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What is Compounding?

Compounding pharmacy is the art and science of creating customized medicine for each patient. Compounding is a specialized skill with the potential to help many patients who could benefit from a more personalized medication. Pharmacists who specialize in compounding listen to their patient, discuss the unique situation with the prescribers, then formulate the medication for that patient. Done correctly, the formulation process itself utilizes:

  • the knowledge and education of the pharmacist
  • the highest-quality chemicals available
  • technologically-advanced equipment in a laboratory dedicated to compounding
  • rigorous quality control and quality assurance measures.

Perhaps the most important element in this equation is the compounding pharmacist’s ability and willingness to make personalized patient care the priority. The purpose of a compounded prescription is to maximize a patient’s ability to use the medication and, therefore, gain maximum benefits of that medication. It may be as simple as flavoring a medicine to the patient’s liking. It may involve creating a dosage form that is easier to give to a child or a pet. Perhaps a patient needs a specific dose of medicine or a combination of medicines that isn’t commercially available. Or, a patient may need a customized medication created to treat individual symptoms. These instances and many more are examples of compounding pharmacy.

The History of Compounding
Compounding is truly the original definition of pharmacy. Throughout the history of mankind, patients have relied on medication made “from scratch” to feel well. In many cultures over many centuries, the responsibility of making medicine has been exclusively held by people with specific talents and training. As societies progressed throughout the 15th century, it was the Apothecary who was the sole source of medication: patients and their prescribers relied on the pharmacist to create each prescription using his scientific and pharmaceutical education. This trend continued, remaining an essential component of healthcare. In the 1950s and 1960s, as bulk-manufactured medications became more available, pharmacists and patients alike enjoyed a new ease in getting and taking medication. However, there are always circumstances in which the cookie-cutter medicines from manufacturers don’t produce the intended results, and in those cases, compounded prescriptions continue to assist patients.

The Modern Equipment of Compounding
Like most areas of health care, pharmacy has seen tremendous advances in the medicines, tools, and methods used to help patients achieve optimal health. The fine techniques of compounding have also evolved and continue to offer unique options to patients who need personalized care. Compounders of the 21st century rely on the basic scientific concepts perfected by the first Apothecaries. However, new tools are utilized to create Contemporary Compounded Dosage Forms with an emphasis on the highest level of quality, safety, and accuracy.

The pieces of advanced equipment described here, along with many others, are utilized daily at Atlantic Pharmacy and Compounding.

The mortar and pestle, pictured at right, is still an essential tool in the compounding lab. Used to crush tablets and mix ingredients, the mortar and pestle are often viewed as the icon of pharmacy practice. An alternative to the traditional mortar and pestle is an Electronic Mortar and Pestle, or EMP.
The EMP is useful in creating even blends of ingredients in an efficient and safe method. When powders are added into a cream, gel, or lotion, or when such topical applications are mixed together, the compounder can use an ointment slab and spatula, a traditional mortar and pestle (seen above) or even the EMP.

Once mixed, placing the preparation in an ointment mill (pictured at left) will decrease the particle size of the powders, making the preparation more pharmaceutically elegant and easier to apply. Compounded dosage forms frequently start in powder-form, and it is of utmost importance that any powders be scrupulously contained to prevent cross-contamination and inadvertent absorption of the drug by anyone in the pharmacy.

Powder containment hoods prevent any loose powder from escaping into the air, trapping it in a HEPA filter for safe, appropriate disposal. These HEPA filters, designed specifically for laboratory use, trap the smallest of particles, much smaller than the naked eye can see. This allows the compounders to safely formulate medicines that will not contain any unwanted ingredients.

A capsule machine allows the trained compounder to utilize the familiar form of capsules to make a personalized dosage that is consistent from one dose to the next. This tool allows the compounder to formulate specific combinations and exact doses of medicines without any extra chemicals that may cause allergies or other adverse effects.

Some medications are administered to patients in a manner that requires them to be sterile, such as injectable medications or ophthalmic (eye) applications. Sterile preparations MUST be created by trained compounders in a specific, dedicated space that meets strict environmental standards set by the United States Pharmacopeia (USP) and state board of pharmacy. Rigorous cleaning procedures, environmental monitoring, and product testing are crucial and strictly adhered to at Atlantic Pharmacy and Compounding.

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