Tag: compounded medications

Your local custom compounding pharmacy is much more than just a place to get medication; they can do much more than other pharmacies can.

These pharmacies are a central hub of information, advice, and products to help you achieve and maintain your wellness, no matter your age, condition, or health situation.

Most people recognize that a good pharmacist is often invaluable to the patients they serve, as is a good pharmacy. But are all pharmacies the same? Not at all!

 

What Is a Custom Compounding Pharmacy?

A custom compounding pharmacy does much more than give advice and fill prescriptions.

They provide a much more in-depth, exhaustive service than everyday pharmacies, going above and beyond to serve patients with unique needs.

They offer:

• Custom dosing
• Ability to combine drugs for convenience and effect
• Alternative dose formats
• Medications for pets
• And much more!

You won’t find services like these at a regular pharmacy!

 

Custom Dosing

Need a custom dose? Normal pharmacies can usually only work with commercially available drugs in specifically-created doses.

If you need more or less of the drug, you may have to opt for the next lowest or highest dose – and that isn’t always an ideal option. Worse yet, it might not even effectively treat your condition.

A custom compounding pharmacy can create custom doses for just about anything, but there are certain treatments that are almost always compounded.

This includes:

• Bioidentical hormone replacement therapies
• Prescriptions for the very young or very old
• Prescriptions for certain metabolic concerns (like liver and kidney disease).

By compounding, the pharmacy can target the amount of dose delivered to the patient’s exact needs.

For some sensitive patients, this can be the difference between accessing the right meds, getting well, and going without.

For others, it simply makes taking medication more safe and far less likely to cause side effects.

 

Combining Drugs for Convenience

Do you take multiple meds for one or more health conditions?

Remembering to follow your medicine regimen can admittedly be a bit of a pain, especially if you have a long list of meds to remember.

Most patients cope by using scheduled pill boxes or simply writing themselves reminders… but what if there was a better way?

A custom compounding pharmacy can often combine medications into a single formula, allowing patients on multiple drugs to cut back on the number of drugs in their regimine.

This simplifies the process of using multiple medications including:

• Pills
• Topicals
• Patches
• Troches
• Ointments
• Even injectables

The result of combining meds?

Taking or using medication requires less time, and the patient is far less frustrated, meaning they’re much more likely to be compliant with treatment protocols – and thus, achieve better results.

 

 

Combining Drugs for Effect

Sometimes, drug combinations aren’t as much about convenience as they are about making treatments work better. The fact is that certain drugs just plain work better together – for example, codeine and acetaminophen.

While both are effective painkillers that work reasonably well on their own, patients are more likely to achieve uniform pain resolution if they take the drugs at the same time.

Topicals are often combined and compounded for similar reasons.

• For example, doctors may sometimes prescribe a compounded mixture of topical steroids and salicylic acid, with or without the Vitamin D analogue drug calcipotriene, to treat severe scalp psoriasis.
• Instead of having to apply three separate topicals, the patient only has to massage in one single solution.

Ultimately, the list of potential combinations – for any reason – is extremely long (and often dependent on a long list of factors).

If you’re curious about whether this might be an option for you, give your local pharmacist a call and ask!

 

1. Adding Flavoring

Let’s be honest: some medications are just hard take – and getting kids to take their medicine?

That can be a real challenge, too, especially if they’re already sick and the medicine tastes bitter or sour.

You don’t have to suffer through bad-tasting medicines or pills you struggle to swallow when you work with a custom compounding pharmacy.

Most can add flavoring or coatings to the medicine, depending on the format, to make it easier to ingest and/or more palatable for little ones. Choose from a long list of flavors like:

• Grape
• Apple
• Banana strawberry
• Bubblegum
• Mint

Flavoring might not seem like a big deal, but it certainly can be – especially when you’re a parent trying to coax syrup into your child at 3 a.m.

Why suffer when you don’t have to? Just talk to your pharmacist for help!

 

2. Alternative Dose Formats

When patients have more advanced challenges, like an inability to swallow (called Dysphagia) or very young age (e.g., infancy), they can’t always swallow pills.

