Category: Compounding

Here you will find information about compounding services, including pediatric compounding, dental compounding, and compounding for pets.

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Compounding Skin Care

7 Types of Anti-Aging Compounding Remedies

Everyone wants to preserve their youth for as long as possible, be it in body, mind, or spirit. A healthy lifestyle and positive attitude go a long way in achieving this goal, but sometimes, aging skin needs an extra helping hand. Anti-aging compounding remedies relieve the side effects of aging and empower you to look your best youthful self as you grow older, wiser, and sharper every single day of your life. Whether you’re just reaching 40 or headed for 90, these pharmacy-created products can brighten, even, smooth, and restore your skin to its natural youthful glow.

 

1. Hand Creams, Lotions, and Moisturizers

Compounded creams, lotions, and moisturizers all achieve one main goal: they impart vital moisture to aging or thinning skin. As our skin ages, it loses elasticity and the ability retain moisture equally; that plays a role in the development of sagging and wrinkles. Moisturizing regularly can effectively offset those effects for some patients. Nutrient-rich blends containing ingredients like hydrating oils, humectants, and vitamins impart moisture where it’s needed most — skin-deep.

Unlike commercial products, anti-aging compounding remedies can be adjusted to suit your needs. Adding or removing ingredients one-by-one makes it easier to limit over-moisturizing and prevent undesired side effects while still achieving your skin care goals.

 

2. Scalp and Hair Growth Treatments

Compounded scalp and hair growth treatments get to the root of the problem to alleviate the following issues:

  • hair loss
  • dry and itchy scalp
  • seborrheic dermatitis
  • psoriasis
  • other scalp conditions related to aging

These remedies often cleanse the scalp and rejuvenate pores along the hair shaft, creating conditions that inspire hair to grow and thicken over time. Medicated products also reduce symptoms of skin and scalp conditions for greater patient comfort.

Some scalp and hair growth treatments may also contain hormones that encourage hair growth long into later life. These products may be especially useful for patients suffering from Male Pattern Baldness (MPB) or certain thyroid conditions.

 

3. Wrinkle and Fine Line Reducers

Compounded products that treat wrinkles and fine lines do so from a number of different approaches. They may plump the skin by injecting moisture to a localized area, or they may utilize antioxidants to reduce toxins that slow the development of wrinkles in the first place. Still others may simply mask wrinkles and fine lines under your daily makeup. Many of these products contain a substance known as retinoic acid (Retinol) that plumps the skin and encourages the production of collagen, encouraging the growth of new connective tissue and skin.

Retinol-containing skin treatments also have the added side effect of greatly smoothing and softening the skin, aiding patients in restoring youthfulness after sun, wind, and weather damage.

 

4. Dark Spot and Uneven Tone Removers

Dark spot removers and tone-evening formulas use a combination of substances like caffeine, vitamins, minerals, skin lighteners, and/or moisturizers to first re-balance your skin to a healthy state. Then, gentle lighteners work to remove age spots, scars, and other undesired blemishes.

Advanced products containing hydroquinone, a prescription-strength lightening cream, and tretinoin, an anti-blemish product often applied to acne breakouts, may work best for patients with particularly sticky spots or hard-to-lighten skin. These products should be used with care under the guidance of a pharmacist.

 

5. Remedies for Specific Skin Conditions

Anti-aging compounding remedies may also address skin problems aggravated by aging, such as:

  • psoriasis
  • rosacea
  • eczema
  • dermatitis

Because aging skin loses elasticity and moisture, many patients find these conditions worsen over time as they age. By creating a patient-tailored formula with prescription ingredients to relieve skin disorder symptoms as well as moisturizers, vitamins, and healthy skin ingredients, patients can fight everyday signs of aging without worsening skin issues.

For patients with psoriasis, compounded Vitamins A, B12 and B6 products work best. Coal tar, alpha-hydroxy-acid, and salicylic acid soften and reduce the appearance of scales and refresh skin.

For patients with eczema, avoiding allergens and sensitivities is especially important as these can trigger eczema in the first place. Compounded cosmeceuticals not only address the issue directly but also allow pharmacists to remove potentially offending substances.

Overall, patients with chronic skin conditions benefit more from compounded solutions than commercially-available products. Every patient is unique — your skin care solution should be unique, too.

 

6. Medicated Ointment Sticks and Applicators

Anti-aging compounding remedies don’t just address the signs of aging directly; they may make it easier to address these issues through delivery format changes. This is especially helpful for patients who may struggle with lids or creams due to mobility challenges or weakness in the wrists. Medicated ointment sticks and applicators make it easier to apply treatments to specifically targeted areas of the face or body, especially in hard-to-reach areas like the armpits.

Other specialized applicators may include:

  • tubes
  • specialized dosing dispensers
  • rollerball applicators
  • transdermal gel delivery systems

All of these make it easier to achieve your anti-aging goals with less hassle, muss, and fuss.

 

7. Antioxidant-Based Skin Treatments

Oxidization stress and skin glycation are two of the primary contributing factors in aging-related skin damage. Over time, free radicals increase dermal protein damage within the first few layers of skin. This leads directly to skin glycation, a condition where skin proteins bind with sugars in the body to encourage the growth of certain damaging bacteria, like Propionibacterium acnes.

There’s a great deal of research that shows eating and applying antioxidants may reduce both oxidation and glycation, especially if patients start early and are consistent with treatment all throughout life.

Compounded antioxidant skin care treatments typically include very specific antioxidants — many of which are the same as those found in the foods we eat. Effective formulas may contain Vitamins A, B, C, D, and E as well as other substances, like essential fatty acids, amino acids, glycolic acid, beta-carotene, or CoQ10. There is at least some evidence that Vitamin C itself may actually encourage the cross-linking of collagen, making it one of the most common ingredients for antioxidant-based skin treatments.

 

In Conclusion

Aging doesn’t have to mean dull, dry, or uneven skin. Through anti-aging compounding, your local pharmacy can create custom-tailored skin care solutions that alleviate your toughest aging-related issues. Find your perfect solution today — schedule a consultation with your pharmacist.

