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Compounding FAQ

What is compound base?

PCCA offers more than 60 high-quality proprietary bases, from leading topical and transdermal technologies to unique oral and nebulization preparations. We bring the brightest minds and the best equipment together to create bases with industry-tested chemical compatibility and superior emulsions.

For a complete overview of PCCA’s bases, please call a Customer Service representative at 800.331.2498.

PCCA Top Bases

Listed in alphabetical order.

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What is Alternative Medication?
Benefits of Compounding

Benefits of Compounding

 Compounding allows a medication to be personalized for an individual patient. The ability to create these personalized medications allows compounding pharmacists to help patients with a wide variety of needs.

Compounding Pharmacists Make Medication That Is Difficult to Find or Discontinued

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Sometimes a large pharmaceutical manufacturer discontinues a medication. Often this happens because not enough patients are taking the drug, so it is unprofitable to keep mass-producing it. But what about the patients who still need that drug? Hundreds or even thousands of patients still may need that medication.

A compounding pharmacist can re-create that medication by compounding it, so even if only one person in the world still needs that medication, they can have it thanks to compounding!

Compounding Pharmacists Make Medication Allergy-Friendly

  • Lactose
  • Preservatives
  • Dyes
  • Gluten
  • Sugar

A patient may be allergic to or intolerant of an ingredient commonly found in the commercially manufactured form of a medication.
Ingredients that may be allergy-inducing include:

A compounding pharmacist can create a personalized medication, formulated to give the patient the treatment they need while leaving out the problematic ingredient.

Compounding Pharmacists Make Medication Easier to Use

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Some medications have a very unpleasant flavor, which makes the patient less likely to take it as directed. A compounding pharmacist can flavor many medications to make it more palatable without compromising the medication’s effectiveness. This is especially handy when dealing with medications for patients who may refuse medication, such as young children, elderly patients, or even pets!

A patient may need their medication in a different dosage form. For instance, patients who have difficulty swallowing a pill may find it easier to take their medication in a pleasantly flavored liquid form. Some medications can be compounded in a topical form such as a cream or a gel that allows the medicine to be absorbed into the bloodstream through the skin.

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What is Flavor Compounding?

Flavor Compounding

Making medication taste better

One of the greatest challenges in prescription medication is a simple fact: some patients just don’t like taking medicine. From a child who can’t stand the taste of a cough syrup to a cat who absolutely refuses to take an antibiotic, taking medicine rarely is a pleasurable experience.

It doesn’t have to be that way. Each patient is unique, with certain likes and dislikes. Others have difficulty swallowing a pill, and might respond better if the pill were compounded into a liquid suspension instead. A distinctive solution to these issues is a flavored medicine. Medicine doesn’t have to taste bad.

Adults & Children

A prime advantage of compounding is its ability to customize medication. What’s the easiest way to customize it? Flavor! Compounding pharmacists have access to many flavors and flavor combinations which can enhance the taste and color of a medication to make it easier to swallow.

A child who has difficulty taking a prescription because of the taste is a prime candidate. He or she won’t mind taking medication that tastes like bubblegum, watermelon, or even chocolate. Most PCCA flavors are sugar-free and some are even dye-free, which benefits patients who are sensitive or allergic. And working closely with a physician, your compounding pharmacist can even change the form of the medication. What if a child’s medicine came in the form of a lollipop or a gummy treat?

Many adults also may benefit from flavored medication. As people age or battle a chronic illness, taste preferences can change. Often, sweet flavors can become unbearable, or bitter flavors may cause nausea. In these instances, your compounding pharmacist can alter or mask certain flavors in order to make medicine more palatable – without changing the strength or effectiveness of the medicine itself. When reflavoring antibiotics, for instance, careful consideration is given to the measurement of pH in order to maintain the medicine’s stability. Whether you prefer a distinct flavor – or no flavor at all – compounded medications may be of benefit to you.

Animals

Cats, dogs, exotic pets and even zoo animals also are prime candidates for flavored medication. Cats don’t like pills, but they do like fish. Dogs may not appreciate a squirt of traditional medication into their mouths, but they’ll gladly take it if it tastes like chicken.

Working closely with a pet owner and a veterinarian, a compounding pharmacist can custom-flavor a medication to fit the tastes and preferences of any kinds of animal. There are beef, cheese, chicken and liver flavors for dogs; fish for cats. Horses prefer alfalfa, cherry, apple, carrot and molasses. Even birds, rodents and reptiles have flavor preferences that can be met by a compounding pharmacist.

Like humans, some animals may require alternate medication forms such as pastes, custards, or traditional pet biscuits and treats. Cats are notorious for eating right around a pill disguised in food, but the right combination of flavor and appearance can take struggle out of medicating your pets. Click here for more information on veterinary compounding.

Do you have a flavoring challenge that could be solved through compounding? Ask your prescriber or compounding pharmacist about custom flavoring.

What is Anti-Aging / Cosmeceutical Compounding?

You may be getting older, but your skin doesn’t have to show it.

Cosmeceuticals: a custom antidote for aging skin

There are many desirable aspects of growing older. Longevity brings with it experience, wisdom and maturity. But the physical signs of this maturity are much less enthusiastically met – the loss of elasticity, the age spots, and the crows’ feet, laugh lines, and other wrinkles that are inevitable as the skin begins to age.

Cosmeceuticals – Rejuvenating Aging Skin

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Though the aging of skin can’t be halted, in many cases it can be slowed down. Recent biotech research has identified many of the factors that cause the wrinkling and loss of elasticity that come with age. These factors include:

  • Damage from sun, cold, or wind
  • Stress
  • Smoking
  • Fatigue
  • Poor nutrition
  • Environmental irritants such as years of harsh makeup, soaps, or detergents.

Over the years, these assaults on the skin lead it to show signs of aging.

It’s impossible to avoid coming into contact with many of these skin-devastating factors on a regular basis. Everyone has been exposed to the sun at some point. All of us have experienced stress and fatigue. While we can’t turn back the clock, we can begin to protect against further damage, and even rejuvenate skin that already has begun to age. How? Through innovative cosmeceutical products.

