What is a Compounding Pharmacy?
Customized medications may sound like something for the rich and famous, but the reality is that this is how people got their medications from pharmacies for centuries. Surprisingly, it’s not as much of a lost art as you might think… especially for Migraineurs.
The Evolution of Prescription Drugs
Today, pharmaceutical companies mass produce medications and sell them by the bottle to pharmacies. Pharmacists count out pills, re-package them and sell them to the consumer. However, this kind of pharmacy has only been in existence about 100 years. Before that time, the pharmacist’s specialty was to take specific ingredients, then measure and combine them according to the physician’s very specific prescription or what the specific patient wanted or needed. Each prescription was customized.
Like now, many average families could not afford the care of a doctor. As recently as the early 1900’s, most families had books that would tell them how to diagnose and treat common diseases and disorders of both human and animals. My family passed down a well-worn book called “The People’s Home Library” for at least 4 generations.
If a doctor was consulted, his job was to tell the pharmacist what he wanted the patient to have and how much. The “how much” often involved complicated math equations for the doctor or pharmacist to determine the correct dosage for the patient based on factors that often included weight, age or other considerations.
The pharmacist would then measure and combine the ingredients, then put them into whatever form was requested — powder, pill, capsule, liquid, etc — and include written instructions for taking the medicine . The patient took the medicine home and used it as directed. Less commonly, the patient might simply order the needed ingredients, take it home and combine it themselves.
The same ingredients were used for people and animals alike.
Today we call these kinds of pharmacies Compounding Pharmacies. The process of taking ingredients, measuring them, combining them and putting them in a specific form is called Compounding.
The creation of pharmaceutical companies and their ability to produce medicines quickly and cheaply nearly put the old time pharmacist out of business. It certainly did change his job from something of a mixologist who created a product, to more of a sales middle-man who knowledgeably sells the product.
All pharmacists are taught the basics of compounding medicines, but not all pharmacists are compounding pharmacists.
Compounding pharmacists are often connected with local hospitals because of the hospital’s need for specialized medicines. Chemotherapy is just one reason why hospitals are usually affiliated with a compounding pharmacy. Not all compounding pharmacies are affiliated with hospitals however. You can usually find a local compounder by making a few phone calls. Regular pharmacies are usually happy to refer you to the local compounder.
Compounding may sound like a luxury, but sometimes that is not the case. A patient who cannot swallow a pill will need their medicine in another form. A patient who is allergic to a particular ingredient may need their drug compounded without it. Sometimes toxic ingredients such as chemotherapy must be precisely mixed in controlled conditions. There are many reasons for compounding medicine.
Compounding can be done in many forms. Some forms you may be able to have your medicine compounded include:
- Liquid suspension or solution
- IV solution
- Suckers or lozenges
- Cream, lotion or jell
- Nose spray
Some medicines can be combined with ingredients that turn them from immediate acting (short acting) to long acting or sustained release.
Migraineurs often do better if their medications are compounded because of Migraine associated gastric stasis — a frequent symptom during a Migraine attack that keeps medicines from being absorbed. Bypassing the oral route of most drugs becomes the only way for them to receive the medication they need.
Physicians often forget that compounding is an option, so most patients find that they need to start a conversation with their doctor about it.