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COMPOUNDING
We go the extra mile for you by customizing your medicine
to meet your unique needs.
Compounding is the art and science of
customized medication prepared by a pharmacist, according to a doctor's
or veterinarian's specifications, to a meet a patient's unique needs. 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 administering 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. Please inform your compounding
pharmacist of any restrictions you may have, such as food and drug
allergies, or medical conditions.
John’s Pharmacy is committed to
providing high-quality compounded medications in the dosage form and
strength prescribed by your physician.
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Prescription compounding is a
rapidly growing component of many physicians’ practices. But in today’s
world of aggressive marketing by drug manufacturers, some may not
realize the extent of compounding’s resurgence in recent years. Ask your
physician about compounding. 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.
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What Kinds of Medicines 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 topical creams and gels. Compounding
applications can include: Natural 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.
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When is Compounding Needed?
There are several situations when a pharmacist is needed to customize a prescription medication, including:
- Medication is discontinued or unavailable from a pharmaceutical manufacturer
- Patient is allergic to certain preservatives, dyes, or binders in commercially available medicationsPatient requires a prescription medication in a specific unavailable dosage strength
- Patient is unable to ingest the medication, and requires a cream, gel, liquid, lozenge, lollipop, popsicle, troche, chewy treat, lip balm or other dosage form that they can easily take.
- Medication requires customized flavoring to make it more palatable for the patient
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NATURAL HOME REPLACEMENT THERAPY
There is an alternative to traditional synthetic hormone replacement.
Over 30 million women in our country are
menopausal. An additional 20 million are within years of this personal
transition. Over recent years, as the number of women seeking hormone
replacement therapy has grown, we have seen increased mass production of
hormone pills, creams, and patches by the drug companies.
The problem with such mass production is that
all women are not the same. Commercially manufactured products do not
always account for unique differences in women. Even minute variations
in hormone therapy can result in very different symptoms from one woman
to another. Compounded Natural Hormone Replacement Therapy is available
and can be designed specifically for your body.
At John's Pharmacy, our approach to hormone replacement therapy is individualized to care for each patient as follows:
- We work in close and continuous collaboration with the physician
and the patient to assess the appropriateness, risks, and benefits of
therapy
- "Start low and go slow" - we believe that the lowest dose appropriate should be used when restoring human hormone levels
- We recommend that any hormone restoration therapy be accompanied by an appropriate exercise regimen and a healthy diet
- Regular physical assessments and evaluation of symptoms, along
with measuring the hormone levels are important for appropriate hormone
supplementation
Our compounding pharmacist uses
hormones that are chemically and biologically identical to those
naturally occurring in a woman's body such as estriol, estradiol,
estrone, progesterone, dehydroepiandrosterone (DHEA), and testosterone,
to compound balanced and patient-specific preparations.
Some of these
conditions are:
- Premenstrual syndrome (PMS)- The Merriam-Webster
Medical Dictionary defines PMS as "a varying constellation of symptoms
manifested by some women prior to menstruation that may include
emotional instability, irritability, insomnia, fatigue, anxiety,
depression, headache, edema, and abdominal pain"
- Perimenopausal (Premenopausal) symptoms- The
Merriam-Webster Medical Dictionary defines premenopause as "the period
of irregular menstrual cycles preceding menopause." Symptoms include hot
flashes, vaginal dryness, sleep problems, mood swings, breast
tenderness, and other complications.
- Menopausal and Postmenopausal symptoms-
Menopause is defined as the complete cessation of menstruation for 12
consecutive months, usually occurring in women between the ages of 45
and 55. Common symptoms include hot flashes, osteoporosis,
palpitations, night sweats, depression, anxiety, mood swings, vaginal
dryness, decreased libido, urinary urgency or incontinence, pain, dry
skin, hair loss, fatigue, irritability, forgetfulness, and other
complications.
- Andropause symptoms- The Merriam-Webster
Medical Dictionary defines andropause as "a gradual and highly variable
decline in the production of androgenic hormones and especially
testosterone in the human male together with its associated effects that
is held to occur during and after middle age but is often difficult to
discriminate from the effects of confounding factors (as chronic
illness, stress, or medication use) that can depress testosterone levels
- This is also known as male climacteric, male menopause, viropause."
Symptoms of andropause include loss of energy, mood swings, loss of
concentration, depression, impotence, and other complications.
NATURAL HORMONE REPLACEMENT DOSAGE FORMS
Just as we will compound your hormone replacement in a dose specific to you, we can also provide a dosage form specific to your individual needs.
The route of administration is one way to
improve the benefits, decrease the risks and side effects, and improve
compliance. Individual variations in response to different dosage forms
increase the importance of having a choice of dosage forms to optimize
patient outcomes. We have the ability to compound many dosage forms to
meet the needs of the physician and patient. The following are just a
few of the dosage forms we offer.