Solutions for Every Skin Type

Just as every face has its own distinctive features, every person has his or her own skin type. Your compounding pharmacist can customize a therapy of cosmeceutical creams especially for your needs, which can help your skin appear younger and healthier.

The results are both short- and long-term. Cosmeceutical products provide cosmetic results by using scientific research and pharmaceutical-grade ingredients to improve the appearance of skin. Custom-prepared cosmeceutical creams can soothe and diminish the appearance of skin irritations, rashes, redness and inflammation. They also may be useful for soothing dry, cracked skin, improving moisturization, and treating blemishes and problem areas. Most importantly, they begin to protect your skin from the harmful, external forces of aging.

Younger-looking Skin

Through cosmeceuticals, your skin can begin to look and feel like it did five, ten, or even fifteen years ago – moist, smooth, protected, and with reduced appearance of wrinkles. Many commercial creams and lotions may claim to offer the same results, but why use a mass-produced product when you can use one that has been custom-prepared to meet your exact needs?

What is Sports Medicine Compounding?

Make sure your active, healthy lifestyle stays that way.

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Running backs for pro football teams rely upon topical compounds to help them recover from game aches. Major league pitchers recover from inflammation to the throwing shoulder more quickly due to topical agents prepared by compounding pharmacists working in conjunction with team healthcare providers. The secret they use to get back in the game is pharmacy compounding, and it’s available for everyone – not just the pros.

Whether you’re a workout enthusiast who needs to soothe aches and strains, a high school player recovering from a sports injury, or a weekend warrior trying to ease pain during the work week, compounding can provide serious benefits for every kind of athlete.

Sports medicine compounding – the best way to get back in the game.

Unique Athletes, Individual Medication

Pharmacy compounding is the art and science of preparing customized medications for patients. In recent years, compounding has experienced a renaissance as modern technology and innovative techniques and research allow many healthcare providers to work with pharmacists to customize medications to provide their patients with the benefit of medications tailored specifically for certain needs.

Sports activities and fitness programs focus upon an athlete’s strengths and are customized to meet his or her individual needs. So why not do the same with medication needs?

  • A compounding pharmacist may be able to combine various drugs into a single dosage form to combat nerve pain, customize topical antifungal medications, or formulate special preparations to heal blisters or calluses.
  • Compounded sun block creams, lotions, and lip balms may help protect athletes participating in outdoor sports.

Working closely with both the athlete and a healthcare provider, compounding allows pharmacists to prepare medication in strengths and delivery systems that are just right for that particular athlete’s body, for the ultimate in therapy.

Strength Variations

Just like a football player and a marathon runner require different training programs, their body types may require different amounts of medication to speed recovery or treat muscle pain. Yet commercially available products often come in a limited variety of strengths. Compounding offers a way to calibrate the exact amount of medication to a certain need and body type, resulting in more accurate dosing.

Unique Dosage Forms

Another important benefit is the compounding pharmacist’s ability to alter the delivery system of medications. Capsules and tablets taken orally must pass through a patient’s digestive tract before making their way into the system. For anti-inflammatories, muscle relaxants and other medications, this can result in gastrointestinal side effects. Topical medications allow the drug to bypass the gastrointestinal tract and potentially minimize those side effects. A compounding pharmacist can prepare custom topical creams, transdermal gels or solutions that may not be commercially available. By treating the pain at its trigger point, relief and recovery can be strengthened.

Personalized prescription compounding may be just what you need to get back in action!

What is Pediatric Compounding?

Do You Want a Better Way to Give Your Child Medicine?

It’s no secret that most kids don’t like taking medicine. There’s nothing fun about being sick, and taking medicine just seems to make it worse. But it doesn’t have to be that way. While there’s no guarantee that taking medicine ever will become an entirely pleasurable event, there are some ways to help.

One of the best involves contemporary pharmacy compounding, the art and science of preparing customized medications for patients. From flavoring medications to make them taste better, to providing individualized strengths and dosage forms, a compounding pharmacist can help make medication time easier and less stressful for your child – and you!

Pediatric compounding – more effective than a spoonful of sugar.

Children are especially suited for custom compounded prescriptions. For various reasons, commercially manufactured drug forms sometimes may not meet the needs of every child. Compounding can benefit young patients in a variety of ways.

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Working closely with a compounding pharmacist, your child’s pediatrician can prescribe medications for:

  • Pain relief
  • Respiratory disorders
  • Oral thrush
  • Diabetes
  • Head lice
  • Diaper rash
  • Skin disorders
  • Cold sores/fever blisters
  • And much more!

Flavored Medicine

Many children refuse medication because of its texture or color, or simply because they know it is medicine. The child who refuses to take his or her medicine because of the taste is a prime candidate for compounded medication.

Many medications can be transformed into colorful, pleasantly flavored dosage forms, which are dispensed in childproof packaging. Dozens of enticing flavors are available to compounding pharmacists, who can enhance the taste and color of a medication without changing the medication’s effectiveness.

Unique Dosage Forms

Many children have a very difficult time swallowing capsules or tablets, especially if they have to take more than one medication during the day. To solve this problem, your pediatrician and compounding pharmacist can develop and prepare medications in alternate dosage forms your child won’t mind taking. These include:

  • Oral liquids
  • Lollipops
  • Gummy treats
  • Topical gels
  • Effervescent drinks

Some compounded medications can be administered using special pacifiers or bottles for infants – and most can be administered in any number of great flavors.

Strength and Ingredient Variations

Each child is unique. Children differ in size and individual needs. Some have allergies and varying drug tolerances, requiring medications which are sugar-freegluten-freecasein-freesoy-free, or dye-free. As a result, can be a challenge to find a commercially available medication suitable for your child’s individual needs. A compounding pharmacist working closely with a caring pediatrician can formulate a medication which meets all the child’s requirements.

Autism

Children affected by autism often have unique physical or psychological challenges that can be exacerbated by ingredients found in food and medicine – for instance casein, soy, sugars, gluten, dyes, carbohydrates, and heavy metals (such as aluminum). Parents must manage their child’s unique dietary restrictions, including the ingredients in the medications they take.

Because each child’s body has its own unique needs, commercially available medications sometimes may not provide the appropriate dosage form or ingredients needed. For these children, compounded medications are a critical tool.

