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. |
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 • Medication is discontinued or unavailable from a pharmaceutical manufacturer |
Natural hormone 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:
1. We work in close and continuous collaboration with the physician and the patient to assess the appropriateness, risks, and benefits of therapy
2. "Start low and go slow" - we believe that the lowest dose appropriate should be used when restoring human hormone levels
3. We recommend that any hormone restoration therapy be accompanied by an appropriate exercise regimen and a healthy diet
4. 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.
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.
VETERINARY COMPOUDNING 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)
The Top Ten Veterinary Compound Preparations:
The following is an excerpt from the International Journal of Pharmaceutical Compounding (Vol. 3 No. 3 May/June 1999):
A regional survey was taken of subscribers of the International Journal of Pharmaceutical Compounding to identify the most frequently compounded veterinary preparations. We received a large number of responses and present the names of the top ten preparations here.
1. Potassium bromide capsules
2. Metronidazole suspension (various strengths)
3. Methimazole 5-, 10-, 100-mg/mL oral liquid
4. Diethylstilbestrol 0.5-mg, 1-mg, 2-mg, 3-mg, 5-mg capsules
5. Potassium bromide solution
6. Cyclosporin 2% ophthalmic solution
7. Prednisone 0.5-, 1-, 5-, 10-mg/mL oral liquid
8. Amitriptyline 5- to 100-mg/mL oral liquid
9. Chloramphenicol 150-mg/mL oral suspension
10. Protamine zinc insulin, 10 to 100 units/mL
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.
Disclaimer: Any health related information is for educational purposes only. None of the information provided here is to be construed as medical advice. Before applying any therapy or use of herbs, you may want to seek advice from your health care professional. The information on our website should not be a substitute for physician evaluation or treatment by a health care professional and is not intended to provide or confirm a diagnosis.
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