 

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Compounding

Common Questions on Bioidentical Hormone Replacement Therapy

Finding reliable information on healthcare treatments is increasingly difficult. How can you determine which information is reliable, and who can you trust? Often, the best way to get answers to your most important questions is to ask the medical professionals you already interact with on a regular basis — your doctor, your specialists, and your pharmacist. For patients recently diagnosed with hormone conditions, the prospect of taking bioidentical hormone replacement therapy (BHRT) spurs on many questions. You want to know whether your treatment is likely to be effective, whether it will cause side effects, and how exactly it aids your condition in the first place. We’ve created this short guide to answer a handful of the most common questions about BHRT.

 

Bioidentical Hormones and Synthetic Hormones – What’s The Difference?

Bioidentical hormones more closely match the molecular structure of human endogenous hormones (e.g. hormones produced within the body), whereas synthetics contain slight structural differences that influence how your body metabolizes and uses the substance. BHRT may be easier for the body to utilize and recognize, leading to better treatment outcomes.

Whether or not synthetics or bioidenticals work best for you depends on a few things, including:

  • your condition
  • how you respond to your treatment
  • your overall treatment goals

Often, a period of trial-and-error is required to get treatment “just right.” Achieving the right balance often takes several weeks.

 

What Does the Research Say About Effectiveness?

To answer this question, we looked at multiple studies into the effectiveness of bioidentical hormones, both alone and compared to synthetics. Here’s what we found:

  • This study concluded that “bioidentical progesterone does not have a negative effect on blood lipids or vasculature” in the same way as synthetic progesterone sometimes does. Ergo, the author believed there was sufficient evidence to support using bioidenticals over synthetics.
  • This study from the Mayo Clinic identified a significant benefit to women going through menopause through compounded BHRT because they “provide practitioners the option to prescribe HT for women who cannot tolerate FDA-approved products.”
  • This study supported that women given BHRT for symptoms of menopause (specifically, irritability) did, in fact, experience a reduction of symptoms within six months of initial treatment
  • This study indicated a potential connection between endogenous estradiol (produced by the human body) and a reduction in breast cancer cells. Because BHRT more closely matches endogenous hormones, this could potentially open up the floor to future breast cancer treatments. Researchers continue to investigate the protective effects of endogenous estradiol.

It is important to note that hormone treatments of any kind are not without risk. Though current research does support the use of BHRT, especially in special situations where non-commercial doses or formulations are required, you should always speak with your pharmacist or physician before initiating treatment.

 

What Are Bioidentical Hormones Made Of?

The exact definition of bioidentical hormones can be confusing, mostly because some patients refer to these products as “natural,” and “natural” can be interpreted in many ways. Though most BHRT supplements do come from nature, not every naturally-sourced hormone qualifies as BHRT.

The main difference between BHRT and synthetic HRT, as mentioned previously, lies in molecular structure. Synthetics aren’t an exact match for your own endogenous hormones, while bioidenticals are an exact match. Research shows the human body may better metabolize, recognize, and utilize bioidenticals, especially for conditions like menopause.

Nearly all bioidential hormones comes from two primary sources: yams and soy. A small number of BHRT products come from other plant and animal sources. Manufacturers and pharmacies extract 17 beta-estradiol, estrone, progesterone, and estriol from these sources and synthesize them into a different delivery format, like powders, pills, creams, or patches.

 

Is Bioidentical Hormone Replacement Therapy Safe?

Like other forms of hormone supplementation and treatment, bioidentical hormone replacement therapy is relatively safe and effective when prescribed and monitored by medical professionals. Furthermore, there is evidence to show that BHRT may carry a lower overall risk profile than synthetics.

BHRT is still a form of hormone therapy. Taking BHRT may increase your risk of certain serious side effects, including certain cancers, strokes, heart attacks, and other cardiovascular events. However, these risks are associated with hormone treatment as a whole and aren’t necessarily specific to BHRT.

Patients taking BHRT should expect to have their condition monitored, with frequent testing to verify efficacy and hormone levels. Medical oversight from either a physician or pharmacist is also vital to improved treatment outcomes.

 

Can it Cause Side Effects?

All medications carry the potential risk of side effects, including BHRT. The most common side effects include:

  • Tirednesss
  • Headaches
  • Breast growth
  • Breast tenderness
  • Issues with mood
  • Issues with sex drive (increase or decrease)
  • Sweating, hot flashes, or perceived temperature changes
  • Memory loss, brain fog, and/or other mild cognitive challenges

Many of these side effects are transient, stopping gradually as the body adapts to hormone treatment over the course of a few weeks. If you find these side effects intolerable, speak with your pharmacist. He or she may recommend a slight dosage change to ameliorate your symptoms.

 

Are there Any Contraindications?

Yes. Despite BHRT’s excellent safety profile, there are some patients for whom hormone therapy as a whole is contraindicated. The American Association of Family Physicians (AAFP) lists the following as contraindicated conditions:

  • Deep venous thrombosis (DVT) and/or pulmonary embolism
  • Active liver disease (e.g. hepatitis C; fatty liver disease; liver cancer)
  • Arterial thromboembolic diseases, including angina and heart attack
  • Allergy or sensitivity to any of the hormones contained in BHRT
  • Genital bleeding and/or undiagnosed gynecological conditions
  • Cancers of the breast, either current, past, or suspected
  • Porphyria cutanea tarda (absolute contraindication)
  • Certain rare estrogen-sensitive conditions
  • High blood pressure and/or high heart rates
  • Endometrial hyperplasia

Ultimately, this list is far from exhaustive. If you aren’t sure whether your health condition allows for bioidentical hormone replacement therapy, ask your pharmacist to review your file. In many cases, BHRT isn’t completely contraindicated; a small dose or format adjustment may ameliorate contraindications.

 

What About Interactions?

Yes. Hormone therapies mostly interact with the following:

  • Other hormone therapies
  • Treatments for cardiovascular disease
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Steroid treatments

However, other interactions are possible. Most interactions are mild and involve a slightly elevated risk for cardiovascular events or mildly uncomfortable symptoms (like nausea).

Tell your pharmacist about all medications and drugs you regularly take, including street drugs, marijuana, cigarettes, and alcohol, to prevent potentially dangerous interactions before they occur.