PCCA Pharmacy Consultant Tricia Heitman, PharmD, explained, “Most compounded medications for children with autism are for younger kids who can be especially finicky and can’t or won’t take capsules or pills. Compounded medications in different dosage forms and flavors are often the only way to administer key ingredients such as melatonin, amino acid and vitamin mixtures that are crucial in managing autism.

“Parents and practitioners working with children with autism must manage ingredients that can trigger reactions, such as hyperactivity, irritability, depression and acting-out, or serious gastrointestinal problems. As the largest supplier to compounding pharmacies in the U.S., we have a special obligation to develop unique products to serve the 1 in 68 children with autism.”

PCCA has several products that benefit the autism community, including:

  • SuspendAll™: A suspension base for oral medications that is free of ingredients known to cause reactions in autistic children.
  • Anhydrous Lipoderm®: A quick-absorbing cream used to deliver medications transdermally. It does not use aluminum silicate – a common binding agent.
  • Effervescent Powder™ Base: A powder base for oral medications that effervesces when mixed with water and is used to help make medications more palatable.
What is Dental Compounding?

Making the dentist’s chair more comfortable…

Trips to the dentist do not have to include unnecessary anxiety or discomfort.

For a variety of reasons, a trip to the dentist can occasionally be met with some apprehension.

The culprits are ingrained into our culture – the ominous whirring of a dentist’s drill, the shiny steel of sharp instruments. Tooth pain or not, some patients simply cannot get past the anxiety associated with dental work.

One of the best tools to fight these fears is pharmacy compounding. Compounded medications can lessen the physical discomforts involved in a trip to the dentist and help ease the patient’s anxiety.

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Compounding is the art and science of preparing customized medications for patients. In recent years, compounding has experienced a renaissance as modern technology and innovative techniques and research have allowed more dentists and other healthcare providers to work with pharmacists to customize medications to meet specific patient needs. Due to its variety of patients, dentistry is an ideal arena for compounded medications. From an eight-year-old getting a cavity filled to an eighty-year-old getting fitted for dentures, each patient is unique and may benefit from custom-compounded medication.

Working closely with a compounding pharmacist, a dental practitioner can prescribe medications for:

  • Procedural anxiety
  • Pain relief
  • Dry socket treatments
  • Fluoride treatments
  • Gum disease
  • Plaque removal
  • Oral ulcers
  • Canker sores
  • Tooth whitening
  • And more!

Unique Dosage Forms

As with many medical treatments, the therapeutic options available to dentists can be limited. Some patients may not respond well to standard medications. Compounding enhances the acceptability and application of medications through its ability to customize dosage forms.

  • Some nauseated patients or those who cannot swallow a pill may receive the medicine through a gel rubbed into the skin.
  • Patients who suffer from needle anxiety may receive a topical anesthetic to allow for painless dental injections.
  • Other creative solutions for medication problems may include liquids, pastes, lip balms, or even lollipops.

Flavored Medication

One obvious challenge with dental-related medication is the involvement of the taste buds – some dental rinses, solutions and gels have an unpleasant flavor. A compounding pharmacist can help the medicine taste better without changing its vital properties and performance. For instance, a bitter pain reliever can be enhanced with chocolate flavor to make it taste better, and children will be glad to take a topical oral anesthetic if it’s delivered through a cherry-flavored lollipop.

From cosmetic medications like bleaching gels to unique formulations to treat oral ulcers or gum disease, compounding can have benefits for all areas of dental medicine.

A caring dental practitioner working closely with a compounding pharmacist can provide the compassionate, customized care a patient deserves.

What is Veterinary Compounding?

Your pets are special. Why not give them customized care?

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As a pet owner, you want your pet to receive the highest-quality veterinary care.

You want them to have treatment as sophisticated and compassionate as you might receive yourself. You’re not alone. Today’s veterinarians realize that pet owners are very knowledgeable, and expect a more advanced level of care.

Why should you consider compounding as a solution for your pet’s medical problems?

That can be answered with another question: how hard is it to get your cat to swallow a pill?

Veterinary compounding – making medication a treat for your pet.

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The practice of pharmacy compounding is becoming a popular solution to veterinary problems. Compounding is the art and science of preparing customized medications for patients. Its resurgence in recent years extends valuable benefits to today’s pet owners. Animals often have variations of the same diseases humans can have, including skin rashes, eye and ear infections, heart conditions, cancer, and diabetes. Medicating pets presents unique problems that often are best dealt with through compounding.

The Compounding Solution

As any pet owner is well aware, animals can be extremely difficult to treat with medications. Cats are notorious for refusing to swallow pills, and usually will eat right around one disguised in food. Dosages can be very tricky with dogs – a dose of medication that works for an 80-pound Golden Retriever may be far too much for a six-pound Yorkie to handle. Large and exotic pets pose many unique medication challenges. A compounding pharmacist is equipped to help them all!

  • Cats
  • Dogs
  • Horses
  • Rabbits
  • Birds
  • Ferrets
  • Reptiles
  • Even animals in zoos and aquariums!

Flavored Medicine

The pet who refuses to take medication because of the taste is a prime opportunity for compounding. Cats don’t like pills, but they do like tuna. Dogs don’t appreciate a traditional solution of medication being squirted into their mouth, but they’ll take it gladly when it’s flavored with meat or part of a tasty biscuit or treat. Birds cannot take large volumes of liquid medication, but they will accept a small dose of a tasty, fruit-flavored, concentrated solution. By working closely with your veterinarian, a compounding pharmacist can prepare medicines in easy-to-give flavored dosage forms that animals happily devour, whether your pet is a cat, dog, bird, ferret, or snake.

Solving Dosage Problems

Just like their owners, animals are individual and unique. They come in different shapes and sizes, and may be sensitive to ingredients like lactose. As a result, not all commercially available medicines are appropriate for every pet. That’s where compounding is especially helpful. In this situation, your veterinarian can prescribe a flavored liquid, treat, or other dosage form with the amount of medication that is exactly right for your pet’s size and condition.

Commercially Unavailable Medicine

From time to time, a manufacturer may discontinue a veterinary medication. Often this is because it is not needed in the vast quantities necessary to make mass production cost-effective, but that doesn’t mean there aren’t still some pets that need it. When that medication has worked well for animals, a compounding pharmacist can prepare a prescription for the required therapy – and tailor the strength, dosage form, and flavor to that pet’s specific needs.