Patients who are immobile or under full-time care often suffer from the same issue, and may even be unable to use topicals or patches.

In these and many other instances, standard dose formats must be changed to better suit the needs of the patient.

For example, if you’re struggling to take pills, the pharmacy can reformat the drug into liquid solution to make it easier to swallow.

If you can’t swallow at all, they may be able to reformat a prescribed pill into a patch or a topical cream instead. Other options include:

• Formatting liquids into troches or lozenges
• Turning injectables into oral solutions
• Making liquids more viscous to ensure safer swallowing

While there are a few rare medications that cannot be reformatted, either for safety reasons or because it deactivates the drug, the vast majority of prescription products can be recreated in a different delivery style.

Just ask your pharmacist whether this is an option for your medication!

 

3. Filler and Allergen-Free Drugs

Some patients have extreme allergies to the fillers, dyes, or non-medicinal ingredients in certain commercial drugs.

In fact, allergic reactions to inactive ingredients are surprisingly common, and they can even crop up suddenly after the patient has been on a drug for many years.

The most common “culprits” are corn starch, wheat, and red dyes. However, allergies are extremely individual, and what triggers one patient may not trigger another.

Researchers aren’t sure exactly why this happens to some patients and not others.

Most studies do show it does occur more often in patients with pre-existing allergies (such as an allergy to bees or nuts). It’s also more likely to happen if patients have a diagnosed autoimmune condition like Multiple Chemical Sensitivity Syndrome (MCSS).

Obviously, taking a drug that contains a filler you’re allergic to isn’t a good option. But opting to just not take the drug? That’s not an option, either.

You could become sick or even lose function, and that’s not okay.

The good news here is that your custom compounding pharmacy can help.

By breaking down the drug into its base ingredients, they can rebuild it from the ground up, leaving out the harmful allergen to ensure you remain well.

It’s really that easy!

 

 

Medication for Pets

Is Fido under the weather? If your vet prescribed a certain medication to help him get back to his silly, fluffy self, you should know that you don’t have to pay expensive vet prices.

It can be far more affordable to buy pet meds through a local pharmacy – and just as with human meds, all you need is a prescription.

While regular pharmacies typically only stock human-specific doses and drugs, compounding pharmacies work with base ingredients. That means they can often create pet meds from scratch in the exact dose your vet prescribes.

Because they’re working with generic base ingredients, treating Fido may even be cheaper, too, and that’s a win-win for everyone involved.

 

Conclusion

Whether you’re trying to find the perfect dose of bioidentical hormones, or you’re struggling with side effects like nausea after taking your nightly pill, you shouldn’t struggle alone in silence.

Tell your custom compounding pharmacy and ask them to investigate your options. Taking, giving, or using medicine doesn’t need to be a daily battle if your medicine is custom-tailored just for you.

Compounded creams can be used for a variety of conditions and can help with reduce symptoms, pain, and swelling.

In the pharmacy, one of our most common compounding requests is for compounded creams and topical medications. These medications allow patients to access the treatments they need in a delivery format or dose that’s easier to use and more appropriate for their illness.

In an effort to help you understand whether compounded creams may be right to you, we want to help you build your knowledge on the subject. Use the information you find here to learn more about this valuable treatment option.

 

First: What is Compounding?

Compounding is the process of creating a medication from scratch by mixing base ingredients. Unlike commercial medication production, compounding occurs on a much smaller, personalized scale, often right within the pharmacy itself.

Instead of simply doling out a pre-formulated medication, your pharmacist combines multiple base ingredients to create a brand-new formula personalized to your illness or needs.

Pharmacists compound many different forms of medicine, including:

• Pills,
• Lozenges
• Patches
• Injections
• Parenteral medications
• Hormones
• Even, in some cases, non-traditional delivery formats like candies or lollipops

Whatever the format, our main goal is to make medications safer, easier to take, and more suitable for the individual patient rather than just their condition.

