May 1, 2021
Pharmaceutical Compounding: Finding solutions to life’s medication challenges
Reuben K Nielsen, PharmD, MBA
If you have never heard of pharmaceutical compounding, it may seem scary — venturing into the unknown is full of uncertainties. You may not be sure where to begin. As I recently said to a colleague of mine, “You don’t know what you don’t know.”
If you don’t know what options are available with your medications, ask your physician or compounding pharmacist!
One example is metformin, an oral tablet used most commonly to control blood sugar levels. It happens to be harsh on the stomach, and a lot of people struggle with this side effect — some of them even stop taking it.
But what if you could have your cake and eat it too? In other words, what if you could take metformin without the nausea and diarrhea? With compounding, you can!
Some patients have found that when metformin is compounded into a cream and used topically, the stomach is bypassed, the medication still maintains blood sugar levels, and side effects are decreased1.
There are times when life takes a turn and physical or mental ailments make taking medications challenging. Knowing what options are available to you can open the door to discuss the situation with your physician and compounding pharmacist – and could change a square-peg/round-hole situation into a perfect fit!
For example:
| Challenge | Solution |
|---|---|
| Difficulty swallowing capsules, tablets, or liquids? | Try a sublingual tablet or topical if appropriate |
| Allergies or sensitivities to fillers in a manufactured product? | Compound the medication without the allergens |
| Need a lower dose or an odd dose of a medication that isn’t available commercially? | Compound with the correct, modified dose |
Changing the dosage form, the way in which the medication is delivered into the body, can make a significant therapeutic difference for some patients. Check out these dosage form options that compounding pharmacies offer:
Pump devices:
- Used for topical cream medications.
- Allows for exact dosing in a convenient small package.
- Depending on the device 1 pump equals ¼ ml, ½ ml or 1 ml, allowing for variable dose adjustments
Topi-Click® devices:
- Used for topical cream medications.
- Allows for exact dosing in a convenient small package, including vaginal delivery
- One twist/”click” of the bottom is equal to ¼ ml, allowing for easy dose adjustments.
Tubes and Jars:
- Used for topical cream medications.
- Allows for dosing in a convenient small package
- Tube Accommodates vaginal dosing
- Patient has high level of control over dose, good for as needed dosing
Suppositories: Vaginal or Rectal inserts Useful when other dosages are not appropriate or are not an option, such as inability to swallow or to avoid the stomach for improved absorption
Troches:
- Waxy, dissolvable lozenges
- Can be used under the tongue or as vaginal inserts
- Useful when other dosages are not appropriate or are not an option, such as inability to swallow
- Can be cut for dose adjustments.
- May require refrigeration
Dissolvable Tablets
- Dissolvable powder tablets, commonly taken sublingually. May include flavoring and sweeteners
- Useful when other dosages are not appropriate or are not an option, such as inability to swallow
- Avoids the stomach, promotes direct absorption into the blood stream
Pharmaceutical compounding may not be able to fix every medication issue, but for some they are a life saver. To find out more, discuss your dosage form options with your physician and compounding pharmacist!
Reference:
- Jones, Jane H, Apothagram (PCCA®) November 2015. Based on Metformin 10% Lipoderm cream. This statement is not meant to nor should it be misconstrued to be medical advice superseding your provider’s medical authority. Please consult with your provider on any and all changes to medication. Topical Metformin therapy is only recommended for patients with optimized A1C and controlled blood sugar levels.
