Custom Compounding

Sep 1, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy


What's in a name? That which we call toast by any other name would smell as delicious. Toast is pretty simple right? I say toast and you picture bread which has been heated until crispy and brown. Apparently, toast is more complicated in the day care set. Among Erics daycare friends, toast can mean different things. One boy has been known to order Toast in a restaurant, but then specify that he doesnt want it cooked or any butter put on it. What he really wants a plain piece of bread. Another boy says he wants Toast, but what he really wants plain, non-toasted bread with Cheez Whiz on it. Both these boys have a really clear understanding of what they want, but being under 6, they have trouble explaining what they mean by Toast to others.


Sometimes, I find I sometimes have trouble explaining what I mean by 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. That usually doesnt mean much to most people. I often have to show people what we do in our compounding lab for it to make sense to them. That used to be difficult as our compounding lab was hidden where the public couldnt see it. In our new building, the compounding lab is right out front, with nice big windows so you can see what we are doing.


At the Dauphin Clinic Pharmacy, we use the art and science of compounding to tailor medications to an individual patients needs. In January I usually talk about how we can compound nicotine lollipops to help people quit smoking. Our most popular compound is called a diclofenac cream. It can be rubbed directly on a sore knee or shoulder to reduce the pain without bothering the stomach. We get to compound some more unusual things too. For example, we made a topical version of haloperidol for a nursing home patient. Haloperidol can be used to calm someone who has dementia and is very agitated. Sometimes if the patient is very agitated, the nurse has to give the haloperidol by injection. But, as you can imagine, trying to give an injection to someone who is very agitated and has dementia can be difficult. There is a pill version of haloperidol, but with some agitated patients it is not possible for the pill to be given and sometimes the nurse even gets bitten. 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 haloperidol 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. In the spring we compound a liquid to prevent scours in calves. We have compounded a liquid antidotes for a dog 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 likes and dislikes.


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 come down and check out our brand new building. Press your nose up against the glass and have a look in the new compounding lab. Check out what we do first hand. When you are watching us mix something together you might get an idea of how we could help you, your family or your animals. Then knock on the glass and ask me your questions. After youve see us work first hand, explaining custom compounding to you will be as easy as Toast.


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.

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



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