When compounding creams, we combine multiple active and inactive ingredients to create a “compounded” formula. This differs from issuing a standard commercial medication because most commercial medicated creams come pre-formulated, pre-packaged doses, even before they even reach the pharmacy.

 

What Exactly are Compounded Creams?

Compounded creams are medications or formulas that are directly applied to the skin to aid pain and swelling, relieve skin conditions, or reduce symptoms from certain systemic conditions.

They may be used specifically, such as in the treatment of localized skin conditions like Psoriasis, or indirectly, such as in the use of topical hormones to treat Menopause.

Compounded creams, by definition, typically contain less than 20 percent water and no more than 50 percent standard compounding carriers (like hydrocarbons, waxes, or polyols). There are some exceptions to this rule, but this is the most common definition used in the pharmacy when comparing compounded creams to other topicals.

Topical Creams Vs. Alternatives

Despite the label “cream,” not every topical medication is a cream. True topical compounded creams fall into two formulaic categories: those made using a water-in-oil mixture, and those using an oil-in-water mixture. Additionally, most have a thick, creamy, or opaque appearance, although exact color can vary.

While common in medicine, creams are far from the only form of compounded topical medication pharmacists work with. Other topical dosage delivery formats include:

• Topical gels
• Lotions
• Salves
• Ointments
• Suppositories
• Pastes
• Liniments

Similarly, these delivery formats are applied directly to the skin or affected area to get the most results. However, they may contain ingredients not found in creams. The may also contain drugs that simply do not absorb well in the form of a cream.

Some people use the term “compounded creams” interchangeably with the term “topical medication,” especially in the case of gels, lotions, salves, ointments, and other formulas similar in consistency to cream. This definition is technically inaccurate. However, topical alternatives may be more or less suitable for treatment than creams in the treatment of specific conditions.

 

What are the Benefits of Compounded Creams?

We know through research that some drugs are just more effective when absorbed through the skin. We also know that compounded topicals can be extremely helpful for a long list of other reasons.

For example, creams show increased efficacy for treating localized issues like sunburns or skin conditions faster than, say, oral or inhalation medications.

This is just the beginning though, here’s a few more important benefits.

1. Avoid FPM

Topical creams avoid “first-pass metabolism” (FPM). FPM refers to the fact that the human body must process certain medications through the liver before the drug becomes effective. Drugs that avoid FPM have a reduced risk for serious liver complications; thus, they may be better for sensitive patient populations, such as children or the elderly.

2. Improve Usability

Using topical creams may improve patient compliance (how likely patients are to use their treatment as prescribed in the right dose every time). Patient compliance is a significant contributor to treatment failure. This is especially true in patients who experience anxiety or stress from anticipating undesired side effects, like nausea or dizziness, from oral or injectable medications. Creams often don’t produce the same side effects, meaning they are easier to tolerate.

3. Ability to Combine Medications

Compounding pharmacists frequently combine multiple medications into the same topical cream. This makes multifaceted treatment protocols easier and less time-consuming for the patient. Instead of needing to take multiple doses at different times of the day, the patient can use one cream with multiple ingredients instead. In certain situations, this may also make using medications more discreet.

4. Can Improve Effectiveness

Sometimes, combining ingredients is less about convenience and more about treatment effectiveness. For example, topical pain creams may contain both a numbing agent to reduce pain and an anti-inflammatory to relieve muscle spasms and swelling. Other formulas may contain both steroids and antibiotics to reduce inflammation while preventing or curing infection.

5. Certain Drugs Work Better

Topical creams show better efficacy for certain drugs, including hormones like estrogen and progesterone. When used to treat conditions like Menopause, vaginal dryness, or atrophied vaginal tissues, patients often experience an improvement in symptoms faster if they apply medications directly to the skin in the area most effective. This may be because stomach acid reduces bioavailability (how much of the dose is destroyed through digestion).

6. Can Moisturize the Area

Lastly, topical creams usually contain a gently moisturizing cold cream base. When applied topically, they condition the skin and reduce the risk of dryness, redness, or irritation. These are common experiences in patients who have sensitivities or allergies to drugs like steroids or anti-inflammatories. This is a particularly important factor for patients with inherently dry skin, Eczema, Psoriasis, Sjogren’s Syndrome, and other skin conditions.

