History of Compounding
The practice of custom-preparing medications dates back to the origins of pharmacy; yet, compounding's presence throughout the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. During the 1950s and 60s, with the advent of manufacturing, compounding declined. The pharmacist's role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms. In the 1980s, and especially in the 90s, physicians and patients again realized the benefits of preparing customized medications to meet specific patient needs. Today, an estimated 43,000 prescriptions are compounded daily, or one percent of total prescriptions dispensed. Also known as "problem solvers," today's compounding pharmacists are using modern technology and innovative compounding techniques to meet specific patient needs.
Reasons for Compounding
There are several reasons why pharmacists compound prescription medications; yet, the most important one is patient noncompliance. Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's consent, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, and add flavor to it to make it more palatable. The pharmacist also can prepare the medication using several unique delivery systems, such as a sublingual troche or lozenge, a lollipop, or a transdermal gel. Or, for those patients who are having a difficult time swallowing a capsule, a compounding pharmacist can make a suspension instead.
Often parents have a tough time getting their children to take their medicine because of the taste. A compounding pharmacist can work directly with the physician and the patient to select a flavoring agent, such as vanilla butternut or tutti frutti, that provides both an appropriate match for the medication's properties and the patient's taste preferences. Compounding pharmacists also have helped patients who are experiencing chronic pain. For example, arthritic patients who cannot take certain medications due to gastro intestinal side effects. Working with their physician, a compounding pharmacist can provide them with a topical preparation with the anti-inflammatory or analgesic their doctor prescribed for them.
Customized Medication Dosages for Animals
Often commercially available animal medications come in only one dosage or strength. In order to properly medicate small animals, a reduced dose often must be given. This can be a problem and a potential source of either over or under medicating, if the needed drug only comes in a solid form. We can provide the exact amount of medication per dose needed to treat smaller animals. Conversely, we can provide larger than commercially available strengths of medications and can format them into single doses.
Meeting Patient and Practitioner Needs
Compounders focus on meeting special needs. This may involve compounding height/weight-appropriate pediatric medications, injections for impotency, medications for veterinarians in a variety of dosage forms and flavors, alternatives in hormone replacement therapy, or dosage options, such as transdermal gels, when treating hospice patients. The ultimate goal in preparing any of these customized medications is to help the physician and patient achieve a more positive therapeutic outcome and patient compliance.
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