Q: What is Compounding?

A: Pharmacy compounding is the art and science of preparing customized medications for patients. Its practice dates back to the origins of pharmacy; yet, compounding's presence throughout the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. With the advent of drug manufacturing in the 1950s and 60s, compounding rapidly declined. The pharmacist's role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms. Within the last two decades, though, compounding has experienced a resurgence, as modern technology and innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs. Today, an estimated one percent of all prescriptions are compounded daily by pharmacists working closely with physicians and their patients.

Q: How does compounding benefit me?

A: There are several reasons why pharmacists compound prescription medications. The most important one is what the medical community calls "patient non-compliance." Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's consent, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, or add flavor to it to make it more palatable. The pharmacist also can prepare the medication using several unique delivery systems, such as a sublingual troche or lozenge, a lollipop, or a transdermal gel. Or, for those patients who are having a difficult time swallowing a capsule, a compounding pharmacist can make a suspension instead.

Q: Can my child (or my elderly parent) take compounded medication?

A: Yes. Children and the elderly are often the types of patients who benefit most from compounding. Often, parents have a tough time getting their children to take medicine because of the taste. A compounding pharmacist can work directly with the physician and the patient to select a flavoring agent, such as vanilla butternut or tutti frutti, that provides both an appropriate match for the medication's properties and the patient's taste preferences. Compounding pharmacists also have helped patients who are experiencing chronic pain. For example, some arthritic patients cannot take certain medications due to gastrointestinal side effects. Working with their physician, a compounding pharmacist can provide them with a topical preparation with the anti-inflammatory or analgesic their doctor has prescribed for them. Compounded prescriptions often are used for pain management in hospice care.

Q: What kinds of prescriptions can be compounded?

A: 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 transdermal sticks. Compounding applications can include: Bio-identical Hormone Replacement Therapy, Veterinary, Hospice, Pediatric, Ophthalmic, Dental, Otic, Dermatology, Medication Flavoring, Chronic Pain Management, Neuropathies, Sports Medicine, Infertility, Wound Therapy, Podiatry and Gastroenterology.

Q: Will my insurance cover compounded medications?

A: Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy. However, almost every insurance plan allows for the patient to be reimbursed by sending in claims forms. While you may be paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost.

Q: Is compounding expensive?

A: Compounding may or may not cost more than a conventional medication. Its cost depends on the type of dosage form and equipment required, plus the time spent researching and preparing the medication. Fortunately, compounding pharmacists have access to pure-grade quality chemicals which dramatically lower overall costs and allow them to be very competitive with commercially manufactured products.

Q: Is compounding legal? Is it safe?

A: Compounding has been part of healthcare since the origins of pharmacy, and is used widely today in all areas of the industry, from hospitals to nuclear medicine. Over the last decade, compounding's resurgence has largely benefited from advances in technology, quality control and research methodology. The Food and Drug Administration has stated that compounded prescriptions are both ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. In addition, compounding is regulated by state boards of pharmacy.

Q: Does my doctor know about compounding?

A: 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, then get in touch with a compounding pharmacy - one that is committed to providing high-quality compounded medications in the dosage form and strength prescribed by the physician. Through the triad relationship of patient, physician and pharmacist, all three can work together to solve unique medical problems.

Q: Is custom compounding right for you?

A: Ask your physician or pharmacist today about the benefits of personalized prescription compounding.

Q: What are natural bioidentical hormones?

A: Natural bioidentical hormones are hormones that are derived from natural plant material, like soybeans, or in the case of progesterone, from plant sources such as yam. Although the bioidentical hormones are referred to as "natural," you cannot ingest the plant and get the same results as you would from Natural Bioidentical Hormones Therapy. The phytoestrogens found in these natural plant sources are converted in a laboratory to the hormones identical to the ones produced by the body. Our bodies do not contain the enzymes required to convert the them to bioidentical hormones, so if one ingested the plant, there would be no effect because the body could not convert it to hormones.

Natural sex hormones such as progesterone, testosterone, estrone, estradiol, and estriol are used in pre-menstrual syndrome, peri-menopause, and post-menopause in women to lessen the effects of the declines that these hormones experience in the mature years of life. They are prescribed as replacement quantities, usually based on levels acquired through saliva or blood testing. Testosterone is often used for the purpose of enhancing libido in women. It is also used to enhance bone growth. They are also used in men for the same purposes as well as others symptoms associated with andropause, which is like menopause in males.

Q: What does compounding bioidentical hormones mean?

A: Pharmacy compounding is the art and science of preparing customized medications for individual patient needs.

The science of compounding bioidentical hormones addresses many problems faced by healthcare providers, and assists in meeting specific patient needs. Many patients are allergic to preservatives or dyes in standard drugs, or are lactose intolerant. A compounding pharmacist can compound bioidentical hormones and other medications that are free of preservatives, dyes, and lactose. Other patients may have a difficult time taking medications in their available form. Another benefit of compounding bioidentical hormones and other medications is the ability to change the strength, dosage form, or flavor of the commercially available drug, making it easier to take. Whether a different strength, altered dosage form, or more palatable flavor is needed, compounding bioidentical hormones can be the solution to many patients' needs.

Q: What is Natural Bioidentical Hormones Therapy?