A caring veterinarian working closely with a compounding pharmacist can improve the health and happiness of your pet.

What is Hormone Replacement Therapy (HRT)?

Are your hormones out of balance?

Unbalanced hormones can make you feel like a stranger in your own skin.

Anyone who has been through puberty knows that hormones have a powerful effect on one’s body. Hormones affect many areas of your health, including your mood, your metabolism, and your sexual and reproductive function. If your hormones become unbalanced, whether due to menopause or other factors, you may end up feeling like a stranger in your own skin. However, compounded hormone replacement therapy (HRT) is a way to restore balance and help you feel like yourself again.

Hormone therapy designed specifically for your body

HRT is most often prescribed to ease the symptoms of menopause, but it also can be used to treat a variety of conditions that women of all ages may experience, including:

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  • Pre-menstrual syndrome (PMS)
  • Irregular menstrual cycle
  • Moodiness
  • Infertility
  • Post-partum depression
  • Weight gain
  • Endometriosis
  • Fibrocystic breasts
  • Sleep disturbances
  • Hot flashes
  • Night sweats
  • Decreased libido
  • Painful sexual intercourse
  • Vaginal dryness

These conditions affect millions of women. As the number of women seeking hormone-related treatment has grown, so has the mass production of pills, patches and creams by the drug industry. However, each woman’s body is different and has its own unique needs, but commercially manufactured products tend to be “one-size-fits-all,” and do not always account for the differences between individuals.

No two women are alike, of course, and compounding pharmacists understand this fact.

Pharmacy compounding is the art and science of preparing customized medications for patients. The advantage of compounded HRT is that it can be adapted specifically to fit each individual’s body and hormone levels. HRT can utilize hormones that have the exact chemical structure as the hormones in the human body. The body recognizes them and allows them to mimic the function of the hormones the body produces on its own.

A compounding pharmacist can provide a hormone evaluation for the patient to fill out. A pharmacist experienced in HRT may assist the healthcare provider in helping interpret the results of serum of saliva tests which measure a patient’s hormone levels. The healthcare provider, compounding pharmacist, and the patient can use the results of these diagnostic tools to help determine a course of treatment which will give the patient the exact amount of hormones her body needs.

Working closely with a woman and her healthcare provider, a compounding pharmacist can help a woman start and maintain a hormone replacement regimen that brings her hormones back into balance and closely mimics what her body has been doing naturally for years. With a healthcare provider’s prescription, the pharmacist can prepare hormones in a variety of strengths and dosage forms, including:

  • Capsules
  • Topical or vaginal creams, gels, and foams
  • Suppositories
  • Sublingual drops or troches

Once the therapy is begun, the pharmacist will continue to work with the woman and her prescriber to make sure the HRT is working correctly, adjusting the dosage if necessary, ensuring that the medication is just right for her body.

It’s your body…why not give yourself the option of a customized, compounded hormone therapy?

What is Men's Health Compounding?

Maintain your health and vitality with customized care.

Compounding pharmacists can help with many health issues that affect men of all ages.

Many men have concerns about:

  • Erectile dysfunction
  • Low libido
  • Loss of zest for life
  • Prostate and bladder health
  • Aches and pains
  • Fungal infections, such as athlete’s foot or jock itch
  • Hair loss
  • Excessive sweating
  • Chronic bad breath
  • Aging skin

A compounding pharmacist can create customized treatment options for these and many other health issues, including nutritional support to help maintain your health.

Maintain your health with treatments that are customized for you.

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Pharmacy compounding is the art and science of preparing customized medications for patients. Modern technology and innovative techniques and research allow many healthcare providers to work with pharmacists to customize medications, which provide their patients with the benefit of medications tailored specifically for certain needs.

A compounding pharmacist can tailor a prescription to the exact strength required by the individual patient, and make it in a dosage form that is easy for the patient to use. This may allow the patient to comply better with the dosing instructions, resulting in a more positive experience and treatment outcome.

Unique Dosage Forms

An important benefit is the compounding pharmacist’s ability to alter the delivery system of medications. Working closely with a healthcare provider, a compounding pharmacist can develop a dosage form that works best for the patient.

Many medications, such as some used to treat aches and pains, are commonly available as capsules or tablets. However, medications taken orally must pass through a patient’s digestive tract before making their way into the system, which may delay the effect of the medication or result in gastrointestinal side effects.

With a prescriber’s consent, a compounding pharmacist can prepare many of these medications as topical preparations – creams, lotions, solutions, or gels which are applied directly to the skin. Topical preparations allow the drug to be absorbed through the skin and enter the bloodstream, bypassing the gastrointestinal tract and potentially minimizing the related side effects.Some medications also may be formulated in dosage forms like flavored troches, which dissolve in the mouth and quickly enter the bloodstream.

Testosterone Supplementation

Your compounding pharmacist can tell you that hormone replacement therapy isn’t just for women – many men can benefit from it too! Recent research has identified a number of common physical and emotional symptoms experienced by men as they age, including:

  • Decreased libido, muscle mass, strength, and stamina
  • Impotence
  • Osteoporosis
  • Heart disease
  • Sleep disorders
  • Depression
  • Anxiety

Termed “andropause” or “male menopause”, these symptoms are related to decreasing levels of testosterone or increasing levels of estrogen.

Your natural balance may be restored though supplementation of the hormone testosterone, which has been shown to relieve the symptoms of andropause. Of course, not all men are the same – different men need different amounts of testosterone to help address their individual symptoms. The value of hormone replacement through pharmacy compounding is its ability to fit your unique body and hormone levels, resulting in better accuracy and a healthier balance.

What is Pain Management Compounding?

Pharmacy compounding offers patients customized options for pain medication. Compounding is the art and science of preparing customized medications for patients.

Don’t let chronic pain keep you from enjoying life.

Everyone experiences some sort of pain in their lives.

It can take the form of a stress-induced headache, a muscle group strained from sports activities, or be the result of an injury at work or an automobile accident. For some, pain can be chronic in nature and something they live with on a daily basis.

