The compounding of medications is one of the oldest practices
in medicine. Compounding is defined by the preparation, mixing,
assembling, packaging, or labeling of a drug or device as the result
of the practitioner, patient, and pharmacist relationship. Compounding
also includes the preparation of drugs or devices in anticipation
of prescription drug orders based on routine, regularly observed
prescribing patterns. In other words, a customized medication prepared
by a pharmacist according to a doctor’s specifications to
meet a patient needs. Pharmacists make medications from scratch
using pure ingredients, powders, and special devices.
Approximately 60 years ago, over one-half of all prescriptions
were compounded by pharmacists. During the evolution of medicine,
pharmacists became more dependent on the dispensing of medicines
instead of making them. Drug manufacturers started to mass produce
medicine, often limiting the medications to a few strengths. The
idea of different strengths and dosage forms made for the masses
works well most of the time. However, some patents need specialized
dosage forms or individual dosing regimens. We compound medicines
to meet the needs of each individual. In other words, we fit the
medicine to the patient, rather than the patient to whatever is
Today, compounding pharmacies are one of the fastest growing segments
of the pharmaceutical industry. We are better educated, better regulated
and much more sophisticated than compounding pharmacies of old.
There are several reasons to compound medications. These are just
a few of them:
Medications that are not commercially available:
M anufacturers must be assured that there will be a return on their
investment when entering the marketplace with a drug. Therefore,
there are limited products available with which the patient can
be treated. These limitations may be dosage forms, strengths, flavors,
or packaging. Compounding allows the physician to prescribe a custom-tailored
medication that is not available commercially.
Medications that are not stable:
Pharmacists prepare smaller quantities of a prescription more frequently
to ensure the stability of the product and the maximum amount of
time before the product expires.
Altered commercially available medications:
Physicians prescribe a commercially available medication in a different
dosage form to meet a specific patient need and ensure patient compliance.
For example, a patient may be allergic to a preservative or dye
in a manufactured product. Compounding pharmacists may be able to
prepare a dye-free or preservative-free form. Some patients have
difficulty swallowing a capsule and require a troche or lozenge.
Many pediatric patients are non-compliant because their medications
tastes poorly or is otherwise not administrable, but become compliant
when the medication is flavored to their liking.
Some dosage forms available from compounding pharmacies are injectables,
capsules, suspensions, suppositories, transdermal creams, ointments,
gels, lollipops, troches, and different types of powders. A compound
may be a simple as combining two different powders together for
a dog or an intrathecal injectable for a human baby.