Compounding The Basics: Techniques, Benefits, and Pharmacy Support
By Nathalie Haggerty
Compounding is a special technique that enables pharmacists to make a drug by combining or mixing ingredients, specifically for a patient, who may not be able to take a medication the way it was originally made by the manufacturer. The technique essentially customizes medications that would be otherwise unavailable via commercial manufacturing. At times, patients may not respond to the commercially available drug on the market, or they may only respond to a different form of medication. Or, patients could respond with an allergic reaction to the original medication because of its components, either because of its original dies or fillers. Compounding allows pharmacists to meet the needs of their patients and help them heal by customizing their medication to fight their particular symptoms.
According to the FDA, compounding must be practiced by a licensed pharmacist, physician, or a person who had been supervised by a licensed pharmacist. Any one of these three practitioners can alter the dosage form, dose, dosing intervals, and route of administration when amending the prescription. Drugs that have been compounded serve a patient’s individualized needs but they are not FDA approved. So, it is important to talk to your pharmacist about the benefits, as well as the possible risks associated with compounding drugs.
What are the techniques in compounding?
We mainly focus on three techniques for compounding: levigating, trituration, and flavoring. Levigation is where we decrease the particle size of powders by mixing them and grinding them up, or triturating them, with a pestle and mortar, mixing in a small amount of liquid within the mixture. Trituration is the actual process of grinding one compound with another or diluting ingredients to reduce the particular size of the particles. Flavoring can enhance the taste of the medication to make it easier for the patient to consume.
At APC, our compounding pharmacy specializes in making mainly pain-related compounds. For instance, we focus on low-dose naltrexone capsules for chronic pain and autoimmune disorders, or even ketamine/buprenorphine troches for pain, as well. We have also combined topical creams to attack pain in localized areas across the body.
What are the benefits of compounding?
Compounding helps our patients to live healthier and more fulfilling lives by taking away their symptoms where commercial medicines may not be meeting their needs. With compounding, we are able to provide unique pain treatments that relieve their individualized pain.
We are able to take medications that may no longer be available through the manufacturer. Sometimes, the manufacturer has discontinued the production of a particular drug, or doesn’t have a particular drug with all the components the patient may need, on the market. Compounding plays a vital role in providing access to patients for those drug components that would otherwise not be available to them.
Compounding provides convenience to the patient by adding multiple ingredients to one compound. I am specifically considering our compounded pain creams, which target our patients’ individualized pain in a particular area on their bodies. It allows medications and creams to be extremely personalized that can target patients’ needs using different strengths and more accurate dosing. We can also tailor the medication to be more easily digestible to take, especially for those who struggle to take certain medications due to their flavoring. And, compounding allows us to remove certain ingredients, like fillers and dies, that can cause an allergic reaction in some of our patients. It simply makes medications more personalized to support our patients’ health.
In some cases compounded medications are more cost effective than some commercially available alternatives. One example we see frequently is buprenorphine products, which can cost $1000 per month. We make an alternative product that is typically around $60 per month depending on the quantity.
How can we support patients’ compounding needs?
We work with patients’ providers to ensure our patients are being educated effectively on our abilities to compound specific therapies. We provide them with all the information they need to best make the right choices for their medical needs. If a patient has been taking the commercial drug but is not getting the results they are looking for, or their pain is not easing; we usually will recommend compounding alternatives.
Compounding also allows us to alter the ingredients of the drug in a way that meets the patient’s price point as well. It can be that the commercial drug is very expensive, buprenorphine troches, for example. Compounding may personalize a drug to be more affordable and also can better meet the needs of the patient, basically making the prescription more effective.
Particularly, for pain medications, we can provide compounding medications in a very timely manner, because we specialize in compounding for those. Because compounding is so familiar to us in certain medications; we usually have them available for patient care on the same day we get the prescription. Overall, compounding is a great way to meet our patients’ needs more effectively and efficiently.