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.