Why Compound?

The compounding of medications is one of the oldest practices in medicine. Compounding is defined by the preparation, mixing, assembling, packaging, or labeling of a drug or device as the result of the practitioner, patient, and pharmacist relationship. Compounding also includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns. In other words, a customized medication prepared by a pharmacist according to a doctor’s specifications to meet a patient needs. Pharmacists make medications from scratch using pure ingredients, powders, and special devices.

Approximately 60 years ago, over one-half of all prescriptions were compounded by pharmacists. During the evolution of medicine, pharmacists became more dependent on the dispensing of medicines instead of making them. Drug manufacturers started to mass produce medicine, often limiting the medications to a few strengths. The idea of different strengths and dosage forms made for the masses works well most of the time. However, some patents need specialized dosage forms or individual dosing regimens. We compound medicines to meet the needs of each individual. In other words, we fit the medicine to the patient, rather than the patient to whatever is available commercially.

Today, compounding pharmacies are one of the fastest growing segments of the pharmaceutical industry. We are better educated, better regulated and much more sophisticated than compounding pharmacies of old. There are several reasons to compound medications. These are just a few of them:

Medications that are not commercially available:
M anufacturers must be assured that there will be a return on their investment when entering the marketplace with a drug. Therefore, there are limited products available with which the patient can be treated. These limitations may be dosage forms, strengths, flavors, or packaging. Compounding allows the physician to prescribe a custom-tailored medication that is not available commercially.

Medications that are not stable:
Pharmacists prepare smaller quantities of a prescription more frequently to ensure the stability of the product and the maximum amount of time before the product expires.

Altered commercially available medications:
Physicians prescribe a commercially available medication in a different dosage form to meet a specific patient need and ensure patient compliance. For example, a patient may be allergic to a preservative or dye in a manufactured product. Compounding pharmacists may be able to prepare a dye-free or preservative-free form. Some patients have difficulty swallowing a capsule and require a troche or lozenge. Many pediatric patients are non-compliant because their medications tastes poorly or is otherwise not administrable, but become compliant when the medication is flavored to their liking.

Some dosage forms available from compounding pharmacies are injectables, capsules, suspensions, suppositories, transdermal creams, ointments, gels, lollipops, troches, and different types of powders. A compound may be a simple as combining two different powders together for a dog or an intrathecal injectable for a human baby.