Pain is the most common symptom for which individuals seek medical help. Acute pain easily can evolve into chronic pain, which can become difficult to treat. Many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia, migraine headaches, and other nerve and muscle pain, but they can also result in unwanted side effects such as drowsiness, dizziness or stomach irritation. Many patients taking these medications come to accept these conditions as part of daily life, but they may find a better solution through pharmacy compounding.

Compounding offers personalized pain relief.

The Compounding Solution

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Struggling through chronic pain or the side effects of pain medication does not have to be a daily activity. Pharmacy compounding offers patients customized options for pain medication. Compounding is the art and science of preparing customized medications for patients. It provides valuable benefits to those for whom pain management has become a way of life.

Every individual is unique, and the types of pain experienced can be equally diverse. By working with a compounding pharmacist, your healthcare provider can prescribe treatments tailored specifically for your pain management needs.

Alternate Dosage Forms

Many patients experience stomach irritation or other unpleasant side effects from taking pain medication. Some have difficulty taking the medication in its commercially available form. Pharmacy compounding can provide alternate methods of delivery to make the process easier. Instead of a capsule or tablet, pain medications often can be compounded as dosage forms such as:

  • A topical gel, cream or spray form that can be applied directly to the site of the pain and absorbed through the skin.
  • A custom-flavored troche that dissolves under the tongue, a nasal spray, or a suppository.

Such dosage forms may bypass the gastrointestinal tract, providing optimal results with less GI irritation, and help patients who have difficulty swallowing pills, removing yet another source of aggravation.

Combined Formulations

Some chronic pain sufferers are placed on a variety of medications to help address the symptoms associated with their condition. On many occasions, multiple medications can be combined into a single dose of a specially prepared compound that combines the medications into a single capsule or topical preparation, providing greater convenience for the patient.

Strength Variations

Because patients vary in size, symptoms, and pain tolerance, commercially available medications sometimes may not provide the appropriate dosage strength for an individual patient. Through compounding, a prescriber and pharmacist can customize the dosage to the exact amount the patient requires, and find a dosage form that best suits the patient’s needs.

Pain can be debilitating, whether it’s acute muscle or nerve pain resulting from an accident, or a chronic condition such as arthritis or fibromyalgia. Pharmacy compounding may help improve a patient’s quality of life by providing relief with potentially fewer side effects and less overall medication.

Compounding For Drug Shortages

The growing drug shortage problem is impacting a range of patient conditions and issues from oral antibiotics that allow pediatric and elderly patients unable to swallow pills to take their medicine, to treatments for leukemia and chemotherapy, to name just a few. Recently, the American Society of Health-System Pharmacists (ASHP) named over 200 medicines on its drug shortage list. During a recent FDA-sponsored forum on drug shortages, a representative from the Drug Information Resource Center (DIRC) reported tracking 210 “new” shortages over the first nine months of 2011, with more than 260 cumulative shortages, new and ongoing.

Compounding pharmacists play an important role in providing access to discontinued medications and drugs in short supply by compounding the specific drug—based on a physician’s prescription, using pharmaceutical base ingredients to help ensure that patients get the critical care they require.

PCCA member pharmacists have access to the highest quality pharmaceutical ingredients from PCCA, and can fulfill a prescription using the latest research, quality control processes, and testing technologies to create compounded medications that meet the individual needs of patients.

PCCA’s Chris Simmons, RPh, talks about how the art of compounding can help fill the need during drug shortages.

Current Drug Shortages

Based on feedback PCCA has received from member pharmacies, these are some of the most requested drugs that either are in short supply or have been discontinued:

  • Ergotamine Tartrate 1 mg/Caffeine 100 mg Capsules
  • Ketorolac Tromethamine Injection Solution
  • Methylpyrazole (4-) 50 mg/mL Injection Solution (Canine)
  • Sulfadimethoxine Capsules
  • Neomycin Sulfate 25 mg/mL Oral Solution

Note: This is not a complete list. Please check with your local PCCA member pharmacy for availability.

Looking for a prescription drug that is in short supply or is discontinued?

Frequently Asked Questions About Pharmaceutical Compounding
What is compounding, and why is it necessary?

Compounding is the creation of a pharmaceutical preparation—a drug—by a licensed pharmacist to meet the unique needs of an individual patient (either human or animal) when a commercially available drug does not meet those needs. A patient may not be able to tolerate the commercially available drug, the exact preparation needed may not be commercially available, or a patient may require a drug that is currently in shortage or discontinued. The U.S. Pharmacopeia Convention (USP) formally defines compounding as “the preparation, mixing, assembling, altering, packaging, and labeling of a drug, drug-delivery device, or device in accordance with a licensed practitioner’s prescription, medication order, or initiative based on the practitioner/patient/ pharmacist/compounder relationship in the course of professional practice.”

Following are a few examples of how a compounding pharmacist can customize medications based upon a doctor’s prescription to meet a patient’s needs:

  • Customize strength or dosage.
  • Flavor a medication (to make it more palatable for a child or a pet).
  • Reformulate the drug to exclude an unwanted, nonessential ingredient, such as lactose, gluten, or a dye to which a patient is allergic.
  • Change the form of the medication for patients who, for example, have difficulty swallowing or experience stomach upset when taking oral medication.

Compounding pharmacists can put drugs into specially flavored liquids, topical creams, transdermal gels, suppositories, or other dosage forms suitable for patients’ unique needs. Compounding does not include making copies of commercially available drug products, as this is not allowed by law.

How is pharmaceutical compounding different from drug manufacturing?

Traditional compounding is the preparation of a medication to meet the prescriber’s exact specifications and to be dispensed directly to the patient, pursuant to a valid prescription for that patient. Pharmaceutical compounding is performed or supervised by a pharmacist licensed by a state board of pharmacy (see question below on legal oversight of compounding versus manufacturing). Manufacturing is the mass production of drug products that have been approved by the Food and Drug Administration (FDA). These products are sold to pharmacies, health care practitioners, or others who are authorized under state and federal law to resell them.

What is a compounding pharmacy?

While most pharmacies offer some level of compounding, most compounding is done in pharmacies that have made the investment in equipment and training to do so safely and efficiently. The preparations offered by these compounding pharmacies can be nonsterile (ointments, creams, liquids, or capsules that are used in areas of the body where absolute sterility is not necessary) or sterile (usually intended for the eye, or injection into body tissues or the blood).