Getting hormone therapy “just right” often takes time, patience, and repeated testing. A difference in just a few milligrams or micrograms can be the difference between success and failure, and that’s what makes compounded BHRT so unique. When pharmacists can individually tailor your dose down to the microgram, it’s easier to achieve success at the lowest possible dose. When bioidentical hormone replacement therapy does work, it can provide the following benefits:

  • Improved mood
  • Reduced the symptoms of menopause
  • Alleviated thyroid conditions
  • A protective effect on the body

If you have questions about whether bioidentical hormone replacement therapy is right for you, schedule a consultation with your pharmacist.

 

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Compounding

How Your Child Can Benefit From Pediatric Compounding

No child looks forward to being sick, much less taking medicine to feel better when they do. If it were up to children, the main treatment for most minor illnesses would be plenty of candies, unlimited video games, or maybe even the freedom to stay home from school just once.

Unfortunately, this is a situation where parents truly know best; sometimes, taking medication is the solution. It’s at these times when finding ways to make it easier and safer for your child to take his or her medication comes into play. This article will discuss how pediatric compounding can make parents feel at ease when it comes to giving children medication.

 

Complex Medication Needs

Medicating children is complicated and often difficult. Their smaller bodies and faster metabolisms often demand dose changes and depending on how small they are, may even necessitate delivery format changes, too.

Even when the dosage is correct, children are more prone to adverse side-effects and interactions. Risks seem to be the highest for infants and newborns, gradually stabilizing by the time most children reach around 12 years of age.

The fantastic news is that pediatric compounding really can help to make medicating your child a less stressful experience. Through pediatric compounding, your pharmacist creates the ideal custom medication to match your child’s treatment plan.  He or she follows the doctor’s prescription and then seeks to make the medicine easier to take, less likely to cause side-effects, and safer for your child.

 

Dosage Adjustments for Size

Commercial medications come in exact doses, and those doses aren’t always suitable for children, much less newborns and infants. Giving a dose that’s even a few milligrams or micrograms off can be the difference between success and severe side effects, so getting it just right matters.

Unfortunately, even age isn’t a perfect predictor of required dose; two little ones can be the same age but may be completely different weights or heights.

Because commercial drugs come in predetermined doses, that can leave your little one’s dosage well outside of the spectrum of what’s available. Giving a slightly higher or lower dose or changing the delivery format on your own (e.g. crushing pills) seems like a viable solution, but it’s neither reliable nor accurate.

Instead, pediatric compounding allows the pharmacist to calculate the exact dose-per-weight ratio for your child. He can then work out exactly how much medication is safe and suitable for your child’s condition. Each prescription is tailor-made for your child!

 

Removing Allergy-Inducing Fillers

Parenting an allergy-prone child can be incredibly stressful and downright frightening, especially if your child experiences anaphylaxis. Though it’s rare, some children do seem to react to certain fillers, binders, and dyes in medications. Unfortunately, it’s not always obvious to identify potential allergy triggers in a pill, liquid, patch, or aerosol medication.

For kids with allergies, compounding can quite literally be a lifesaver. Because pediatric compounding strips the drug down to base ingredients, pharmacists can remove as many potential risks as possible while maintaining treatment efficacy.

If you know what substance is triggering the allergic reaction, the pharmacist can leave it out. If you’re not sure which filler is the problem, the pharmacist can re-compound the medication with fillers or binders with a lower likelihood to trigger allergies in the first place.

Depending on the drug, it may be possible to compound the base drug into flavoring or delivery systems alone instead of with binders, fillers, or preservatives. That’s particularly useful when trying to identify unknown allergy triggers.

 

Combining Multiple Medications

You know your child can’t stand taking medicine. They kick up a fuss, run, hide under the couch, and spit the pill out. It’s no fun for anyone when taking medication is a struggle. Whether you’re treating something like an ear infection or long-term, chronic childhood conditions, the prospect of mediation time can become something to dread. Add multiple medications into the mix, and that struggle begins to telescope into a potential nightmare.

Here’s the thing: if your child doesn’t ingest the drug, it’s not helping. Combining multiple drugs shown to be safe when taken at the same time into a single delivery format reduces the amount of time you spend struggling with your child, and most importantly, probably results in more medicine reaching your son or daughter’s system. It gets all of you through medication time with less muss, less fuss, and happier family members all around.

Though it isn’t possible to combine drugs in every case (contraindications and negative interactions may exclude combination medications as an option) your pharmacist can mix many medications into a single capsule, patch, cream, aerosol, or liquid.

The potential for combinations is extensive, including:

  • certain antibiotics
  • specific seizure drugs
  • combination medications for conditions like ADHD

Instead of three or four doses, you only need to worry about convincing them to swallow one, making it much easier on the entire family.

 

Dye-Free Pediatric Compounding Solutions

There’s good evidence that food dyes may trigger sensitivities in little ones. By far, the most common trigger seems to be red lake dyes (specifically Red 40), but it’s difficult to predict how children will respond to dyes of any color. Some little ones experience allergic reactions, while others experience hyperactivity. Some experience migraines, stomach upset, and other more subtle undesired responses.

Current evidence shows that children with ADHD may react to food dyes at a higher rate than children in other patient populations. The same research tells us there is a link, but it doesn’t say exactly how far that link extends and whether it’s just correlation or causation.

Truthfully, we just haven’t reached a point where we know exactly how, what, why, or when medication dyes affect children. What we know so far is that there is a potential risk.

Researchers continue to probe the issue for conclusive evidence one way or another, but in the meantime, many pediatricians recommend parents avoid dyes altogether whenever possible.

Dye-free compounding produces medications that don’t contain dyes, drug preservatives, and other potential triggers, ameliorating the risk of triggering these sensitivities in the first place. It’s not a sure-fire way to reduce side effects, but it is a proactive way to protect your child until researchers are sure.

 

Delivery Format Changes

Delivery format (how your child takes his or her medication) can be just as important as the medication dose itself. The wrong delivery format will make it difficult or even downright impossible for a little one to take their medication with ease. In the case of infants and newborns, it may even pose an additional choking hazard.

