By Steve Bernardi and Gary Kracoff/Daily News Correspondents
For many people, pharmaceuticals are a one-size-fits-all product. Your doctor writes a prescription, you go to the drugstore, and you come home with an amber vial of pills to treat the illness or condition for which they are intended.
But what if your elderly parent or small child can’t tolerate pills? What if you are allergic to an ingredient in the pills? Or what if the pills you need are back-ordered or otherwise unavailable?
The solution to all three quandaries is a compounded medication.
Pharmacy compounding is a small but vital part of the big world of medical treatments and cures. Compounding pharmacies can alleviate the need for workarounds used for a person who cannot tolerate a medication in its manufactured form, such as cutting a tiny pill into even tinier pieces to get a smaller dosage or mixing a medicine with chocolate syrup so your child will swallow it.
Compounding allows prescriptions to be precisely tailored to an individual’s needs. Drugs that are normally in pill form can be turned into liquids, lozenges or creams. Dosages not manufactured by pharmaceutical companies can be made for children or others who need a particular strength that would be otherwise unavailable. And medications that have artificial dyes or binding agents or fillers that cause allergic reactions in some people can be specially made without those inactive ingredients.
The compounding pharmacy is a core component of individualized medicine. And, as in many other areas of health care, it’s rapidly changing. We’ve been involved in compounding pharmacies for more than 40 years, and they’re nearly unrecognizable from how they were in the old days — like when we were in college.
In the last several decades, the practice has gone from a relatively informal one in which a pharmacist calculated the ingredients of a medication by hand on scratch paper and then mixed them up for the patient, to one that’s heavily regulated (by the state and the FDA), uses highly specialized equipment to ensure proper dosages, purity and hygiene and that has layers of checks and record keeping to make sure procedures are properly followed.
Long ago, before the mass production wave that occurred during the middle of the last century, most medications were mixed and provided by the local pharmacist — often called “druggists” in those days. Compounding was routine.
Probably one of most dramatic changes to compounding in recent years, besides the regulations and safeguards, is the technology. It used to be that most of the work was conducted on a tile surface and in beakers — much like those you might remember from your high school chemistry laboratory. Now, professional compounding pharmacies invest in advanced equipment that mechanically mixes and measures ingredients for ointments, spins the components of a medicine, and filters the air in specialized rooms, under equipment called “hoods” to protect the integrity of drugs and the safety of technicians. Staff wear garb that resemble space suits and that ensure all body parts are 100 percent covered.