All licensed pharmacists learn during their training and education to perform basic compounding. In addition, most pharmacies have some compounding tools, such as a mortar and pestle for grinding materials, graduated cylinders for measuring liquids, balances for weighing solids, spatulas for mixing materials, and ointment slabs on which to work. With such tools and through applying their knowledge, all pharmacists routinely prepare nonsterile compounded preparations when requested by prescribers.

Of the approximately 56,000 community-based pharmacies in the United States, about 7,500 pharmacies specialize in compounding services. This means the pharmacists in those facilities spend most or all of their time compounding special preparations for patients. Preparations made in these pharmacies are more likely to include both sterile and nonsterile dosage forms. Compounding also takes place in hospital pharmacies and at other health care facilities.

Who regulates compounding pharmacies? Do compounding pharmacies follow the same regulations as drug manufacturers? Why or why not?

The practice of compounding is regulated by state boards of pharmacy. Community and hospital compounding pharmacists are allowed exemptions to the Federal Food, Drug, and Cosmetic Act of 1938 if they comply with the regulations outlined in Section 503A. All pharmacists and pharmacies engaged in compounding are subject to oversight by both federal and state authorities.

Pharmacists engaged in compounding are expected to follow applicable standards and regulations for the types of preparations that are compounded. FDA has oversight for the integrity and safety of the drugs (called Active Pharmaceutical Ingredients, or APIs, by FDA) used in compounded preparations.  The Drug Enforcement Administration (DEA) has oversight for any controlled substances used in the preparation of compounded medications. Controlled substances include narcotics such as hydrocodone, amphetamines, and similar drugs, and drugs such as those used for anxiety and sleep disorders.

In addition, the United States Pharmacopeial (USP) Convention issues standards that apply to compounding. This private, nonprofit organization defines the chemical purity of drugs and also issues practice standards. USP develops standards for the identity, quality, strength, and purity of medicines, dietary supplements, and food ingredients that may be used in compounding preparations. These standards in particular are relevant to compounding pharmacists.

USP General Chapter <797> is a national standard for the process, testing, and verification of any compounded sterile preparations. It provides guidance on preventing microbial contamination and other variances in compounded sterile preparations, regardless of setting (e.g., hospitals, community pharmacies) or who is performing the compounding (pharmacists, nurses, pharmacy technicians, or others).

USP General Chapter <795> provides similar guidance for nonsterile preparations that are compounded in health care settings. It describes categories of compounding (simple, moderate, complex), defines concepts such as beyond-use date and stability, and provides criteria for compounding pharmacists to follow in preparing various drug preparations.

USP General Chapter <800> is a new standard developed by USP that establishes practice and quality standards of hazardous drugs to minimize the exposure to hazardous drugs within health care settings. This standard aims to promote worker safety (pharmacists, pharmacy technicians, veterinarians, veterinary technicians, and many others), patient safety, and environmental protection. This standard was published on February 1, 2016, but will not be officially implemented until July 1, 2018. The current list of hazardous drugs is available from the National Institute for Occupational Safety and Health (NIOSH).

Compliance with these and other USP guidelines is considered the minimum standard of practice in pharmacy.

Pharmacy Compounding Accreditation

Pharmacy Compounding Accreditation is a service of the Accreditation Council for Health Care (ACHC) that assesses the nonsterile and sterile pharmacy compounding process as defined by a specific set of standards that concentrate on the quality and consistency of medications produced.

How would patients know if their medication is compounded? Knowing that, should they take any precautions, or do anything differently?

Ask. A patient can receive compounded drugs from a typical community pharmacy or a specialty compounding pharmacy, or compounded drugs can be administered by doctors or other health professionals in clinics or medical offices. Patients should ask the person administering a medication or the pharmacist dispensing a prescription whether it was prepared in a compounding pharmacy or manufactured by a drug company. A widely accepted standard of practice is to label all compounded preparations with information stating the medication has been “compounded.”

If a prescription calls for a compounded drug, patients can ask whether the compounding pharmacy is accredited. Lists of accredited compounding pharmacies are organized by state on the Pharmacy Compounding Accreditation Board’s (PCAB) website.

Does a compounding pharmacist have special training?

Compounding is a central activity to the practice of pharmacy. Pharmacists are taught in pharmacy school how to properly compound medications, and many states test pharmacists’ compounding knowledge and skills before issuing them a license.

Pharmacists who practice in the 7,500 pharmacies that specialize in compounding services have generally had advanced training in compounding after they graduated from pharmacy school. No state currently requires a particular type of training, and no nationally recognized specialty exists for pharmaceutical compounding.  Specialized training in pharmacy compounding processes is available through several of the active pharmaceutical ingredient (API) suppliers serving the needs of the compounding pharmacy community.

When is a compounding pharmacy necessary?

A health care provider will prescribe a compounded drug only when commercially available drug products do not meet your needs. If you do not understand why you have been prescribed a special formulation, ask your prescriber.  If you are concerned about taking a compounded drug and you and your prescriber agree that you can tolerate the commercially available drug, you may also ask if there is any evidence that your outcome will be better on the compounded formulation.

Where is more information about compounding available?

APhA has made available on this website the introductory chapter of a leading book it publishes on compounding pharmacy. Author Loyd V. Allen Jr., a recognized expert in pharmaceutical compounding and editor of the International Journal of Pharmaceutical Compounding, provides detailed information about many topics, including those presented in these FAQs.

For additional information about compounding pharmacy, contact IACP, PCAB, USP, the National Association of Boards of Pharmacy (NABP) or the appropriate state board of pharmacy.

If you are interested in information on new regulations, news stories, and practice standards in compounding pharmacy, these are available on APhA’s “Just the Facts” page. The FDA and CDC websites provide up-to-date information, lists of affected facilities and states, treatment guidelines, FAQ statements and other resources to assist health care providers and the public in addressing this issue.

What caused the meningitis outbreak, and how could it have been prevented?

In 2012, patients developed fungal meningitis after receiving injections into the spinal column of a product prepared by the New England Compounding Center (NECC), according to the Centers for Disease Control and Prevention (CDC) and FDA.