A: Natural Bioidentical Hormone Replacement Therapy is the replacement of hormones that are normally produced by the body with natural hormones that are biologically identical in chemical structure and function. Only natural hormones that exactly match those produced by the body will have the same effects in hormone therapy. Commercially available synthetic hormones, such as conjugated pregnant mare urine, do not produce the same desirable effects in hormones therapy as the body’s own natural hormones, and may produce increased negative side effects and risks.

Natural bioidentical hormones for therapy are available in a variety of dosage forms including capsules, topical or vaginal creams, gels, troches, or suppositories. Generally, those forms that are applied to the skin do not undergo a process called first pass metabolism by the liver like the forms that are swallowed. Lozenges that are placed in the cheek or under the tongue also bypass this process. Troches and lozenges can also be flavored to individual preference to make natural bioidentical hormones therapy pleasant to take.

Q: How soon does BHRT work?

A: Provided you have had the necessary blood (or preferably) saliva tests, and the BHRT has been formulated accordingly, you should notice a difference within to three to four days. However, each person's response is slightly different and in many instances the initial formula may have to be changed by your doctor once or twice during the initial two or three months until a suitable balance is achieved. Patience and perseverance are required to achieve the desired result and the advantage of BHRT is the ability of the doctor and Compounding Pharmacist to make a prescription specifically for you, rather than use a ready prepared synthetic preparation with a fixed formulation.

Q: Which hormones are used in BHRT?

>A: Progesterone, Tri-est (Oestriol, Oestrone and Oestradiol combination), Testosterone, DHEA, Pregnenolone, Melatonin, Desiccated Thyroid Extract, T3 & T4 are the main hormones used and the quantities can be varied according to each patient's requirements.

Q: Is BHRT safe?

A: Long term use of any form of HRT is not recommended. Work still needs to be done using BHRT in human trials to fully validate its usage in the eyes of every member of the medical profession, however its use in the world over the past 10 to 15 years has created large and positive anecdotal base.

There are however, a number of doctors who have prescribed BHRT over many years and have fortunately written about it.

Dr John Lee's book "What Your Doctor May Not Tell You About Breast Cancer" and Sandra Cabot's "Hormone Replacement The Real Truth" cover this question most adequately.

Q: What forms of BHRT Medication are available, and which should I use?

A: Transdermal (Creams, Gels, Pessaries)
Creams and to a lesser extent gels, offer a pleasant, non-invasive way of getting BHRT hormones into the body. Most are absorbed quickly onto the surface of red blood cells and liberated within one or two seconds where they attach to target cells (breast, uterus etc.) quickly. In the case of Progesterone, transdermal absorption may be ten times as great as oral.

Oral (Capsules)
When hormones are ingested by mouth they are subject to "the first pass effect" which refers initially to the break down by the gut. Often the hormones may be rendered useless by the action of gut and liver enzymes as they pass through and/or may become quickly protein bound and unable to be released at the target site. The main advantage of using capsules is one of convenience but it is important to formulate capsules for those hormones which don't suffer unduly from this effect (eg DHEA, 7-Keto DHEA, Melatonin, T3, T4.)

Buccal (Sub-lingual Drops, Troches)
As there are many blood capillaries and veins close the surface of the mouth, it is possible to have direct absorption into the bloodstream, thus bypassing the First Pass Effect. This is called Buccal Absorption. Troches have become very popular for this reason while sub-lingual drops allow hormones which require very small doses to be administered. Troches and Sub-lingual Drops are usually flavoured.

Vaginal (Creams & Pessaries)
Vaginal creams & pessaries are often made for women who dislike the taste of trouches. Generally, the dose required by this route is similar to troches although this may vary depending on the hormone.

Q: What flavours do you have for Troches and Sub-lingual Drops?

A:

Q: Blood Test or Saliva Test - Which is better?

A: Unfortunately, many doctors only use blood (serum) tests to assess hormone levels and are unfamiliar with the protocol for saliva testing.

Most hormones in the body are protein bound (approx. 90%) and not freely available to target tissues. Serum test results include this bound portion as well as the unbound and consequently don’t give a true picture of the amount of freely available hormone.

Saliva tests measure only the freely available unbound portion of hormone and thus enable a more accurate picture to be obtained.

Saliva hormone testing can be used to guide supplementation, to determine if an oral hormone supplement such as DHEA is being absorbed, and if the dosage is appropriate as bioavailability of oral hormonal supplements can vary widely. The saliva test can also help you evaluate if estrogens are well balanced with progesterone following supplementation with progesterone cream. Too much estrogen, relative to progesterone, leads to excessive tissue proliferation, whereas too much progesterone in the absence of adequate estrogen can exacerbate estrogen deficiency problems.

Extensive study using saliva tests over the last 20 to 30 years has been done on Oestradiol, Oestrone, Oestriol, DHEA, Progesterone, Testosterone and Cortisol.

Please contact us for information on how to obtain a Saliva Test.

Q: What Sweetener do you use? Does it cause Dental Problems?

A: We use Stevia mainly as it is from a plant source and has insignificant calorific value. The only potential Dental problem may occur with people who have very acidic saliva and who choose a flavour which is also acidic and adds to the problem.