstream by melting or dissolving into the body cavity and can be used for delayed-release medications, hormone replacement therapy, or to treat local conditions such as hemorrhoids, anal fissures, infections, or inflammation.