A number of things went wrong with these preparations. Because the compounded preparation was a suspension (with visible particles) rather than a solution (a dispersion of the drug at the molecule level), the liquid could not be filtered in a way that would have removed bacteria and fungi. Because the preparation was being injected directly into the spine, no preservative or other additives that might have prevented fungal growth could be added. The drug itself was a type of steroid, and these agents decrease the body’s response to microorganisms, and this might have prevented some patients from fighting off the fungi on their own. Finally, because NECC was distributing the preparation to many states in large quantities—something that compounding pharmacies are not permitted to do under state and federal laws—some of these preparations remained unused for a long time in some cases (allowing the fungi to grow), and a large number of patients were affected.

Inspections of NECC by FDA and the Massachusetts State Department of Health found unsanitary conditions at NECC facilities and violations of the USP<797> standard as well as local law.

The report also found that NECC was distributing large quantities of compounded preparations “apparently for general use rather than requiring a prescription for an individual patient.” State law requires a prescription for compounding and dispensing medication.

“Manufacturing and distributing sterile products in bulk was not allowed under the terms of its state pharmacy license,” the report said. “If NECC was appropriately licensed as a manufacturer with the FDA, the company would have been subject to additional levels of scrutiny.”

Congressional hearings on November 14–15, 2012, examined what went wrong in the NECC case, the role and responsibility of regulators, and what can be done to prevent another such outbreak in the future.

Will the outbreak lead to reconsideration of or changes in current policy/regulations?

The Compounding Quality Act of 2012 was a direct outcome of increased regulation over compounding.  This landmark legislation is also called the Drug, Quality and Security Act (DQSA) of 2013. The first section, Title I, is concerned with compounding.  Title II deals with Track and Trace rules.

The DQSA established for FDA clear authority over certain aspects of compounding.  The Act also created a new entity, called Outsourcing Facilities.  Section 503B of the FD&C Act was added by this bill to govern outsourcing facilities.

Requiring board certification of pharmacists and/or accreditation of compounding pharmacies to provide complex compounding services could also be a result of the fungal meningitis outbreak.  The Board of Pharmaceutical Specialties is developing a specialty designation for sterile compounding.

Provider FAQ

Do you compound medications for office use only?
We do not compound medications for OFFICE USE.  We only ship pursuant to a valid prescription prescribed for a specific patient.
Customized compound medications

Key Compounding Pharmacy can customize compound medications to meet the needs of you and your patients. Provide us with as much detail as possible and we will respond with the drug availability and price.

Our compounding pharmacists working closely with you and your physician can prepare medication in a dosage form that has been customized to your particular needs.

For any questions or to speak with a pharmacist, please call: 1-800-878-1322

PLEASE NOTE: We do not take custom requests for sterile compounds. Also, we do not compound a product that is commercially available.  We do not compound medications for OFFICE USE.

Unique medication delivery for your unique needs

 With the prescriber’s authorization, pharmacists can custom-prepare medications in a variety of unique dosage forms, including:

  • Capsules
  • Oral liquids
  • Troches or lollipops
  • Topical preparations
  • Suppositories
  • Eye and ear drops
  • Nasal sprays
  • Sterile injections
 

Custom Flavoring

illus-custom-flavoring

Custom flavoring is available for most oral medication forms, and unique delivery systems may be employed to help give medication to finicky patients. Many medications can be taken through a flavored lollipop. Infants especially benefit from alternate delivery devices such as pacifiers or baby bottles. These devices, which are provided in child-proof packaging, allow parents to dispense prescription medicine easily and accurately.

 

Capsules

illus-capsules

Medication can be compounded into customized capsules, especially in cases where an alternate strength is required or to omit potential allergens or irritants, such as dyes, preservatives, or gluten. To lessen the number of doses to be taken, multiple medications often can be combined into a single dosage or made into sustained-release capsules. Vegetarian capsules made from cellulose are available for patients who do not want to take a gelatin capsule.

 

Oral Liquids

illus-oral-liquids

Many medications can be compounded as oral liquids for those patients who have difficulty swallowing tablets and capsules. Some patients may have problems tolerating the taste of a commercially available liquid, but a compounding pharmacist can make a pleasant-tasting, custom-flavored oral solution or suspension which can be administered easily and accurately. Some medications may be available as effervescent powders, which are mixed with water to make a fizzy drink.

 

Troches/Lollipops

illus-troches-and -ollipops

Troches and lollipops are used to keep drugs in the mouth when local action is needed there. Troches also may be placed under the tongue and allowed to dissolve, which allows the medication to enter the bloodstream quickly and easily. Some troches can be chewed and swallowed by a patient who cannot or will not take a capsule or tablet. These dosage forms can be enhanced with natural sweeteners and pleasant-tasting flavors, making them ideal for geriatric and pediatric patients.

Topical Preparations

illus-topical-preparations

Topical methods of delivery also are widely used because they allow the absorption of medicine directly through the skin, and may help avoid potential side effects such as stomach upset or drowsiness. Topical medications often are prescribed for pain management, inflammation and nausea/vomiting. They are easy to use and are effective delivering the medication as needed. Topical medication forms include:

  • Gels
  • Creams and lotions
  • Sprays
  • Foams
  • Stick applicators, such as lip balms

Suppositories

illus-suppositories

Patients who cannot take medications orally are ideal candidates for compounded suppositories. Available in various shapes depending on the route of administration, suppositories can be given rectally, vaginally or urethrally. By melting or dissolving into the body cavity, they allow the medication to pass quickly into the bloodstream. They can be used for hormone replacement therapy (HRT), to fight nausea, or to treat local conditions such as hemorrhoids, infections, or inflammation.

Do Compounded Medications Require FDA Approval?
The FDA approval process is intended for mass-produced drugs made by manufacturers. Because compounded medications are personalized for individual patients, the federal government has approved the use of compounded medications for those individuals who have received a prescription for that specific compounded medication.
Have you ever had a patient who had difficulty taking the medication you prescribed?

You’re not alone. Patient non-compliance is a familiar challenge, and can result in the treatment being less effective than it should be.