 

Curious about whether or not topical and compounded creams are right for you? Every patient’s situation is unique. Give us a call or drop by the pharmacy; we’ll pull up your file and discuss your situation with you to determine the right compounded medication format for your condition.

Whether you’re reducing Menopause symptoms or treating a serious skin condition, we are your partner in better health and wellness.

In the pharmacy, we often talk about patient compliance and how it impacts treatment outcomes. “Compliance,” sometimes called adherence, simply refers to whether or not a patient follows all medication and treatment protocols at all times (e.g., taking the right dose at the right time each day). Compliance is necessary for every type of medication and administration, whether that be sublingual medication, buccal medication, or typical pill administration.

Most experts believe around 75 percent of all patients don’t take medications as prescribed. Despite having serious conditions, for some reason, they don’t take their medications as directed. When this happens, patients can sometimes become very sick or even experience fatal symptoms.

However, pharmacists also recognize that not every patient becomes non-compliant on purpose. Some patients genuinely struggle with taking medication. This is often the case for patients who find it difficult to swallow pills. These patients want to stay compliant, but they can’t manage to get the pills down in the first place, creating a perpetual anxiety loop that makes the entire experience horrible.

If you can relate, your pharmacist may be able to provide an easier solution: sublingual medication. In the article below, we’ll share our knowledge on these formulas and how they can help you achieve better treatment compliance.

 

What Exactly is a Sublingual Medication?

Like regular tablets and caplets, typical sublingual medication come in pill form. However, they aren’t swallowed; they are placed under the tongue or in the side of the cheek instead. Once nested into place, they melt and dissolve, releasing the medication into localized tissues.

Once tucked into place in your mouth, your saliva breaks down the pill over the course of five to 15 minutes. Local mucosal tissues (the lining of the mouth and tongue) absorb the medication, which then travels directly into the bloodstream. Even though you never swallow the medication, you still gain all of the benefits from your treatment all the same.

 

 

Sublingual Medication Formats

Every sublingual medication is different; the exact, size, shape, and delivery format may differ depending on your treatment protocol and unique health situation.

The vast majority of sublinguals are a similar shape to regular pills. All formulas fall into one of these four main categories:

• Tablets
• Liquids
• Sprays
• Films

Tablets and films are often referred to specifically as sublingual medication; sprays and liquids may be called sublingual or buccal depending on how and where they’re inserted into the mouth. Both sublingual and buccal refer to medications that absorb through the mucosal tissues in the mouth.

Types of Sublingual Medicaitons

Let’s break these medications down a bit further:

• Tablets are the most like standard pills in shape, size, and appearance. These often come in foil packs or simple pill bottles you can carry along with you. Most sublingual pills contain sugar or flavorings to make taking medication more pleasant.
• Liquids are similar to most other oral liquid formulations. However, their formulas may be slightly different. Most sublingual medication liquids contain special ingredients to speed absorption and flavors to make taking medication more pleasant.
• Sublingual sprays spritz into the mouth, usually onto the tongue or inner cheek. Because the medication is dispersed over a larger area of tissue, this may be a more rapid absorption method than sublingual pills or liquids.
• Films are compounded in the pharmacy and look like a small, ultra-thin, semi-transparent square of slightly rubbery material. Patients place them onto the tongue where they immediately begin to dissolve and absorb.

It is important to note that not every form of sublingual medication is right for every patient. Depending on your condition, your doctor or pharmacist may recommend one format over another. For example, patients who cannot swallow and/or those with paralysis affecting the jaw or mouth may be better suited to sprays rather than pills or films.

 

 

Advantages vs. Disadvantages

Like all medications, sublingual formulas have distinct advantages and disadvantages. Most crucially, a sublingual will carry all of the same potential risks, benefits, and potential side effects as your regular medication. Be sure to ask your pharmacist to explain these factors if you’re not familiar with them in the first place.

