Integrative Clinical Pharmacist Scott Berliner, RPh
Compounded is the combining of two or more ingredients to form a final product. In the pharmaceutical industry, it refers to the practice of customizing medication to meet individual patient needs based on the specifications set by the physician. This defines what we do in a compounding pharmacy.
In conjunction with the patient, physician, dentist or veterinarian, the pharmacist can help determine a sensible formulation for the treatment of a health condition in which there are little or no better options.
The pharmaceutical industry is geared to doing things in large volume while maintaining large margins of profit. To this end, both dosage options and the delivery route of a medication may be limited. In addition, medications may be discontinued because of lack of profit once the patents have expired.
If you need a medication for a child and there is only an adult version available, chances are it will be too strong and undeliverable to a young child who cannot swallow tablets or capsules. What if the medication is available from a manufacturer but the child cannot tolerate the flavor or is allergic to one of the additives? In a compounding laboratory, we can start with the same active ingredient, whether it is natural or pharmaceutical, and put it into a hypoallergenic vehicle with the appropriate flavor.
Not all of the compounded products we make are natural, but they are all functional. This means that whatever the purpose of the herb, vitamin, mineral or pharmaceutical agent, it will be in the appropriate strength for the person or animal for which it is intended.
Fortunately, many products can be delivered through a transdermal method for absorption through the skin into the bloodstream, bypassing the gastrointestinal tract and eliminating the most common of all side effects, stomach distress. At the same time, this method allows for the use of lower doses since there is no chance of breakdown in the stomach from stomach acid and enzymes. Using lower doses also means reduced side effects, whether the active ingredient is natural or not. This transdermal delivery can be invaluable in getting the active ingredients delivered into the blood in a less distressing way for those who have digestive issues and do not absorb well through the gut. We now have several formulations that we make in lollipops or chewable lozenges as well as sublingual vehicles (delivered to the blood stream through the route under the tongue) much like nitroglycerin is used with heart patients.
With custom formulation, many health situations can be addressed with less toxic chemicals. One of our popular compounded prescription items has had remarkable effects on eczema and psoriasis without the use of cortisone based creams or immuno-suppressive drugs. In integrative medicine, we combine a functional approach to health using lifestyle and diet changes in combination with appropriate herbal, vitamin, and mineral support. Some herbs are only available as tinctures or in encapsulated extracts making it difficult for children to take. Therefore, we pay special attention to making palatable liquid suspensions for them. With proper flavoring we can mask the bitter nature of some and make it easier for the parent to administer.
Compounding of medications goes back to the very beginnings of medicine. We now have advanced technology that makes it possible for a qualified pharmaceutical laboratory to achieve the accuracy of pharmaceutical companies while treating each case individually for optimum results.