The most obvious example of this concept is pills and infants three months of age or less. These little ones aren’t yet old enough to know how to swallow properly, and thus, a pill isn’t a suitable delivery format for them. Even older children can struggle with unusually large tablets. Sometimes it’s just as easy to have the pharmacist reformulate your prescription.

Your child’s particular health condition may also indicate a need for a delivery format change. A child with pneumonia often benefits more from liquid inhalation via aerosol delivery rather than a pill or liquid antibiotic. Likewise, children treated with CBD derivatives for seizures certainly can’t smoke marijuana (though not every pharmacy offers CBD processing just yet).

In cases like these, your pharmacist can re-compound the base drug into the best delivery format for your child. As treatment goes on, he or she can utilize pediatric compounding to continuously adapt the treatment to better suit your child’s waxing or waning needs.

 

In Conclusion

Pediatric compounding strategies aren’t always about improving treatment; sometimes, it’s just a way to make the experience easier for your child. As a whole, it may include:

  • adding flavors to bitter or bad-tasting medications
  • creating aerosol inhalation mixtures to treat pediatric asthma and other lung conditions
  • creating liquids from pills or capsules from powders
  • reformulating everyday medications into painless patches or creams for easier application

Either way, the primary goal is that your child spends less time struggling with the medication and more time being his or her happy, healing self.

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Compounding

How do Topical Pain Relievers Work?

Treating pain: it is one of the hottest topics in medicine over the last 20 years. With the potential side effects some patients experience while taking narcotics, NSAIDs, and other pain-relieving drugs orally, researchers continue to study ways to relieve pain safely and reliably. New and inventive solutions are opening up the scope of pain treatment and making it easier than ever to reduce pain without side effects. One of those solutions is topical pain relievers.

 

The Pain Treatment Problem

The biggest issue researchers face to date with pain relief is the fact that side effects seem to be intrinsically connected to efficacy. Some studies show that the euphoria experienced when taking opiates may be part of the reason narcotics are so effective at reducing pain. Other studies show that safer drugs just aren’t as effective as those with serious side effects, leaving physicians in a constant quandary about what to prescribe and when to tell the patient there are few options available to them.

 

How Topical Pain Relievers Help

Enter topical pain relievers. These medications, often compounded, are applied directly to the skin rather than entering the body through the stomach. In many cases, they’re an effective balm against everything from aches and pains to serious, intractable nerve pain. What makes topicals so unique is that many formulas never reach beyond the first few layers of skin and tissue, and thus, won’t enter the bloodstream, significantly reducing risks and side effects.

 

Treating Conditions Safely With Topicals

Topical pain relievers may reduce risks while treating problems almost as effectively for patients, especially those in sensitive populations. This burgeoning sector of the medical industry shows great promise. Researchers expect the list of topical treatments to grow exponentially over the next 10 to 20 years, but even today they’re of benefit to plenty of patients with conditions like arthritis, fibromyalgia, and everyday aches and pains.

 

Topical Pain Reliever Classifications

Topical pain relievers fall into specific classifications, each of which may or may not be suitable for treating your pain. These classifications include:

  • Counterirritants
  • Salicylates
  • Capsaicin
  • Steroid/corticosteroid drugs
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Local anesthetics and numbing agents

 

Counterirritants

Counterirritants produce mild irritation at the site of the pain. Though it may seem backward, “busying” the nerves locally reduces the intensity and frequency of pain signals to the brain. The nerves are too busy “reporting” on the sensation from the counterirritant to properly pass on more severe pain signals, reducing the overall sensation to a mild burning or stinging. The most common counterirritants include alcohol-based rubs like A535, Icy Hot, and mentholated Tiger Balm.

 

Salicylates

Salicylates contain a similar substance to aspirin, an NSAID drug. They may reduce inflammation and block localized prostaglandins near joints and soft tissue damage points. Unlike oral Aspirin, topical salicylates are much less likely to excessively thin the blood or cause stomach damage.

 

Capsaicin

Capsaicin-based topical pain relievers contain a substance derived from pepper; they produce a “hot” sensation that feels as if it penetrates deep into the tissue. They work in a similar way to counterirritants in that they keep local nerves busy and interrupt pain signals before they reach the brain. There’s also evidence that capsaicin creams may encourage better circulation to the area of an injury, speeding healing. The only caveat is that some patients do seem to react more strongly to topical capsaicin than others, especially if they have sensitive skin.

 

Steroid/Corticosteroid Drugs

Topical steroids and corticosteroids effectively reduce localized inflammation for many patients and are most commonly used to treat potentially painful skin conditions like psoriasis. If an autoimmune disease causes localized pain, they may suppress the immune system in the area just enough to stop the patient’s body from attacking the area and causing pain. Topical steroids can also do the following:

  • narrow blood vessels
  • reducing pain from varicose veins
  • enlarged blood vessels
  • and other venous or tissue damage

Because steroid topicals are the one class of topical pain reliever that can eventually reach the bloodstream with regular application, these drugs are usually only prescribed if other treatment methods have failed.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Only one main topical NSAID is approved for treating pain in the United States: diclofenac. The two most common formulas offer patients relief through a gel or cream. Diclofenac reduces pain by reducing localized inflammation and prostaglandins and may be especially useful for patients with osteoarthritis. Unlike oral NSAID drugs, the risk of adverse stomach and gastrointestinal side effects and/or heart complications is almost nil with topical NSAIDs, making their use much, much safer than oral medication alone.

 

Local Anaesthetics and Numbing Agents

Local anesthetics and numbing agents work by causing changes in how nerves perceive pain in the first place. If you’ve ever had stitches or had your mouth frozen at the dentist, you’ve experienced a local anesthetic first-hand; it makes the localized tissue feel virtually nothing but the sensation of pressure.

Numbing and anesthetic creams may contain a variety of substances, including:

The “caine” here is what matters; it refers to a particular class of drugs known to dull sensation.

The most common local anesthetics and numbing agents include over-the-counter formulas like Bacitracin, Neosporin, and Bactine — all commonly found in medicine cabinets across the country. These formulas are remarkably safe. Stronger prescription numbing creams can sometimes reach the bloodstream and may cause complications; thus, most physicians only prescribe them when necessary.

