Cathy Puffer is passionate about compounding. Chances are most of us don’t really know what that means from a pharmaceutical standpoint – it’s just not one of those everyday words.
Yet compounding — the art and science of creating personalized medicine — solves many problems that patients have. And Remedy’sRx is the only pharmacy she knows of in Kawartha Lakes that offers this service.
“We can compound dosages that aren’t commercially available for patients,” Puffer says. “This is helpful in many instances. Patients trying to stop medications often find it easier to wean off rather than stopping suddenly.” She uses anti-depressants as a good example of this.
Remedy’sRx can make the weaning more gradual by personalizing dosages for patients. For instance, SNRIs are a class of antidepressants that are often very difficult for patients to discontinue. One in particular, Cymbalta, is only commercially available in 30 mg and 60 mg capsules which cannot be split.
“We are able to use compounding to help patients come off of medications like Cymbalta by compounding lower strength capsules (i.e. 15, 10, and 5 mg), making the discontinuation more tolerable.”
Another valuable aspect of this technique, Puffer says, is her pharmacy’s ability to help children receive the medications they need. That might mean compounding medications into liquids or other dosage forms to make them easier to administer.
“We are also able to add or modify flavours and textures in cases of autistic children or children with special medication requirements.”
The pharmacy owner says compounding really only exists with a triad of communication between the pharmacist, the physician and the patient.
“It is a very personal area of medicine.”
Compounding pharmacies can also often make medications that have been discontinued. That’s helpful for patients who have success with certain products no longer available. In some cases the pharmacy can also compound medications that are on back order, to prevent therapy interruption due to the manufacturer’s inability to supply the medication quickly enough.
Such pharmacies also can provide dosage forms that aren’t commercially available — liquids when only capsules and tablets are available, or creams for topical application to avoid side effects and drug interactions, capsules that are free of allergens, lollipops and suppositories.
It requires specialized equipment, though, which is a significant investment. Since everything is personalized, the time required to make these prescriptions is significant.
“Most pharmacies don’t have the space and manpower to provide this service,” Puffer says.
The training to successfully offer compounding never ends. “I took a four-day course at the University of Florida when I first started and have continued to update with courses at least every year,” she notes.
Puffer will also send her staff who work in the compounding lab for continuing education courses. Basic compounding courses are required for PharmD students as part of their curriculum at University of Toronto and Waterloo (the only universities in Ontario that offer pharmacy degrees).
All pharmacists will have some knowledge of compounding; however more education is required to be a true compounding pharmacist and operate a compounding lab.
“I maintain a yearly membership with PCCA,” she says, which is a compounding resource that supplies equipment, ingredients, and expertise from a team of qualified international pharmacist and physician consultants.
Puffer says this is actually just using “the roots of pharmacy.”
“This used to be the only way to obtain medications prior to the 1960s and the start of commonly available manufactured medications. I like to think of a compounding pharmacy as the ‘problem solver’ — we can help patients who haven’t been able to get results from manufactured medications.”