Myrtle Beach Sun News, 07-06-06
The mortar and pestle, those classic emblems of a pharmacy, have been little more than symbols in recent years.
In the early days of pharmacies, all drugs were compounded, that is, made to a doctor's specifications for each patient.
"Today about 99 percent of all prescriptions are already made up" when they arrive at the pharmacy, said Joshua Wenderoff, spokesman for the International Academy of Compounding Pharmacists. The exception is hospital pharmacies where many drugs are compounded, including all IV and chemotherapy preparations.
Outside of a hospital situation, the mortars and pestles of most pharmacies remain idle. The overwhelming majority of drugs dispensed today, over the counter and prescription, are made by large drug manufacturers. But when a person's health needs are unique and nothing from a drug manufacturer fits the bill, a physician may write a prescription for a custom-made preparation.
Compounded medicines are made in the pharmacy to meet an individual's needs in strength, dosage and form. Compounding is regulated by state Boards of Pharmacy. Materials used in compounding are all sourced from licensed Food and Drug Administration-registered manufacturers. Often a compounded preparation is for a common drug such as ibuprofen, when it is needed in an uncommon form, such as a cream instead of a pill.
"All pharmacy schools teach compounding, but not all pharmacies do compounding on a regular basis," Wenderoff said. "If you ask your physician, he or she can usually refer you to a compounding pharmacy."
These days, not all pharmacies have equal experience in the practice. One pharmacy may make up a compound every so often, but in a pharmacy that is known as a compounding pharmacy, the pharmacists spend much more time with the mortar and pestle.
"You should choose your pharmacist as carefully as you choose your doctor. So if you need compound medications, ask about your pharmacist's skill and experience in compounding the medication you use," said Susan C. Winckler of the Maryland-based American Pharmacists Association. "Choosing your pharmacist is important because he or she is the medication expert on the health care team and can help you make the best use of your medicine."
Often, pharmacists in compounding pharmacies have also taken further training to become specifically certified in compounding. Such is the case at Seashore Drugs, where all compounding is done at the Calabash, N.C., location.
"In the past 10 to 15 years I have seen a steady increase in requests for compounding," said fourth-generation pharmacist Edward R. Thomas IV, owner and pharmacist at Seashore Drugs. "It gives doctors an alternative."
Thomas and Terry Bellamy, a certified compounding technician, work on compounds all day, every day. Bellamy said he finds compounding to be "an art."
As with any prescription, communication is vital with a prescription that requires compounding.
"A patient needs to tell the doctor and the pharmacist about all allergies, all other over-the counter drugs, prescription drugs and herbal supplements and vitamins being taken," Thomas said.
When picking up a prescription, patients can again ask to speak to the pharmacist or technician to review the procedure for taking or applying the medication, he said.
The how of compounding
When filling any prescription and especially when making up a compound drug, Thomas and Bellamy pay scrupulous attention to cleanliness.
They clean the work surface and instruments before and after each prescription. They then carefully review each prescription and begin the formulation process with a careful weighing, mixing and final review of each prescription.
Among pharmacies that do compounding on a regular basis, Seashore's Calabash location is one of the few to have a dedicated sterile room for compounding things such as antibiotics, where even normal air could affect the preparation. The room, the machinery and the procedures used meet federal and state regulations for sterile rooms.
The pharmacist or technician enters the small white room, and does all medication preparation with his hands inside a laminar flow hood.
Cost and time
While prescriptions filled by counting pills from a large container into a smaller one can be accomplished in just a few minutes, a compounded prescription may take a day or so to fill. The cost of compounded prescriptions is covered by most health care plans, usually under the same rules that apply to other prescribed medications.
"The main point to remember is that compounding fills a need for patients that cannot be met by manufactured products," Wenderoff said.
"A compound is always prescribed by a physician, and patients should exchange as much information as possible with their physicians and the pharmacists."
Area compounding pharmacies
Seashore Drugs, 10227 Beach Drive S.W., Calabash, N.C., (910) 579 3200
Nye Pharmacy, 1600 W. 10th Ave., Conway 248-5015
To locate other compounding pharmacies in this area, call the IACP Toll Free Compounding Pharmacist Referral at 1-800-927-4227 or visit the Web site at www.iacprx.org
Some reasons for needing compounded medicines:
Patients who need medications flavored to make them easier to take, Patients who are unable to take medications orally and need compounded ointments or solutions
Patients taking multiple drugs who want them put in a single dose (often hospice patients with multiple pain management medications)
Cancer patients whose chemotherapy treatments are specially designed
Patients who are allergic to certain commonly used binding agents or preservatives in commercially manufactured pharmaceuticals.
Source : The International Academy of Compounding Pharmacists
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