The History of Compounding

Compounding pharmacists provide valuable service through customized medications.

The role of the independent community pharmacist has evolved greatly in the last few years. Many pharmacists have returned to the early roots of pharmacy when they made medications tailored to specific requirements. Also known as problem solvers, these pharmacists are practicing the art and science of pharmaceutical compounding, which is the method of preparing medications to meet each physician's and patient's unique needs.

Setting the Standards

Compounding is achieved through an essential triad relationship - patient, physician and pharmacist, and is regulated by state boards of pharmacy. 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 community pharmacists the opportunity to provide superior, patient-oriented services.

History of Compounding

The practice of preparing medications dates back to the origins of pharmacy; yet, compounding's presence throughout the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. During the 1950s and 60s, with the advent of manufacturing, compounding declined. The pharmacist's role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms.

In the 1980s, and especially in the 90s, physicians and patients again began realizing the benefits of preparing customized medications to meet specific patient needs. Today, an estimated 0.7 to one percent of all prescriptions are compounded daily.

Reasons for Compounding

There are several reasons why pharmacists compound prescription medications; yet, the most important one is patient non-compliance. 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.

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 gastro intestinal side effects. Working with their physician, a compounding pharmacist can provide these patients with a topical preparation with the anti-inflammatory or analgesic their doctor prescribed for them.

Compounding pharmacists focus on meeting special needs. This may involve compounding a dermatological cream, an injection for impotency, preparing medications for veterinarians in a variety of dosage forms and flavors, providing natural alternatives in hormone replacement therapy, or assisting physicians in treating hospice patients.

The ultimate goal in preparing any of these customized medications is to help the physician and patient achieve a more positive therapeutic outcome.

 

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