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In every field of medicine, there are some patients who don't respond to traditional methods of treatment. Sometimes they need medicine at strengths that are not manufactured by drug companies, or perhaps they simply need a different method of ingesting a medication.

Pharmacy compounding meets these needs. It provides a way for physicians and compounding pharmacists to customize an individualized prescription for the specific need of their patient. Compounding provides solutions which are not met by commercial products.

At Hook's Apothecary, we have aligned ourselves with Professional Compounding Centers of America (PCCA) to provide the highest quality chemicals possible, unparalleld pharmacist consulting support and top of the line continuing education in the field of compounding.

Q: What is compounding and what are its benefits?

Pharmacy compounding is the art and science of preparing customized medications for patients. Its practice dates back to the origins of pharmacy; yet, compounding's presence in the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. With the advent of 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.

Within the last two decades, though, compounding has experienced a resurgence as modern technology and innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs.

There are several reasons why pharmacists compound prescription medications. The most important one is what the medical community calls "patient non-compliance." Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's consent, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, or add flavor 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 cream that can be absorbed through the skin. For those patients who are having a hard time swallowing a capsule, a compounding pharmacist can make a liquid suspension instead.

Compounding pharmacists have the opportunity to work with a variety of practice specialties, such as hospice, pediatrics, pain management, and OB/GYN, which in turn broadens the scope of their practices and creates other opportunities to provide other pharmacist care services. Your pharmacy can become a compounding pharmacy - one that is committed to providing high-quality compounded medications in the dosage form and strength prescribed by the physician. This triad relationship between the patient, the physician, and the pharmacist is vital to the process of compounding so all three can work together to solve unique medical problems.

Q: Can children or the elderly use compounded medication?

Yes. Children and the elderly are often the types of patients who benefit most from compounding. Often, parents have a tough time getting their children to take 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, which 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, some arthritic patients cannot take certain medications due to gastrointestinal side effects. Working with their physician's prescription, a compounding pharmacist can provide them with a topical preparation with the anti-inflammatory or analgesic their doctor has prescribed for them. Compounded prescriptions often are used for pain management in hospice care.

Q: What kinds of prescriptions can be compounded?

Almost any kind. Compounded prescriptions are ideal for any patient requiring unique dosages and/or delivery devices, which can take the form of solutions, suppositories, sprays, oral rinses, lollipops and even as transdermal sticks. Compounding applications can include: Bio-identical Hormone Replacement Therapy, Veterinary, Hospice, Pediatric, Ophthalmic, Dental, Otic (for the ear), Dermatology, Medication Flavoring, Chronic Pain Management, Neuropathies, Sports Medicine, Infertility, Wound Therapy, Podiatry and Gastroenterology.

Q: Is compounding legal? Is it safe?

Compounding has been part of healthcare since the origins of pharmacy, and is widely used today in all areas of the industry, from hospitals to nuclear medicine. Over the last decade, compounding's resurgence has largely benefited from advances in technology, quality control and research methodology. The Food and Drug Administration has stated that compounded prescriptions are both ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. In addition, compounding is regulated by state boards of pharmacy.

PCCA's Quality Control department is exhaustively devoted to assuring the quality of the chemicals received, repackaged, and sold to our members. Steps include obtaining a Certificate of Analysis for all chemicals received, verifying the identity of every bulk chemical received both before repackaging and completing a second identity test after repackaging, conducting regular tests of all chemicals in inventory, and verifying all unique identifier numbers prior to shipping.

As a repackager of unformulated chemicals for pharmacy compounding, PCCA is registered and inspected by the FDA and DEA. The company is also licensed in the state of Texas and other states where licensure is required.

Q: What is PCCA's role in this?

PCCA now has become the nation's complete resource for compounding pharmacies. The company's members are more than 3,500 independent community pharmacists in the United States, Canada, Australia, Europe and New Zealand. PCCA provides high-quality fine chemicals and pharmacy equipment to members, and maintains a sourcing department to locate those hard-to-find chemicals and devices. We also host a variety of ACPE-accredited training and continuing education classes for pharmacists and prescribing physicians. (Click here for more information on PCCA's CE Programs.) PCCA also maintains close, working relationships with several universities. In fact, PCCA is a dedicated rotation site for the University of Houston's College of Pharmacy.

When pharmacists join PCCA, they gain access to a staff of more than 20 consultant pharmacists, pharmaceutical chemists, and training personnel ready to serve their technical support needs. On average, PCCA's Pharmacy Consulting Department answers more than 600 consulting calls a day from member pharmacists who have technical questions about preparing medications for patients. Our members and consultants have access to a formulary database of more than 8,000 proprietary formulas that have been pre-tested with PCCA's chemicals.

PCCA offers comprehensive marketing consultation and support to help member pharmacies develop their business strategies and inform patients and physicians in their community about the benefits compounding can offer them.

Prescription compounding is a rapidly growing component of many physicians' practices, providing expanded treatment options and solving challenging medication needs. Consider contacting a compounding pharmacy - one that is committed to providing high-quality compounded medications in the dosage form and strength prescribed by the physician. This triad relationship between the patient, the physician, and the pharmacist is vital to the process of compounding so all three can work together to solve unique medical problems.

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