The biggest advantages of sublingual medication are ease of administration and rapid absorption. They may work faster and more efficiently than regular tablet medications to relieve your symptoms. If you take your medication in emergencies (e.g., when you suspect you are having a heart attack or when you experience allergic reactions), sublinguals may help you to manage your condition faster.

Sublingual medications may also benefit patients who have stomach, liver, kidney, or bowel conditions. Because they enter the bloodstream directly, they have virtually no impact on the liver and/or stomach, preventing serious gastrointestinal irritation. Drugs taken sublingually also have a higher “bioavailability,” meaning you require a lower dose to achieve the same desired results.

Unfortunately, sublinguals aren’t right for every patient. If you smoke, drink, experience frequent mouth sores, have oral cancers, or suffer from any other serious dental health concerns, sublinguals may not absorb correctly in your mouth. In these instances, other delivery formats (such as injectables or patches) may be a better choice for treating your condition.

 

Are All Medications Available As Sublinguals?

Unfortunately, no. The vast majority of medications can be compounded into sublingual formats in the pharmacy upon request. However, some medications may be unsuitable for this particular route of delivery due to taste, drug potency, or molecular solubility.

If you’re curious about sublingual medication, speak to your pharmacist. He or she can assess the drug and give you information on its suitability. Reasons for incompatibility include formulas that are incredibly foul-tasting, too potent to absorb directly, or can’t be used by the body until after they are processed through the stomach and liver.

Medications that provide extended-release benefits are also generally unsuitable for sublingual use. Because sublinguals absorb rapidly, they also metabolize rapidly in the body. Unfortunately, this does mean they won’t remain in the body long enough to provide ample coverage for certain conditions.

 

 

What Should I Know About Taking Sublinguals?

If you are already taking sublinguals, you can increase the chances of successful treatment by ensuring you take your medication as prescribed. This means using your prescription on time every time.

Drink water approximately 10 to 15 minutes before you take your medication; this will help to ensure that your mouth has enough saliva to break down the pill. Once you take the medication, do not eat or drink for at least 30 to 45 minutes afterward. Doing so may wash away part of the dose, causing treatment failures or a return of symptoms.

Don’t brush your teeth directly before or after you take your medication. If you smoke, avoid smoking for two hours before and two hours after you use your medication. Both can interfere with absorbance for certain medications.

Knowing what to do if you miss a dose or a dose doesn’t absorb properly is also important. If you remember your missed dose within a couple of hours, it’s generally fine to take it as soon as you remember. If it’s been longer than one to two hours, call your pharmacist for more specific instructions. Never double up your dose unless your doctor or pharmacist advises you to take a double dose.

Does the thought of taking medicine strike fear into your heart? If so, you may suffer from a rare phobia called pharmacophobia – the irrational fear of taking medication. Patients who suffer from pharmacophobia experience a broad range of symptoms when faced with the prospect of taking and managing medication, including palpitations, panic attacks, racing heart rates, trembling, nausea, and even weakness. These are all traditional anxiety symptoms that stem from an overactive “fight or flight” system in the body.

Symptoms from pharmacophobia can be severe enough that patients stop taking medications altogether, harming themselves in the process. The nature of this phobia also makes it especially difficult to treat; the idea of taking a pill is what produces the anxiety in the first place.

Here’s the good news: it is possible to overcome your pharmacophobia. Start with these strategies to build up your anxiety coping toolbox.

 

Define How Your Pharmacophobia Started

People who develop pharmacophobia usually develop this phobia after a negative past experience. They may have experienced a negative side effect or allergic reaction, or they may have seen a loved one become very ill or even die after taking medication. Even if the death or illness isn’t directly related to the medication, the brain can draw correlations between the two. This may cause patients to fear that they will have the same experience. Therapists often refer to this as “fearing the fear” itself.

Do you remember when you first became fearful of taking medication? If you can trace your fear back to when it may have started, you may also identify what’s causing it in the first place. Think back to negative experiences you or someone you know has had with medication. How did those experiences affect you? Remind yourself that someone else having a negative experience does not necessarily mean you will, too.

