What is compounding and what are its benefits?
Pharmacy compounding is the art and science of preparing customized medications for patients needing alternatives to "off the shelf" products for such things Autism, BHRT, pain management and many others ailments. Its practice dates back to the origins of pharmacy; yet, compounding’s presence in the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. With the advent of drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist’s role as a prepare of medications quickly changed to that of a dispenser of manufactured dosage forms.
Within the last two decades, though, compounding has experienced a resurgence as modern technology and innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs.
Why Should One Use A Compounding Pharmacy?
There are several reasons why pharmacists compound prescription medications; yet, the most important one is patient noncompliance. Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's prescription, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, and add flavor to it to make it more palatable. The pharmacist also can prepare the medication using several unique delivery systems, such as a sublingual troche or lozenge, a lollipop, or a transdermal gel. Or, for those patients who are having a difficult time swallowing a capsule, a compounding pharmacist can make a suspension instead. All will increase patient compliance and of course improve health.
Pharmacists have routinely altered the release rates of different dosage forms over the years. For example, topical and transdermal preparations can be formulated for a very rapid release of the drug for systemic effects, or for a much slower release of the drug for more local effects; suppositories can be 
formulated for rapid release as in the case of an analgesic drug, or for slower release as in the case of treatment for hemorrhoids; ophthalmic solutions can be prepared with low viscosity so that they are rapidly washed away by tears, or with higher viscosity so that they will remain longer in the eye; parenterals can be prepared using an aqueous vehicle for rapid effect or an oil vehicle for a prolonged effect; and orally administered capsules can be formulated to release the medication rapidly, if lactose or some other very water-soluble filler is used, or to release the medication more slowly, if a gel forming polymer is used. So, yes, pharmacists can alter the release rate of compounded medications.
Often parents have a tough time getting their children to take their medicine because of the taste. A compounding pharmacist can work directly with the physician and the patient to select a flavoring agent, such as vanilla butternut or tutti frutti, that provides both an appropriate match for the medication's properties and the patient's taste preferences. Compounding pharmacists also have helped patients who are experiencing chronic pain. For example, arthritic patients who cannot take certain medications due to gastrointestinal side effects. Working with their physician, a compounding pharmacist can provide them with a topical preparation with the anti-inflammatory or analgesic their doctor prescribed for them.
Working with manufactured products, we soon realized that not every person requires the same dosage form or dosage strength are all unique individuals. The pharmaceutical manufacturers could provide only those medications that were profitable. Thus, as new products were introduced into the marketplace older ones were discontinued. Although many patients did well on the newer medications, some patients were allergic to the pharmaceutical excipients and required unique dosage forms. How was the patient to receive the proper medication? The pharmacist, reviving one of their original roles, could compound the medication for a particular patient to address a specific need.
The Triad Relationship
Compounding is achieved through an essential triad relationship — patient, physician and pharmacist. The physician first prescribes the medication, then the pharmacist takes the necessary ingredients, compounds them, and dispenses the medicine to the patient after a thorough consultation. This enables patients to receive the type of personalized care they deserve and allows independent community pharmacists the opportunity to provide superior, patient-oriented services.
It is quite evident that the single most distinguishing feature of compounding is the specific physician/patient/pharmacist relationship. Quite possibly, the close relationship with the patient is the only differentiating factor, the one factor that compounding pharmacists are best qualified to serve. As the diversity of pharmaceutical dosage forms and the number of products available decrease and the uniqueness of patients’ requirements and preferences to ensure and enhance compliance increases, pharmaceutical compounding for both human and veterinary patients will continue to play an important role in meeting patients’ health care needs.
Meeting Patient and Practitioner Needs
Compounders focus on meeting special needs. This may involve compounding height/weight-appropriate pediatric medications, medications for veterinarians in a variety of dosage forms and flavors, alternatives in hormone replacement therapy, or dosage options, such as transdermal gels, when treating hospice patients. The ultimate goal in preparing any of these customized medications is to help the physician and patient achieve patient compliance.
