The Most Common Types of Pharmacy Compounding Formulas

There are many pharmacy compounding formulas that can be created on an individual scale to provide custom medication to a person. Here are the most common formulas used.

Compounding – the art and science of hand-creating medications from base drug ingredients – is very complicated. While it shares similarities with drug manufacturing, these pharmacy compounding formulas are created on a much smaller level (usually in-house at your local pharmacy). Instead of creating thousands of pills or formulas, your pharmacist assesses your needs and creates a custom prescription just for you.

Every patient is unique, and that means there’s no one perfect compounded medication for every patient. But that doesn’t mean they don’t typically fall within a few specific categories of pharmacy compounding formulas. From dissolving tablets to hormone formulas, we’ll reveal the most common right here.

Common Types of Pharmacy Compounding Formulas

Compounding is unique in the sense that it allows each patient to receive personalized medication based on their specific needs. This is beneficial if the dosage of medication must change, or the method of delivery must change as well.

Although each medication is custom to a specific individual, the pharmacy compounding formulas mostly stay the same. The five most common types of pharmacy compounding formulas include:

• Rapid dissolve tablets
• Oral liquid vehicles
• Cream medication
• Oral chews and lozenges
• Hormone supplements

We will discuss each of these formulas in below.

1. Rapid Dissolve Tablets

Rapid Dissolve Tablets (RDTs), sometimes referred to as Orally Disintegrating Tablets (ODTs), dissolve quickly when placed under or on top of the tongue. Instead of requiring digestion for use in the body, the medication dissolves and immediately absorbs into the oral mucosa (lining of the mouth).

RDTs are especially useful for patients who struggle with swallowing pills or those who have gastrointestinal and liver conditions. They may also be beneficial for patients who cannot chew or swallow on their own (including pets). Most formulas take only a few short seconds to fully dissolve, making it easier to take the medication quickly.

Pharmacists can only formulate certain medications as RDTs; the drug in question must have the right chemical structure for dissolving action in the first place. Generally, any drug that can be compounded into a liquid, injection, or patch can also be compounded into an RDT.  Drugs weighing over 500 milligrams, drugs that call for sustained-release action, and strongly bitter drugs are a poor choice for dissolve tablets.

2. Oral Liquid Vehicles

An Oral Liquid Vehicle (OLV) doesn’t have anything to do with a car; instead, it refers to liquid formulas that act as a carrier for a specific drug. This category includes:

• Liquid suspensions
• Elixirs
• Solutions
• Tinctures
• Syrups

Rather than being an active medicine, the liquid itself simply dilutes the drug down to the correct dose (and often improves the flavor). Most Americans have already used OLVs like cough syrups or liquid allergy medicines at home at least once. If you have kids or pets, you may even have experience giving OLVs with flavoring – this, too, is a form of compounding. That grape, apple, banana, or strawberry flavoring is part of the OLV itself!

Like rapid dissolve tablets, your pharmacist can only compound certain medications in OLVs. The biggest concern is stability; some drugs (like doxycycline) rapidly break down when exposed to moisture. In your body, this is essential. Outside of the body in the bottle, it leads to drugs expiring much faster than they would in pill form. This is also why some OLVs must remain in the dark or in the refrigerator.

OLVs are especially helpful for parents (of kids or pets) because they make it easier to deliver and swallow medications. As the pharmacist can add flavoring, OLVs may make medication time less stressful, too. As expected, they’re also easier for people who struggle to swallow pills.

3. Wound and Scar Creams

Medication in the form of creams is one of the most common pharmacy compounding formulas. Compounded wound and scar creams treat problem skin issues right where they start – in the first few layers of the dermis. Unlike oral medicines, which are systemic and flow throughout most of the body, most creams (with the exception of steroids) remain local in the tissue. Not only is this safer, but it’s usually more effective, too.

Most wound and scar creams contain a combination of multiple substances or drugs. Vitamin E is especially helpful for patients with scars because it encourages the body to heal, especially in the first three to six months after an injury. Steroids reduce severe inflammation, while antibiotic salves reduce or prevent infection. Numbing agents like lidocaine or benzocaine “turn off” nerves in the skin locally, reducing pain.

Some wound and scar creams also contain drugs like Retinol, Dimethicone, alcohol, glycerine, zinc oxide, or even silver nitrite, which is common when treating burns. Others may contain Vitamin D analogues, which are common for treating Psoriasis and other autoimmune skin conditions.

4. Oral Chews and Lozenges

Like RTDs and OLVs, oral chews and lozenges make it easier for patients to take medication and may also increase treatment compliance. These unique pharmacy compounding formulas come in a variety of formats, including:

• Gummies
• Caramels
• Soft chews
• Hard candy
• Chewable tablets

The most common oral chews and lozenges on the commercial market are vitamins, nausea drugs, and cough drops. Most patients are familiar with these options, but pharmacists can also compound many other prescription drugs into similar formulas. In fact, oral chews are one of the most common delivery formats for pets. Pets often prefer a medication treat over a plain pill.

In order for your pharmacist to compound your drug into an oral chew or lozenge, it must have a few special properties. Primarily, it can’t be extremely bitter or taste bad, and it can’t deliver an exceptionally high dose (over 500 mg). They should also be safe to mix with non-medicinal ingredients to create the chew or lozenge.

Some patients prefer certain drugs as chews or lozenges for specific reasons. For example, Nystatin, a drug that treats oral yeast infections (thrush), is often given as a lozenge because it keeps the drug localized in the mouth where it is most effective. Patients who are quitting smoking benefit more from oral nicotine lozenges from patches as the drug is faster-acting when absorbed through the mouth.

5. Hormone Supplements

Hormone supplements (called Hormone Replacement Therapy, or  HRT) work by providing by balancing hormone levels in the body. They are most commonly prescribed for the treatment of conditions like menopause, hypothyroid, hyperthyroid, gender reassignment, and certain reproductive conditions like PolyCystic Ovarian Syndrome (PCOS). They may also be prescribed to treat rarer conditions like adrenal gland insufficiency, benign or cancerous pituitary tumors, or autoimmune conditions like Hashimoto’s Thyroid disease.

Hormones come in two main forms: synthetic and natural. They may be bioidentical hormones, meaning they are an exact molecular match with the body’s natural hormones, or close matches instead.

While most hormones are available in commercially-available formulas, the doses don’t always match a patient’s condition or needs. The human body is remarkably sensitive to hormones; sometimes an adjustment of just a few micrograms is enough to throw off treatment.

Hormone compounding lets the pharmacist micro-adjust dose and change the delivery format to best suit the patient. Potential formats include:

• Topical creams (often best for estrogen replacement)
• Pills
• Sublingual pills
• Vaginal suppositories

Injectable solutions are an option, but are typically only prescribed for fertility treatment or advanced condition management due to increased risks.

Conclusion

Compounding pharmacies help to treat specific patients for their exact needs. Talk to your pharmacist today about these pharmacy compounding formulas to learn more!