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Compounding Pharmacy Services

Compounding Pharmacy Services

Nick, Amcal Coffs Harbour's resident Pharmacist & Compounding Guru, explains it all.

June 2020

What is compounding?

Compounding is the science of combining, altering or mixing ingredients to create a tailored medication solution for the needs of an individual patient.

Why would people need medications compounded?

There are many reasons why compounding pharmacies can help our patients, such as:

  • Allergies & intolerances to diluents/excipients in commercial products:   A diluent/excipient is a technical term for the extra 'non-active' ingredient in medication preparation.  These are often used to 'bulk-out', stabilise or create uniformity in medication.  If you had to make a 1mg  tablet only using the active ingredient, the tablet would be smaller than a grain of sand, which is not very practical. Hence medication is bulked-up, stabilised with a range of non-active products.  These can include tiny traces of compounds such as lactose, gluten and preservatives.  If you are severely lactose intolerant and all the commercially available brands of your prescribed medication contain lactose, then you need another option, compounding may be your solution.

  • If you are unable to take a dosage form or to make the medication more palatable: Tablets can be turned into liquids, distinctive flavours can be added, thickeners can be used for people with swallowing difficulties.  Changing the dosage form is especially useful for children, as some prescribed medication may only be readily available in the 'adult' dose form, which may be a large tablet or capsule.  A child may not be easily able to swallow a tablet or capsule, leading to poor medication adherence, or an unhappy child in unnecessary discomfort

  • Unique strengths and forms:  While there are thousands of commercially available medication forms, they are not always suited for your individual needs. For example, if you need a 20mg dose of a medication that is only available in a 1mg dose, you will have to take 20 tablets.  Twenty tablets are not only impractical but can also be quite expensive, not to mention the potential side-effects of consuming large quantities of diluents/excipients that are designed to be safe when taken in normal amounts.  On the other hand, if a medication is prescribed at 1mg, and only readily available in a 20mg form, then it is not at all practical to accurately split 1/20th of a tablet.  Again, this is where compounding pharmacy products may be a solution.

  • The prescribed product is commercially unavailable:  There are many reasons why your medications may be unavailable.  See our popular article on five reasons why your medicine is out of stock.  These can include insufficient allocation in the global supply chain, shortage of raw materials, manufacturers choosing to sell to other counties before Australia and stock hoarding from customers and pharmacy chains. In some cases where a commercial product has been discontinued or is projected to be out of stock long term, the raw ingredients may still be available, and the medication may be produced at a compounding pharmacy. 

What compounding does Amcal Coffs Harbour specialise?

  • Bio-Identical natural hormones: these are medications which are 'compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body'.  These can include specific progesterone and thyroid hormone preparations, which may require tailored dosing to suit an individual's requirements.  These products are often unavailable in the regular commercially made formulations. 

  • Sleep Improvement medication; such as compounded Melatonin: Melatonin is a hormone naturally released by your body at night to assist with the regulation of sleep cycles (circadian rhythms).  It is often prescribed to adults and children with sleeping difficulties.  There are very few commercially available preparations of Melatonin.

  • Pediatrics (children's medicine); such as omeprazole suspension, which is often used to treat infant heartburn and reflux.  Omeprazole is readily available in adult strengths but can be complicated to stabilise in diluted preparations.  Specially compounded omeprazole can be created in simple doses form, such as flavoured solutions with stable shelf lives, making the medication more palatable and practical, and much easier for the parents!

  • Neuropathic pain (nerve pain); such as P.E.A. (Palmitoylethanolamide) and Amitriptyline cream. P.E.A. (Palmitoylethanolamide) is a compounded treatment option for chronic pain, recommended by pain specialists and clinics throughout Australia. At present, there few TGA approved available preparations containing this medication.  Amitrypltine cream is another compounded medication can work like an anaesthetic to decrease nerve pain.  A locally applied preparation of Amitriptyline cream will often have less systemic absorption, and therefore fewer side effects than an oral alternative.

  • Dermatologically (specialist skin medication); such as Tacrolimus, which an immuno-suppressant used in some conditions such as psoriasis, dermatitis and other autoimmune skin conditions.  Corticosteroid based creams (often known as 'steroid creams') are used for inflammatory skin conditions, which are frequently mixed into a range of tailored preparations prescribed by General Practitioners and Dermatologists.

  • High-dose prescribed vitamins; such as compounded Vitamin D, which controls calcium levels and is often used to support bone strength, muscles and overall health.  While Vitamin D is produced by the skin when in contact with sunlight, many adults in Australia are deficient in Vitamin D. Over-the-counter preparations of Vitamin D frequently contain 1,000IU per capsule. In contrast, commonly prescribed doses may be 25,000IU per capsule, and require compounding.

  • Women's' health; such as Boric acid pessaries, which are often used for certain treatment-resistant gynecological conditions

  • Many other formulations and customised medicine solutions are available upon request. If you have a product which requires compounding or have any questions on compounding, feel free to reach out and contact us.

What equipment is needed to compound? 

  • Powder Hood; this is a positive pressure workstation to keep air to a single space to avoid cross-contamination and ensure the safety of our technicians. The Powder hood is equipped with a HEPA filter to trap dispersed powders and prevent airborne contamination.

  • Electronic balances and scales, capable of weighing down to 1mg (which is 1/1000th of a gram; the size of a grain of sand!). The correct weight is essential in compounding. Our scales are regularly calibrated following industry regulations.

  • Hot plate mixers; which ensure even temperature, consistency and uniformity of medication distribution.  Capsule machines, mixing equipment, glassware, the list goes on.

  • All of our raw materials are sourced from the Therapeutic Goods Administration (TGA) Approved pharmaceutical wholesalers.

Some of our compounding equipment in Amcal Coffs Harbour

Can any pharmacist compound, or is there specialised training?

Any registered pharmacist in Australia can compound 'simple' preparations, such as olive oil and glycerine in sorbolene cream. However, only registered pharmacists who have completed specialist training with an approved education body, such as Medisca, can legally compound 'complex' preparations in Australia.  The training involves months of diving deep into pharmaceutical theory and a multi-day intensive hands-on practical course. Becoming a compounding pharmacist is not something for the faint-hearted! A pharmacist is also only legally allowed to compound 'complex' preparations when the pharmacy has the required equipment mentioned above. 

Why does Nick, Amcal Coffs Harbour's resident Pharmacist and Compounding Guru, love compounding?

I love the ability to create a personalised medication to help people's needs.  Compounding takes you back to the 'old days' of pharmacy, but in a new and wholly modernised fashion. Old meets new, contemporary nostalgia.  The challenge is great, I can help people while playing with some fancy toys!

For more information on our compounding services, feel free to contact us, we are here to help.