 

What Conditions Can Topical Pain Relievers Treat?

The list of conditions that may benefit from topical pain relievers is long — much too long to list in a single post. However, it is possible to “guesstimate” whether you may benefit from a topical based on your medical condition. Any time patients experience pain that’s either within the skin, soft tissue, or surface-level joints like the shoulder, the potential for benefit does exist. This includes:

  • Fibromyalgia
  • Soft tissue damage (e.g. bruising)
  • Sprains, strains, and mild injuries
  • Mild to moderate joint pain
  • Osteoarthritis and/or psoriatic arthritis
  • Certain painful skin conditions (like eczema or psoriasis)
  • Certain cancerous melanomas and/or benign growths
  • Everyday cuts, scrapes, and minor injuries
  • Nerve pain that occurs within the first few dermal layers
  • Other forms of arthritis-like pain (e.g. autoimmune, Rheumatoid Arthritis)
  • Pinched or compressed nerve pain (e.g. sciatica, herniated discs in the spine)

What’s most important is that you recognize that topical pain relievers are still medications. Thus, you should never undertake treatment on your own. Your pharmacist is an excellent source of information; if you’re considering topical pain relievers to relieve your pain, ask for a consultation. He or she can help you to find the very best topical solution for your individual health profile.

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Compounding

What Are Compounded Thyroid Medications?

Your thyroid: if you’re like the average person, you don’t give it a second thought. It sits in your throat quietly producing the TSH hormone needed to keep you alive. It’s only when something goes wrong with the thyroid’s production that most of us (including doctors) take notice of it, and often, issues creep up and don’t become obvious on lab tests until they’re firmly entrenched.

By that time, most patients feel symptomatic. These thyroid symptoms can include:

  • abject exhaustion (feeling bone-tired all the time)
  • nervousness
  • anxiety
  • palpitations
  • flutters in the throat
  • racing heartbeats
  • blood pressure issues
  • and in serious cases, cardiac complications

This article discusses the possible causes of thyroid issues and the benefits of treating them with compounded thyroid medications.

 

What Causes Thyroid Problems?

When the thyroid produces too much or too little TSH, or an unreliable amount of TSH, you’re experiencing a thyroid condition. The most common of these conditions are hypothyroidism and hyperthyroidism, low or high thyroid production respectively. But these are from the only conditions that can interfere with thyroid hormones; these generally fall into one of three additional categories:

  • Structural abnormalities
  • Genetic disorders and diseases
  • Medication side effects and/or toxicity

Certain cancers and tumors may also interfere with the thyroid, even if they aren’t on the thyroid itself. That tiny little gland is immensely sensitive, if a bit finicky sometimes!

The good news is that treating the average thyroid condition is no longer difficult. While it can take some time to get the treatment just right (we’ll cover that a bit later), for the most part, all that’s needed for most patients to regain balance and eliminate symptoms is medication.

 

The Need for Individual Treatment Approaches

We’ve mentioned that the thyroid can be finicky; this is the main reason many patients and physicians go through a period of trial and error with medication. Generally, doctors will treat patients for thyroid problems by using one of these two methods:

  1. supplementing certain hormones the thyroid naturally produces
  2. blocking overproduction

Exactly how each patient reacts to each dose can vary dramatically; sometimes even a few milligrams is enough to make two patients with the same levels feel completely different.

We still don’t fully understand exactly why this happens, so the most common approach is to slowly tweak the medication in either direction until both lab results and patient reports indicate success. Very often, what reveals the success of treatment isn’t just the lab reports, but the fact that the individual patient feels so much better, too.

 

Commercial Vs. Compounded

Commercial Thyroid Medication

Many brands have their own form of commercial thyroid medication, including:

  • Synthroid – Synthroid is best known for being a synthetic (man-made)
  • Armor Thyroid – Armor is derived from pigs and is therefore natural.

Patient response to synthetics versus natural hormones can also vary unpredictably.

 

Compounding Thyroid Medication

Then there are compounded thyroid medications. Unlike commercial thyroid treatments, compounded treatments are individualized for each patient on a personal basis. The pharmacist takes the base compounds and creates a brand-new, custom-made medication based on the patient’s lab reports, how the patient feels, or what the physician believes is best. Often, this is the best way to find the exact correct substance and dose to treat particularly finicky conditions.

 

Bioidentical Thyroid Hormones

Compounding also allows patients to access bioidentical hormones. These substances are virtually identical to your own hormones in molecular structure, and research shows they may be easier for the body to recognize and utilize. Certainly, some patients seem to respond to bioidenticals much more readily than synthetics or natural hormones.

In comparison, synthetic and pig-derived hormones both differ ever-so-slightly from the human body’s own natural hormones. Researchers theorize that in some cases, this may cause the human body to fail to properly “recognize” the hormone for what it is, leading to poorer treatment outcomes for patients.

Bioidentical hormones aren’t available in commercial standardized doses or formats, so every prescription is hand-made. This customization may also benefit patients who don’t fit within normal dosing ranges.

 

Why are Compounded Thyroid Treatments Better?

Compounded thyroid medications open up a world of possibilities for patients and their physicians. It’s especially beneficial for patients who haven’t responded to (or who have responded poorly to), standard commercial thyroid treatments in the past.

Because each compounded prescription is individualized in both dose and contents for the patient, and because the pharmacist works with base compounds rather than predesignated doses, it’s possible to adjust the dose by as little as a microgram or grain at a time.

Dosage micro-adjustments and changes to delivery format may also make it possible for physicians to respond to thyroid issues long before they become serious.

Up until the last decade, most physicians lived by a “wait and see” approach. If the patient was borderline low thyroid (or high), but wasn’t especially symptomatic, they’d hold off treatment. If the patient was symptomatic, but lab results only showed a slight elevation or lowering of TSH, they’d often suggest lifestyle changes before medication.

Through research, we now know that many patients hover somewhere along the “borderline” level before thyroid hormones range far enough out of whack to necessitate medications. Lifestyle changes like eating a good diet and getting enough exercise certainly can help, but they’re simply not a cure for a thyroid that’s just not working correctly.

