The Role of Compounding in Tomorrow’s Care of Patients:
Personalized Pharmaceutical Care
Loma Linda University
School of Pharmacy
Loma Linda, Calif.
Personalized pharmaceutical care is at the heart of compounding pharmacy. Pharmacy practice began with compounding – before commercially manufactured products, compounding drug preparations was the main practice of pharmacy. Up until the 1920s, about 80% of all prescriptions were compounded. In the 1970s, compounded prescriptions reached a low of less than 1% of all prescriptions. Today, between 30 and 40 million prescriptions are compounded each year. Compounding pharmacy is making a comeback in the United States. The future of compounding pharmacy lies with the ability of compounding pharmacists to work with patients and physicians to create more personalized pharmaceutical care than what can be dispensed with commercially manufactured products.
Compounded prescriptions are usually performed because a commercial product that meets an individual's need is not available. This could occur because a product is not stable enough to be commercially produced, a different route of administration is needed, the patient is vegetarian and needs to have a capsule that is not gelatin, or the flavor needs to be altered for a pediatric patient.
Patients and physicians can use compounding pharmacies to help tailor the medication to the patient's specific needs. Individualized pharmaceutical care helps to ensure the patient is receiving the greatest benefit from the medication being prescribed and allows greater flexibility in dosage forms and concentrations than what is commercially available.
The ability to personalize pharmaceutical care opens up many possibilities for future therapies. One of the more recent developments in personalized care is hormone replacement therapy or HRT. Bio-identical hormones have a molecular structure that is identical to the hormones naturally produced in the body. These bio-identical hormones are synthesized from yams and soy. Although studies are limited about the effectiveness of these compounded bio-identical hormones, many of the studies have positive results. One study showed that 97% of women using HRT had some relief of the symptoms of menopause. Complications that are usually associated with HRT, such as myocardial infarction, stroke and dementia, did not develop in the patients receiving bio-identical hormones. If being able to personalize hormones that are deficient in menopause helps women have a smoother transition with fewer irritating symptoms, such as night sweats, insomnia, and lowered libido, perhaps other patients with different conditions will also benefit from more individualized compounded medications. The future of pharmacy compounding should head in the direction of discovering disease states and therapies that can be better served by individualizing medication, as in the example of hormone replacement therapy.
Another future direction for pharmacy compounding is with off-label use of drugs. Pharmaceutical companies invest a lot of money and time into gaining approval for uses of the drugs they develop. Many of these drugs have off-label uses that are not approved by any governing body, but are effective. Off-label uses of drugs help to give more options to therapy when the usual therapy fails for a patient and allows already existing drugs be examined for alternative uses. Physicians who prescribe drugs for off-label uses need to have supporting documentation for using a drug for a purpose other than its approved use. However, off-label use also includes demographics that are not included in original studies, such as children and pregnant women, who can benefit from the originally intended use, but may not have an appropriate dosage form or concentration that is available commercially. Compounding pharmacists can help make these off-label uses more accessible for personalizing patient therapy by making different dosage forms available or compounding for dosage sizes or concentrations that are not normally available for the medication in question.
Individualized pharmaceutical care is an important topic for the future of compounding pharmacy. Hormone replacement therapy and off-label uses for medications are just two of a sea of possibilities for how compounding pharmacists can work with physicians to give patients with special needs or needs that are not addressed by commercially available products the best pharmaceutical care possible. With a wealth of knowledge and skills about how to tailor medications to individual patient needs, whether by dosage form, flavor, or creating preparations with or without specific excipients, compounding pharmacists are at the heart of personalizing pharmaceutical care for patients.
Cowen, D, Helfand, W. Pharmacy: An Illustrated History. New York: Mosby, 1990.
McPherson, TB, Fontane, PE, Jackson KD, et al. Prevalence of compounding in independent community pharmacy practice. J Am Pharm Assoc. 2006 Sep-Oct;46(5):568-73. PubMed PMID: 17036642.
The U.S. Pharmacopeial Convention. Pharmacy Compounding Accreditation Board. Available at: www.usp.org/audiences/pharmacist/pcab.html (Accessed April 24, 2011).
Pifer Than, T. Individualized Drugs for Individual Needs. Review of Optometry. 16 Jan 2009. Available at: http://www.revoptom.com/content/d/news_review/c/14924/ (Accessed April 24, 2011).
Harvard Health Publications. What are bioidentical hormones? Available at: http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm (Accessed April 22, 2011)
Mahmud, K. Natural hormone therapy for menopause. Gynecol Endocrinol. 2010 Feb;26(2):81-5. PubMed PMID: 19995152.
Return to Student Writing Competition Main Page