 

Take Your First Dose at the Pharmacy

Can’t bear the thought of taking a pill at home? Many patients with pharmacophobia fear becoming extremely ill after taking medication for the first time in a location where they cannot easily get help. Someone with an extreme phobia may feel fear even if there is a telephone present or another resident at home to monitor them. Depending on your condition, not taking the medication may not be an option.

Instead, take your first dose at the pharmacy. With medical staff on-site, it may be enough to ease your anxiety and convince you that your medication won’t harm you. If nothing else, you will at least have access to support if something goes wrong.

A note: although this strategy is technically enabling your phobia (something therapists never recommend), it does work as a temporary measure for many patients. Research tells is that people with pharmacophobia experience the most fear with the first dose. As they take their medication and witness the lack of side effects, the anxiety lessens – hopefully it lessens for you, too.

 

Try Talk Therapy

When you just can’t get over your phobia yourself, it’s time to seek outside help. Talk therapy, including both Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), can both significantly help people who suffer from pharmacophobia. The first attempts to change how you perceive your fear, and thus, its outcome. The second approach teaches you to be mindful and stay in the moment.

Finding the right therapist is important, especially in phobias where regressions and triggers can potentially cause more harm than good if mishandled. Additionally, talk therapy works best when patients mesh well with their therapists (from both a clinical and personality perspective). Don’t be afraid to consult with several therapists until you find the right one.

Can’t see a therapist? Try DBTSelfHelp.com. This website contains a database of DBT-based exercises and information you can put to use right at home. Practical skills learned include distress tolerance, emotional regulation, and mindfulness. Best of all, it’s totally free.

 

Try Exposure Therapy

Still struggling despite all attempts? Exposure therapy may help to desensitize you. This form of therapy exposes you to your fear with a therapist by your side to help you work through the negative emotions you experience. Research and statistics show the highest level of efficacy in resolving extreme phobias. In some patients, it is even more effective than using sedative medications.

When therapists engage in exposure therapy, they base your progress on where you are right now. If you can’t even tolerate seeing a pill, they may start by having you hold the pill first. If your issue causes you to struggle with swallowing pills, your therapist may advise starting with sugar pills or candy instead.

Exposure therapy is often gradual, so a complete fix may not happen for months or even years. However, it is still a valuable long-term tool. Patients with phobias who undergo exposure therapy often come to resolve their fears completely and permanently.

 

Change Your Dosing Method

For many patients with pharmacophobia, the phobia itself is related to a specific form of dosing rather than the medication itself. Patients may struggle with swallowing pills but do fine when given intramuscular injections. Others may be fine with pills but struggle with topicals. Even the fear of choking on medication can be enough to dissuade some patients from sticking with treatment.

Exactly why phobias play out this way isn’t always clear. Unfortunately, they are inherently irrational, and thus, they aren’t easy to explain. Changing the approach to accommodate may be easier than eliminating it.

If your phobia is attached to a specific dosing method, your local compounding pharmacy may be able to help by recreating your medication from scratch in a way that’s easier and less stressful to take. This approach might see the pharmacist making pills smaller and easier to swallow, changing topicals into a patch, or combining all of your medications into a single dose to reduce triggers. Compounded medications make it easier for you to take your medication dosage in a way that work specifically for you.

Compounding is especially useful for children with pharmacophobia, who may be more willing to take a medication that tastes great over a formula that’s bitter or sour. Pharmacists can add flavoring to make the medication more palatable!

Have questions about managing your pharmacophobia? Talk to your pharmacist directly. He or she is an invaluable resource that can help you decide how you want to move forward, whether you decide to take your medication to refuse it in the end. What’s most important is that you know pharmacophobia is nothing to be ashamed of – plenty of patients struggle with it, and most eventually overcome their fears. You can, too!

And if you need more information about how Burt’s Rx can help, call us today! We offer services such as pet compounding, compounded medication for pain management, BHRT, and dental compounding.