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The Lost Art

The practice of pharmacy is defined in part by the capacity to prepare medications for patients. This practice of customizing medications for individual patient needs is called compounding. As late as the 1930's, roughly half of all prescriptions were compounded, but during the 1950's and 1960's compounding declined as drug manufacturers offered more and more products in standard commercial forms. Today, studies suggest that approximately 5% of patients' true medical needs cannot be met by mass-marketed, mass-produced commercially available prescription products. These unmet patient needs are the driving force behind the resurgence of prescription compounding

For drug manufacturers, and ultimately patients, it costs millions of dollars to get a single drug approved. The significant costs involved limit the chemical forms, dosage forms, strengths, flavors, delivery systems, and packaging that are available for physicians to prescribe. Often the physician can offer more appropriate therapy for a given patient by custom tailoring a drug, dose, or delivery system specifically for that patient's needs.

One of the important reasons to use a compounded medication is limited patient tolerance of a commercial product. Many patients are allergic to preservatives or dyes, may be too sensitive to the effects of a needed drug, or may find side effects unpleasant. Through prescription compounding the physician can change the strength, request dye-free or preservative-free forms, or change the route of delivery to eliminate side effects.

Compounding allows physicians and pharmacists to collaborate in solving problems for patients in any given area of drug therapy. Drug products that are no longer manufactured due to limited demand are often available in a pure drug form that the pharmacist can prepare to order. Transdermal, or through the skin delivery, provides a mechanism to avoid gastrointestinal side effects of drugs such as medications for arthritis. Children or adults with difficulty swallowing may need access to drugs that are commercially prepared only in tablet form but could be compounded in a flavored liquid.

If you still think of a mortar and pestle as just a symbol of pharmacy, stop in a modern compounding pharmacy. You'll find advances in chemistry and technology that allow compounded medications even in forms that aren't available at all commercially, and yes, we still use that mortar and pestle, little changed for hundreds of years. And the next time you struggle to get that yucky medication down, remember- your compounding pharmacist may have a flavor just for you!