Thanks to compounding, physicians can begin with infinitesimally small doses of thyroid hormone (or hormone blockers) in an effort to alleviate symptoms. They can also adjust the dose by a fraction until the right blood serum levels are achieved. If overt hypothyroidism is detected, this may make it easier to treat at lower doses early after diagnosis.

Compounded thyroid medications also make it safer and more effective for physicians to treat cases of subclinical hyperthyroidism and hyperthyroidism when they believe treatment is warranted (though treatment isn’t warranted in every instance).

Compounding may also be preferred in cases of cancer, severe allergies, and other life-threatening conditions where issues with fillers or additives could cause the patient more harm than benefit.

 

Are Compounded Thyroid Medications Right for Me?

Every patient is different, especially when it comes to hormones. Exactly which approach is right for you is best answered by your physician or endocrinologist. But research does show that patients who require thyroid medication do often respond more quickly, more evenly, and with a lower dose when using compounded bioidentical thyroid hormones. Your pharmacist can also address questions about thyroid treatments and whether compounded hormones may be right for your needs.

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Compounding

What is Gluten Free Compounding?

Do you suffer from Celiac’s Disease or gluten reactivity? If you do, you should know that it isn’t only food you need to restrict to avoid reactions. Even the medication you take on a daily basis can contain trace amounts of gluten–enough to cause a reaction for many patients. But the options for gluten-free medications ate rare on the commercial market. That’s why many pharmacies are turning to gluten free compounding instead.

In this short guide, we’ll help you break down the nuances to gluten sensitivities (including misconceptions). Then, we’ll outline how gluten free compounding may help you avoid trace sources of gluten.

 

What is Gluten Sensitivity or a Gluten Allergy?

Approximately 3 million people throughout the United States have a legitimate gluten sensitivity issue. This usually presents as either Celiac’s Disease or Non-Celiac Gluten Intolerance. Both are legitimate and extremely serious medical conditions that cause pain, bloating, and digestive upset.

For patients with true allergies, even a molecular amount of gluten can spur on cramping, diarrhea, constipation, gas, and general discomfort for days. Responses can start as little as 15 minutes after eating the offending product or taking the gluten-containing pill, while others may not react for as much as four days.

 

Gluten: Trend or Tragedy?

There’s so much misconception around gluten. Although a small number of people really do experience gluten sensitivity and gluten allergies, the rate is quite small. Surprisingly, nearly 30 percent of Americans admit to shopping for gluten-free products. They seem to tolerate gluten fine, yet still avoid it.

What exactly is happening here? Why would people shop for gluten-free products if they don’t have an allergy?

The answer lies in the fact that bread (and more specifically, breads that contain gluten) have erroneously been connected to weight gain and poor health.

Though it’s true that eating too many carbs and not exercising enough certainly can cause weight gain, this is less of an issue with gluten and more of an issue with calories in, calories out. Of course, weight loss and weight gain is also influenced by everything from genetics to lifestyle, too.

To further confuse the matter, some people do react to other substances in gluten-containing foods. Short-chain triglycerides called FODMAPS are known irritants for patients with:

  • Irritable Bowel Syndrome (IBS)
  • Irritable Bowel Disease (IBD)
  • Crohn’s Disease (CD)
  • and other gastrointestinal upsets

For these patients, avoiding anything sourced from wheat may be beneficial–including gluten-containing medications.

The most important step to take is to have your doctor work to find the source of your issues rather than self-diagnosing a gluten issue.

When Gluten Strikes: How Gluten Free Compounding Helps

You’ve determined that you have a legitimate gluten sensitivity. Or, your doctor recommends that you cut out all sources of gluten to lessen symptoms from a condition like IBD or IBS. You’ve changed your diet, now it’s time to check and alter your medications, too.

Your pharmacist can run your medications through the system and bring up their MSDS or pharmacology sheets. These information sheets contain extremely in-depth technical information about what exactly is inside your medication. If gluten or gluten-containing fillers are present, they will be able to identify them from the sheet alone.

If your pharmacist identifies that your medication contains gluten, he or she will evaluate it for gluten free compounding.

Gluten free compounding allows the pharmacist to re-create commercial medications without the offending gluten (or perhaps without any fillers at all). Compounding can also reformulate medications to make them easier to take or use, or to combine multiple medications.

When compounding your medications, your pharmacist takes all of the base substances in your medication and then removes anything that may be harmful. Then, he or she can combine the substances back together into a liquid, a pill, a patch, a cream, or some other delivery method altogether.

 

What Medications Contain Gluten?

Surprisingly, the list of medications that contain either gluten or trace amounts of gluten is quite extensive. That’s because gluten is an excellent filler; it’s a protein that becomes stretchy like a web when manipulated.

This is why bread is kneaded to make it softer and denser.

In a medication, gluten holds all of the other substances together into one cohesive pill, patch, or substance. Unlike other potential allergens, the FDA has no required law to label whether pills contain gluten or gluten-sourced substances. It’s up to your pharmacist to investigate your medication on an individual level to see if they contain gluten.

Certain medications may be more likely to contain gluten or gluten-sourced substances if they contain specific ingredients. These will be listed on the MSDS or pharmacology data sheet, and are usually listed as:

  • Wheat
  • Pregelatinized starch
  • Dextrates/Dextrin
  • Dextrimaltose
  • Caramel coloring
  • Barley malt

Essentially, anything with a filler or coloring sourced from a gluten-containing plant is a problem. Furthermore, the above list is far from exhaustive. If you’re not sure whether your medication contains gluten, ask your pharmacist to pull the data sheet for it.

 

What About Non-Prescription Medications and Supplements?

If you rely upon non-prescription medications and supplements, your pharmacist may be able to use gluten free compounding to better suit you, too. Surprisingly, gluten is extremely common in vitamins and health supplements. This is because those who do not have a gluten sensitivity or allergy really can benefit from the nutrition found in gluten-containing plants, like wheat protein or wheat germ oil.

Unlike prescription medications, the FDA does require that all over-the-counter products be marked clearly if they are gluten-free. This labeling makes it significantly easier to identify which commercial products are safe and unsafe.

