Compounding in Pharmacy

Compounding in Pharmacy

     At one time, nearly all prescriptions were compounded. With the advent of mass drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms, and most pharmacists no longer were trained to compound medications. However, the “one-size-fits-all” nature of many mass-produced medications meant that some patients’ needs were not being met.

     Pharmacy compounding is the art and science of preparing personalised medications for patients. Compounded medications are made based on a practitioners prescription in which individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customise a medication to meet the patient’s specific needs. 

    The small-scale preparation of medicines from basic ingredients for a limited period of use (usually 3 - 7 days) is called compounding or extemporaneous dispensing. Compounding is one of the traditional duties of the pharmacists and it is unique to the pharmacists amongst the health care professionals. However, it is less common in current practise in the world since almost all the medicines used in the therapy today are prescribed in the form of ready made dosage forms manufactured by the pharmaceutical industries. 

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 through consultation. This enables patients to receive the type of personalised care they deserve and allows independent community pharmacist the opportunity to provide superior, patient-oriented services.

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 system, such as a sublingual troche or lozenge, a lollipop.l 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 medication for veterinarians in a variety of dosage form and flavors, providing natural alternatives in hormone replacement therapy, or assisting physicians in treating hospice patients.