The Art and Skill of Pharmacy Compounding
Because every patient is different and has different needs, customized medications are a vital part of quality medical care.
The preparation, mixing, assembling, packaging, or labeling of a drug or device as the result of a practitioner, patient, pharmacist relationship in the course of professional practice, or for the purpose of or as an incident to, research, teaching, or chemical analysis and not for sale or dispensing. Compounding also includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns. A customized medication prepared by a pharmacist according to a doctor’s specifications to meet an individual patient need. Pharmacists make medications from scratch using raw chemicals, powders and devices.
Compounding: The Need
The basis of the profession of pharmacy has always been the “Triad”, the patient-physician-pharmacist relationship.Through this relationship, patient needs are determined and decisions are made about treatment regimens that may include a compounded medication, including but not limited to:
Medications that are not commercially available
Manufacturers must be assured that there will be a return on their investment when entering the market place with a drug product. Therefore, there are limited chemical forms, dosage forms, strengths, flavors and packaging that are available for the physician to prescribe and the pharmacist to dispense. Compounding allows the physician to prescribe a custom-tailored medication that is not available commercially.
Medications that are not stable
Pharmacists prepare small quantities of a prescription more frequently to ensure stability of the product for its intended use.
Altered commercially available medications
Physicians prescribe a commercially available medication in a different dosage form to meet a specific patient need and ensure patient compliance. For example, a patient may be allergic to a preservative or dye in a manufactured product that compounding pharmacists can prepare a dye-free or preservative-free dosage form. Some patients have difficulty swallowing a capsule and require a troche or lozenge. Many pediatric patients are non-compliant because their medications are bitter, but become compliant when the medication is flavored to their liking.
The Right and Responsibility of the Pharmacist to Compound
No other health care professional has studied chemical compatibilities and can prepare dosage forms. Even when modern scientific technologies have produced new chemical entities, the ability of the pharmacist to combine one or more chemicals into a new preparation or process the existing dosage form into one that is better suited to the patient’s needs, has remained the domain of the pharmacist. Compounding of medications by pharmacists is a long-standing and traditional part of pharmacy. The right – if not the obligation – to compound exists under the pharmacy laws of each of the fifty states and is pervasively regulated by the fifty states. States require that pharmacy schools must – as part of their core curriculum – instruct students on the compounding of pharmaceuticals.