That said, those with a gluten allergy should never rely upon labeling alone. Some patients find that even substances grown or sourced near gluten are enough to trigger an attack. Your pharmacist can pull the ingredient lists and MSDS for many over-the-counter products, too, and will help you to make an informed decision about OTC products.

Need information about your medications? Your pharmacist is standing by to take your call. Informative patients make better choices about their health in nearly all cases, so you should never be afraid to ask for clarification or investigation. Reach out to your pharmacy today for more information on your medications and gluten free compounding.

 

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Compounding

What are Compounding Pharmacies?

If you’re hearing the term “compounding pharmacy” tossed around lately, it’s no surprise. Compounding pharmacies are rapidly growing in popularity thanks to their ability to custom-tailor medications that better suit individual patient needs. As a facet of the healthcare industry, they provide an invaluable service to patients who may not necessarily fit the standard treatment guidelines for medications.

Any facility who makes medications either from scratch or by combining substances to make a drug that isn’t commercially available is classified as a compounding pharmacy. This includes medications that need to be adjusted for dose, delivery method, or even flavor.

Curious if compounding pharmacies can help you to achieve your healthcare goals? Let’s dive in and take a look at how and why it works.

When is Compounding Used?

Your pharmacist turns to compounding whenever a standard medication doesn’t make sense. It is a science of adjustments that focuses on customizing patient medications to be as easy to take and effective as possible.

Exactly how he or she utilizes compounding depends entirely on the patient for whom the compounded drug is intended. Drug compounding is all about customizing treatments to better suit patient needs.

 

Compounding for Children

Compounding for children is exceptionally common. A young child or infant might need a smaller dose of a certain medication, or may be unable to swallow pills. The pharmacist can transmute the correct dose into liquid form to make the drug in question accessible. One of the most recognizable forms of compounding for children includes flavoring antibiotics and other medications to make them easier to take.

 

Drug Allergies

Compounding can also resolve issues of drug or filler allergies, too.

Example 1: Patients who are gluten-intolerant may need their drugs compounded by hand to prevent gluten-based fillers from causing severe allergic reactions.

Example 2: A patient might have an allergy to one of the components in a drug that is commercially available. The pharmacist can access the base drug in question without the additives, and then create a solution that’s free of the allergen instead.

In both instances, the compounding pharmacy would be responsible for making the form and correct dosage of the drug while ensuring that it did not contain any of the offending ingredients.

 

Discontinued Medication

A medication that has been discontinued for lack of profit or for increased risk of side effects may also remain available via compounding in special situations. This is most common for life-saving medications that either lose approval or lack the approval to be sold on the public market.

The compounding pharmacist orders the necessary ingredients from a wholesale supplier and then compounds it to a specified dosage based on the patient’s needs. He or she works directly with the doctor to adjust or modify the dose as needed. This prevents patients from falling through the cracks due to a one-size-fits-all approach.

 

Side Effects

Sometimes, patients might need a specific medication because the commercially-available form causes intense side effects for them. This is most common in combination medications, but can also include solitary substances. Commonly experienced side effects include:

  • drowsiness
  • irritation
  • stomach pain
  • diarrhea
  • constipation

Though a medication change is often needed, in some cases, all that’s required is a change in the formula itself. Compounding pharmacies prepare the specified medication in a way that eliminates side effects.

For example, the pharmacist may create a transdermal numbing cream that patients apply directly to the source of pain. This eliminates the need to take harsh pills that may harm the stomach.

This is a common application for many non-steroidal anti-inflammatory medications (NSAIDs) like ketoprofen and diclofenac. NSAIDs are notoriously harsh on the gastrointestinal tract, but don’t cause the same damage when applied topically.

Medications for neuropathic pain (including gabapentin and Lyrica) are also good candidates for transdermal patches and creams. Applied topically, they don’t cause drowsiness or come with the risk of behavioral changes in elderly or liver-compromised patients.

 

Availability of Compounding Pharmacies

According to the IACP (International Academy of Compounding Pharmacists), there are 56,000 compounding pharmacies based in American communities all across the country. Nearly half of those serve local doctors and patients, while others serve medical facilities and healthcare organizations directly. Around 7,500 American pharmacies fall under what the IACP refers to as advanced compounding services. These facilities have special licenses and more technology, allowing them to handle high-tech compounding projects. Of these pharmacies, 3,000 specialize in making products that are sterile.

 

Compounding Pharmacies and the FDA

When it comes to drug manufacturers, the FDA is responsible for overseeing all regulations. But when it comes to pharmacies, regulations are handled by the state. Compounding pharmacies fall under a totally separate governing body, though they are still guided by FDA requirements.

There are a total of three government level agencies that regulate compounding pharmacies. Each state has a pharmaceutical board who ensures that pharmacies follow all state regulations. These boards also dictate the regulations for pharmacy practices.

The FDA is responsible for regulating the actual integrity of the drugs that are made by a compounding pharmacy as well as any active pharmaceutical ingredients that go into them.

Finally, the DEA (Drug Enforcement Administration) is responsible for regulating the way that compounding pharmacies handle controlled substances.

The independent PCAB (Pharmacy Compounding Accreditation Board) makes its official seal of approval available to those pharmacies that can pass very strict inspections. Requirements are lengthy and include a host of rigid but voluntary standards designed to keep pharmacies effective and accountable.

 

Is My Medication Compounded?

In nearly all cases, your physician or pharmacist will advise you if a drug requires compounding. If you’re not sure, ask your local pharmacist directly. In some cases, a compounded version of a medication may be more effective for you, so don’t be afraid to ask your pharmacist whether compounding can improve your treatment outcomes.

Your health matters, and if you take medication on a regular basis, compounding may be able to help you achieve better health. Whether your pharmacist removes an offending filler or allergen or compounds a topical cream for you from scratch, the goal is always the same: to make taking your medication easier and more effective with less hassle and struggle. If you have any further questions about compounding, speak with your pharmacist.

