Custom Compounding

Jun 11, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

My mom has a picture of me with my dad, Bob, my grandfather, Stan and my great-grandfather Tom. I was very young in the picture and I dont remember meeting Tom. But at least I was alive at the same time as him. I dont know anything about Toms dad, my great-great grandfather. Now imagine if my great-great grandfather without writing it down, could somehow give me the knowledge of how to get to a secret cabin in the woods. Remember, were never alive at the same time. Sounds a little like science fiction, doesnt it? Well thats exactly what Monarch butterflies do!

Monarch butterfly generation one is born in Mexico flies north to the southern US, mates and dies. Generation two flies from the southern US to the northern US, mates and dies. Generation three flies from the northern US to Canada, mates and dies. Each of these three generations lives only about a month. Now generation four is special. Obviously this is because it is Canadian. Generation four lives for about 9 months. Nine times longer than each of the previous generations. But the really incredible thing is generation four flies all the way back to Mexico. It flies over 3200 km. It seems to know where to go even though it never flew it before. In fact no butterfly has flown the trip in four generations. Just like if my great-great grandfather passed the knowledge of the location of the secret cabin in the woods to me.

Other useful knowledge from the past is custom compounding. Custom compounding is when a pharmacist mixes together a preparation that isnt commercially available for a patient at the direction of a physician, vet or dentist. In the past, a lot of what pharmacists did was compounding because there werent that many commercially available medications around. Now most pharmacies dispense pre-fab pills. However, there are some pharmacies that have retained the knowledge from the past of how to customize a medication for a particular patient.

Atthe Dauphin Clinic Pharmacy, we have taken the arcane knowledge of compounding and given it a modern twist so we can tailor medications to an individual patients needs. For example, we made a topical version of lorazepam for a nursing home patient. Lorazepam can be used to calm someone who is very agitated. But, as you can imagine, trying to give a pill to someone who is very agitated and has dementia can be difficult. Sometimes the nurse even gets bitten. There is an injectable version of lorazepam, but again it is difficult for the nurse and distressing for the patient. But, holding an agitated patients hand and rubbing a medication on their wrist is a very natural and calming thing for a nurse to do. So, we made a topical version of lorazepam so the nurse could rub into onto the wrist. It worked well for both nurse and patient.

For animals, under a vets direction, we have made a variety of products. We have made everything from injections for cattle to liquid antidotes for dogs who ate rat poison. One interesting thing we compounded was an antibiotic for a cat. We started with a human medication, ground it up an put it into a special fish paste that the cats love. However, we found one cat didnt like fish, so that cat gets its medication in a chicken paste. When the patient is a cat, it is still important to listen to the patients needs.

Any one who has had hemorrhoids will tell you how annoying, painful and itchy they can be. The problem is most suppositories slide right by the hemorrhoid and so they dont release much of their medication onto the hemorrhoid. At the Dauphin Clinic Pharmacy we have a suppository mold called a Rectal Rocket. It flares at both ends so the suppository stays where it can do the most good. And, of course we can customize which medications we put in the suppository.

So just like the Monarch Butterflies, we have received our compounding knowledge from our pharmacy fore-fathers. Then we put a modern twist on the knowledge of compounding and with it we can help our patients by customizing their medications to their specific needs.

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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