CREAMS AND OINTMENTS
Creams and ointments can be compounded with a
variety of different hormones and with complete strength and dosage
flexibility. The consistency can be changed depending on the absorption
required and the site of application. Our formulas are hypo-allergenic
and can be made preservative free to minimize patient allergies and
sensitivities. Most creams may be applied only once a day.
PERCUTANEOUS GELS
ALL HRT needs to be individualized for
optimal effect. Variances in individual levels due to differences in
absorption can easily be corrected by simply adjusting the volume or
strength of the gel used by the patient. The gel dries completely within
a few minutes of application, leaving no visible trace or smell. Two or
more hormones may be combined into a single dose to increase ease of
application and compliance.
There are seldom problems with skin
irritation as is sometimes the case with transdermal patches. Like
ovarian secretion, percutaneous gels do not deliver HRT via the portal
system, thereby avoiding the first pass effect of liver metabolism.
Unlike oral routes, a more physiologic estrogen balance is preserved.
NOTE: There are major differences in
gel formulations. Some gels are not designed for delivering a 24-hour
effect, e.g. PLO gels. Other gel forms include types of alcohol and
other ingredients that are not appropriate for daily use.
SUBLINGUAL TABLETS
A true sublingual tablet can offer many of
the benefits of a non-oral route. Dissolving the tablet under the
tongue introduces the hormones directly into the blood stream while by
passing the metabolism that may occur in the liver. By delivering
hormones directly into the circulation, problems with bio-availability
due to the digestive tract might also be avoided, and often a lower dose
can be used effectively. Generally there may be a 5-7% increase in
absorption when using a sublingual tablet. We can compound all of our
hormones either singly or in combination, per your prescription order.
The tablets are placed under the tongue and dissolve quickly.
CAPSULES
We can provide a wide range of release
systems and excipients to be used with individual hormones or hormone
combinations. We can offer capsules with an extended release delivery
system for those medications and conditions that require a more
continuous release to achieve the desired effect. Also available is a
large variety of fillers for those patients who have multiple allergies
or are extremely chemically sensitive.
SUPPOSITORIES
Estradiol, estriol, estrone, progesterone and
testosterone, as well as boric acid, acidophilus and more, can be
compounded in suppository form.
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When you choose a hormone replacement therapy, choose one that uses hormones that look and act just like the hormones you have naturally in your body.
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VETERINARY COMPOUNDING FOR PETS
At John's Pharmacy we work together with veterinarians and pet
owners to solve medication problems.
Anyone who has ever given their pet a
medication knows just how difficult that can be. We can compound
customized medicines that meet the unique needs of each animal. Our goal
at John's Pharmacy is to work with the veterinarian to enhance their
ability to treat their animal patient in a more effective and efficient
manner. We are able to achieve this goal by offering innovative dosage
forms that are patient specific in strength and formulation.
Examples of problem solving Solutions:
- Preparation of medications in commercially unavailable dosage forms (e.g.
liquids, troches/lozenges, topical creams/ointments/gels, otics,
inhalation solutions, suppositories, veterinary "treats", capsules,
powders, transdermal gels, etc.)
- Flavor adjustment (e.g. chicken, beef, or liver
for canines; fish for felines; fruit flavors for birds; apple, cherry,
or caramel for horses; etc.)
- Preparation of medications in commercially unavailable dosages (e.g. increase or decrease dose, dosing on a mg/kg basis, sustained release)
- Removal of unnecessary or unwanted ingredients (e.g. fillers, dyes, preservatives)
Advantages of Transdermal Dosage Forms
Various alternative dosage forms permit medication to be absorbed by non-oral routes to meet your pet's specific needs. The term"transdermal"
dosage form refers to incorporating the medicine in a cream, gel, or
solution that is formulated to penetrate the animal's skin and deliver
an appropriate level of medicine in the bloodstream. Although
the parenteral and rectal routes are traditional alternatives to oral
administration, transdermal absorption offers many advantages. For example:
- It's quick and easy, and many medications are compatible with transdermal bases
- Transdermal delivery is particularly useful for animals that
should not be stressed due to cardiovascular or hypertensive illness
- When medication is absorbed directly into the bloodstream,
without first entering the gastrointestinal system, a smaller amount of
active ingredient may be required for therapeutic effect
- Direct application and absorption at the target site can mean
higher tissue levels and blood levels of various medications. As a
result, side effects such as garstointestinal irritation may be avoided
or minimized
- And perhaps the most important, it is appreciated by owners who
no longer have to deal with an animal that resists being medicated via
the oral or other less convenient route
John's Pharmacy compounded medications are not intended for use in food chain or food producing animals. A valid prescription from a licensed veterinarian is required. Contact our compounding pharmacist today to discuss customized medication options for the health care needs of your pet.
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