 

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Compounding

Different Types of Compounded Medications for Pets

You’re an animal lover–you want what’s best for your bet, especially when they are sick. A trip to the vet can cause stress for both you and your pet. With payments, medications, and lists of do’s and don’ts, it’s easy to feel overwhelmed. While most vets have a pharmacy right on site, there are some medical problems that require specific or targeted treatments. That’s where your local compounding pharmacy comes in. Compounding pharmacies can mix ingredients to the very specific doses that your pet requires, alter the flavor of a medication, or create pet-specific combination medications that improve your ability to treat your pet. Here is a list of some of the different types of compounded medications for pets that your local compounding pharmacy can provide.

 

Transdermal Gels

These compounded medications for pets are made into a gel that is put inside the animal’s ear flap. Vets prescribe transdermal gels most commonly to deliver antiparasitics, anti-inflammatories, and sometimes, hormones. Transdermal gels work in the same way as transdermal patches–by transferring the medication through the derma (skin) and into the bloodstream.

 

Methimazole

Vets use Methimazole to treat canine or feline hyperthyroidism, also known as an overactive thyroid. It’s used in both dogs and cats, but is a much more common and effective treatment for felines. The medicine used in the transdermal gel is the exact same as the tablets, and often comes in ready to use syringes for easy dosing of your pet.

This is a fast-acting medication, though full results can take some time. Compounding pharmacies can also create oral methimazole suspensions and pills. Wet versions of the drug have a three-month lifespan, whereas pills generally last approximately one year..

 

Amitriptyline

Amitriptyline is a tricyclic antidepressant. It balances certain receptors and chemicals in the brain. It treats a variety of behavioral issues in pets, and is often prescribed for anxiety, separation anxiety, excessive grooming, spraying in cats, and overgrooming. Some pets may benefit from using this drug for chronic nerve pain and severe itching.

Amitriptyline pills are small and easy to dose, so it isn’t really common for a vet to prescribe it in a transdermal gel. Vets typically prescribe it when other dosing methods have failed or when the pet has pre-existing liver considerations.

 

Prednisolone

This medication is a steroid that decreases inflammation and alters the immune system’s response. Vets prescribe it to treat itching, swelling, and redness associated with allergies, breathing and skin problems, and a wide range of auto-immune conditions. Veterinary oncologists also prescribe it alongside chemotherapy treatments for particularly aggressive or difficult-to-treat growths and cancers.

Prednisolone is available in a long list of delivery methods, but the transdermal gel is particularly appropriate for pets with autoimmune skin conditions as it can be applied directly to the affected area.

 

Capsules

Another type of compounded medications for pets is capsules. Capsules mimic the style and shape of a pill, but rather than being sold, are pre-filled and then snapped together by your compounding pharmacist. Dosing a capsule is identical to dosing a pill; the only difference is that your pharmacist can alter what’s inside the pill before you begin.

 

Diethylstilbestrol

Commonly known as DES, this medication is used to treat estrogen responsive urinary incontinence. This condition occurs in spayed female dogs and may be related to incomplete spay or other hormone conditions. Estrogen responsive urinary incontinence can be a serious challenge for pet owners; to some, it may seem like the dog has regressed. But no amount of potty training will change this condition. Only medications like DES can help.

DES is also used to treat male dogs with an enlarged prostate, whether due to a condition like cancer or even just old age. The medication reduces the swelling and relieves pressure.

DES has a short shelf life of just 20 weeks. You should closely monitor your usage of the drug and request a refill at least one week in advance of the end of your current prescription.

 

Potassium Bromide Capsules

Potassium bromide treats seizures and neurological disorders. This drug is one of the oldest anti-seizure drugs available on the market to date, and was first created to treat people in the late 1800s. Today we have better medications for humans, but in pets, potassium bromide remains a go-to medication for hard-to-treat or resistant epilepsy.

This medication contains the original medication potassium bromide, but comes in an easier-to-dose capsule form. Compounding pharmacies sometimes combine it with other medications, like phenobarbital or benzodiazepines, to increase the efficacy of the other drug.

During treatment, your vet will monitor your pet’s blood work closely. He or she may make adjustments to the amount of potassium bromide that your pet receives daily along the way.

 

Cisapride Capsules

The medical and veterinary industries both rely upon Cisapride as a medication that reduces gastrointestinal complaints. It is remarkably effective at treating acid reflux, G.E.R.D., and diarrhea or constipation in Irritable Bowel Syndrome.

Cisapride capsules increase motility in the upper gut, preventing food and substances from sitting too long in the stomach. This improves digestion and reduces irritation along the bowel for most pets.

Like potassium bromide, Cisapride has a short shelf life. Seek refills at a maximum of every 90 days.
 

Mixed Form Medications

Mixed form medications come in such a broad range of options that it would be functionally impossible to list them all here in a single blog post. Essentially, anytime your pharmacist mixes two medications together, they are creating a new mixed form medication. This is useful for pets with filler allergies, pets who are particularly small or very large, and any animal who has a special health consideration or pre-existing condition.

For example, Trilostane commonly treats pets who suffer from Cushing’s Disease, also known as hyperadrenocorticism. This is a disorder where the body produces too much cortisol.

Because the exact dose can vary based on your pet’s hormone levels, compounding is almost always necessary for adrenal issues. But there’s another good reason to give Trilostane as a compounded substance; vets often add other medications into it, like steroids, when treating conditions like cancer or adrenal tumors.

Some medications, depending on the pharmacy, may also come in flavored chewables, micro tablets, eye drops or gels, otic ear packs, and sterile injectables. All of these give you the option and ability to meet your pet’s needs however suits you both best.

 

How to Access Compounded Medications for Pets and their Prices

Do you have a prescription for a compounded medication? If so, understand that ordering compounded medications for pets doesn’t need to be any more difficult than ordering any other medication. Speak with your pharmacy to get started; most human pharmacies also provide this service by request.

Sometimes, compounded medications for pets do come at a premium. But for the most part, you’ll find that compounded medications are just about on par with standard commercial medicines. The peace of mind and healing achieved through a tailor-made medication is well-worth any slight increase in price. To your companion, be it dog or cat, the interactions you have with them mean everything. When those interactions are negative due to medications, it affects your pets bond with you and may even hamper their ability to heal.

 

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