Compounding
Prescriptions...A Lost Art?
By Mark Hobbs, RP.h, CP.h
Hobbs Pharmacy, Merritt Island
Recently, a physician called me to inquire about the compounding of
a prescription medication that is now out of production. His question
was simple, "Do you still make prescriptions the old fashioned way?
You know, make them from scratch?"
I explained that even though we are approaching the new millenium,
the art of prescription compounding is not dead. In fact, we are seeing
a resurgence in the need for patient specific compounded formulations.
Not a day goes by when I do not receive an inquiry concerning compounding.
Compounding of sterile and nonsterile products represents a rapidly
growing part of my practice. Compounding pharmacists develop a unique
relationship with the patients they serve. We work with physicians to
solve problems not addressed by commercially available dosage forms.
Clean Room Facilities
Clean room facilities are being constructed in compounding pharmacies
for the preparation of sterile products. We recently compounded a 1,100
square feet Class 100 clean room facility with both horizontal and vertical
laminar flow hoods. In addition to traditional IV products, such as
antibiotics, hydration and TPN we have been asked to prepare customized
injectable products. With this sterile facility, we can produce preservative
free, specialized injections. Our most common request is for combination
mixtures for the treatment of male impotence.
Non-sterile products have traditionally been prepared for dermatological
patients. Today, we are receiving an increasing number of inquirues
concerning pediatric, geriatric, and even veterinary formulations. Many
pediatric patients are unable to master the swallowing of pills and
tablets. For oral products that are not available in liquid form, we
can prepare pleasant flavored liquid formulas. The simple addition of
a more palatable flavoring may significantly improve the compliance
for selected patients. These same issues are often found for geriatric
patients.
Terminally ill patients have a variety of needs that may be solved
with compounded products. Specialized rectal suppositories for pain
control or nausea and vomiting can be customized for the needs of a
particular patient. Metoclopramide and ondasetron as single agents and
metoclopramide/ haloperidol/ dexamethasone/ diphenhydramine in combination
are some examples. Some of these patients may benefit from aromatherapy,
a practive which has been used for thousands of years. Aromatherapy
compounds can evoke a sense of well being, remembrance, freshness and
vitality.
New Gel Formulations
New gel formulations allow the topical administration of anti-nausea
and anti-inflammatory formulations. The topical use of nonsteriodal
anti-inflammatory agents such as ketoprofen and ibuprofen may provide
relief for patients who cannot tolerate oral administration. Promethazine
gel applied to the wrists has been found effective for controlling nausea
and vomiting. We are also seeing expanded use of compounded hormone
products. Vaginal suppositories and creams are being used to deliver
progesterone. Topical preparations of progesterone and estriol are becoming
increasingly popular.
Today's compounding pharmacists have turned back the clock to the time
when medicine was about individualized patient care. The high tech/high
touch practice of compounding serves the patient and the physician as
we move to the future. The next time you have a patient who may benefit
from a compounded product call a compounding pharmacist.
Mark Hobbs is a compounding pharmacist and the owner of Hobbs Pharmacy
in Merritt Island. He is a past president of the Florida Pharmacy Association.
If you have any questions, he can be reached at (321) 452-0080 or via
e-mail hobbsrx@msn.com.
