Compounding Pharmacy
When you see your doctor for any illness, your last stop is the pharmacy. It has a staff of pharmacists to fill your prescription exactly as the doctor ordered it. This is an important step in treating any illness, and many people help with it. Technicians process the prescription, thereby allowing the pharmacist to monitor therapy and check for accuracy in patient treatment. Clerks and stock personnel keep the flow of people and medicine going smoothly. A modern pharmacy has an integrated computer system with an up-to-date drug-interaction monitoring system. Pharmacies have an inventory of all the commonly used medications in stock and can restock these supplies daily as patients need them.
How Compounding Pharmacies differ from Traditional Pharmacies
For patients with fibromyalgia, compounding pharmacies play a different role than conventional pharmacies do. They offer dosage forms unavailable from commercial pharmacy manufacturers. They also offer unique medications not produced for nationwide distribution. Compound pharmacists have more training, equipment, and knowledge than traditional pharmacists do. A traditional pharmacist may compound medications occasionally, but a compound pharmacist compounds unique dosage forms of capsules, creams, suppositories, and liquids daily.
A compound pharmacy has thousands of dollars invested in special equipment like capsule-making machines, extremely sensitive scales to can measure milligram doses accurately, ventilating hoods for safety, mills to reduce particle size, and mixing devices.
Medication-Unique Delivery Systems
Doctors treat fibromyalgia with many different products. Due to manufacturing techniques and limited availability of the bulk products, some can be obtained only in a compound pharmacy.
Some types of medications that we can make in a compounding pharmacy are transdermal gels, capsules (in both immediate - and sustained - release versions), suppositories, and oral troches. There are different reasons for using each, and all effectively deliver the right medication to the patient.
Transdermal Gels
Transdermal gels are useful for patients who have a hard time taking oral medications and for those who must medicate a specific body site. For example, you might use a transdermal gel if non-steroidal anti-inflammatory medications (NSAIDs) upset your stomach or if they might irritate a gastric ulcer.
Capsules
In a compound pharmacy we can customize capsules to suit a patient's needs. Doing so may limit side effects and get best results by bypassing the set dosages in some commercial products. We can also make medications that aren't commercially available. And we can make them available in sustained-release preparations for long-term results.
Troche forms
Troche dosage forms are for dissolving in the mouth, where the bloodstream absorbs the medications in them. The effect is immediate, so troche dosage forms are for people who need the medication to take immediate effect. They can also be (a) an alternative to an injection in acute episodes and (b) a way to avoid destruction of medications in the acidic environment of the stomach.
Suppositories
Suppositories are for dissolving in the rectum, where the bloodstream absorbs the medications in them. Again, the effect is immediate. Although the anal route isn't a preferred administration route in the United States, suppositories are an alternative to troche dosage forms for some medications when the oral route isn't an option.
In all these dosage forms a compound pharmacy can make the exact dose in the right form for that particular patient.
Medications Specifically for Fibromyalgia
Dehydroepiandosterone (dhea) is a hormone thought to lessen fatigue in fibromyalgia patients. Dhea levels fall with increasing age in the general population and are low in fibromyalgia patients. Dhea increases energy in patients with low levels of it. Unfortunately, the over-the-counter versions of dhea in most pharmacies can vary in strength by up to 10 percent from lot to lot. Compound pharmacies insure a consistently high level of dhea by using a higher pharmaceutical grade of dhea.
Ketoprofen is an anti-inflammatory medication many doctors use for fibromyalgia muscle pain. The most common way to administer ketoprofen is in a transdermal gel applied directly to the sore spot. This is a two-phase gel that opens the pores and allows the ketoprofen to be carried to the ailing muscle and connective tissue. We can add other medications to increase the treatment's effectivenesse. For example, we can add other anti-inflammatory medications like diclofenac (Voltaren), ibuprofen, and piroxicam (Feldene). To fight the painful burning sensation some people experience, we can add topical anesthetics like lidocaine and tetracaine. To fight muscle spasms we can add skeletal-muscle relaxers like cyclobenzeprine (Flexeril) and baclofen (Lioresal). Other agents found to give fibromyalgia relief include gabapentin (Neurontin), orphenadrine (Norflex), amitriptyline (Elavil), and pentoxifylline (Trental). Doctors find that combinations of these and other agents give local pain relief. To get such complex prescriptions filled, you need to visit a compounding pharmacy.
And so, compounding pharmacies are an alternative to conventional pharmacies. They're on the cutting edge of fibromyalgia treatment, continually adapting to the ever-changing practice of medicine.
Jeff Bennett., R. Ph.
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