Common reasons for patient non-compliance may include:

illus-10632---Luea-Pharmacy-093
  • Stomach upset when taking oral medication
  • Reluctance to take the medication due to its taste
  • Issues with the route of administration, such as difficulty swallowing pills
  • Requiring a different dose of medication than that which is available from a manufacturer
  • Difficulty keeping track of multiple medications
  • Patients who don’t want to take medication at all, especially children or pets

A compounding pharmacist may be able to provide solutions for challenges such as these. Working closely with the patient and the prescriber, compounding gives the pharmacist the means to customize medication to meet the individual needs of each patient.

What is the process for handling my patient’s compounded prescription?
Please check out our online resources.
What kind of prescriptions can be compounded?
  • Hormone replacement therapy
  • Hospice
  • Pediatrics
  • Pain management
  • Ophthalmology
  • Dentistry
  • Otic
  • Dermatology
  • Medication flavoring
  • Neuropathy
  • Veterinary
  • Sports medicine
  • Wound therapy
  • Podiatry
  • Gastroenterology
  • And many more
Physician Organizations
Key2health Webinar for Pharmacist

Key Compounding Pharmacy believes it is important to promote the continuing education of members of the pharmacy profession. Pharmacists play a key role in facilitating the physician-patient communication and the successful implementation of treatment plans.

Rapid changes in genomics, medical technology, medically oriented consumer electronics, biomaterials, artificial intelligence and tissue engineering are pointing the way to a radically different future for medicine. In addition to changing the way diagnoses are made and therapies applied, these developments will create a major shift in the traditional patient-physician relationship.

Key Compounding Pharmacy through its Key2Health Professional Webinar Series is helping to foster awareness of these new developments and evolve their practices to meet the new clinical future.  Our Key2Health Professional Webinar Series offer continuing education credits to pharmacists through the Washington State Association of Pharmacists (WSAP).

Training Videos

Training for the Philips Respironics Elegance:

Training for the Omron NE-U22V nebulizer:

Training for the Nasoneb:

Training Resources

Below is a link to an article about the nystatin regime developed by Dr John Mansfield at the Burghwood Clinic, Surrey over many decades while working there as a Consultant Allergist.

Nystatin - how to take it

Glutathione Research 

Cataract
 
Drug Abuse

Health Topics

Adrenal Fatigue / Thyroid Imbalance

adrenal-fatigue-depressedThe adrenal glands secrete hormones such as cortisol, estrogen, and testosterone that are essential to health and vitality and significantly affect total body function. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women. Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or chronic illness can lead to Adrenal Fatigue, which is an important contributing factor in health conditions ranging from allergies to obesity.

Anti-inflammatory and anti-oxidant adrenal hormones like cortisol help to minimize allergic and negative reactions, such as cancer and autoimmune disorders. These hormones closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, and cardiovascular and gastrointestinal function. Proper adrenal support is essential to complete the hormonal pathway to optimal health, and includes proper nutrition, getting plenty of sleep, regular moderate exercise, stress management, slowing down to regain a proper perspective on life, and replacement of deficient hormones.

Thyroid Hormone Therapy

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). Some hypothyroid patients remain symptomatic, and T3 may also be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 is synthetic liothyronine sodium in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects, including heart palpitations. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects.

Take our short questionnaire to see if you might be a candidate for thyroid hormone therapy.

 

Compounding Options

Many patients have tried synthetic thyroid hormones, such as levothyroxine and liothyronine, and have found that Natural Thyroid is the only form that works adequately for them, reporting that they simply do not feel as well when they take levothyroxine alone or with liothyronine.

Currently, certain forms and strengths of Natural Thyroid are available only through compounding pharmacies. In addition, we can blend T4 and T3 pure powders in a specific ratio by prescription.

Commercially available tablets contain fillers and excipients that may not be tolerated by all patients. When we compound customized dosages, we have the ability to omit any problem-causing inactive ingredients and substitute non-reactive fillers

Estrogen Therapy to Prevent or Reverse Skin Aging

Beautiful woman face with a flowerOur compounding professionals can prepare individualized therapies for a myriad of dermatological problems. Compounding pharmacists continue to improve both the aesthetic and therapeutic aspects of customized medications, offering alternatives and advantages for dermatology.

We can compound medications into cosmetically appealing creams, topical sprays and powders, as well as create customized oral dosage forms (such as flavored troches or lollipops) and various preparations for other routes of administration.Compatible drugs can be combined into a single dosage form to simplify a medication administration schedule and improve compliance. USP approved chemicals can be utilized to enhance the absorption of topically applied medications. We commonly prepare unique formulations that physicians develop to meet specific needs of their patient population, or “tried and true” formulas acquired during medical training.

Estrogen Therapy to Prevent or Reverse Skin Aging

Declining estrogen levels are associated with a variety of cutaneous changes, many of which can be reversed or improved by topical or systemic estrogen supplementation. Studies of postmenopausal women indicate that estrogen deprivation is associated with declining dermal collagen content, diminished elasticity and skin strength, loss of moisture in the skin, epidermal thinning, atrophy, fine wrinkling, and impaired wound healing. Keratinocytes, Langerhans’ cells, melanocytes, sebaceous glands, collagen content and the synthesis of hyaluronic acid are under hormonal influence. Estrogen may attenuate inflammation in psoriatic lesions. Alone or together with progesterone, estrogen prevents or reverses skin atrophy, dryness and wrinkles associated with chronological or photo-aging. Estrogen and progesterone stimulate proliferation of keratinocytes while estrogen suppresses apoptosis and thus prevents epidermal atrophy. Estrogen maintains skin moisture by increasing acid mucopolysaccharide or hyaluronic acid levels in the dermis, and accelerates cutaneous wound healing.

Low estrogen levels that accompany menopause exacerbate the deleterious effects of both intrinsic and environmental aging. Estrogens clearly have a key role in skin aging homeostasis as evidenced by the accelerated decline in skin appearance seen in the perimenopausal years.

At Yale University School of Medicine, the effects of long-term hormone replacement therapy (HRT) on skin rigidity and wrinkling at 11 facial locations was assessed using the Lemperle scale by a plastic surgeon who was blinded to HRT use. Skin rigidity at the cheek and forehead was measured with a durometer. Demographics including age, race, sun exposure, sunscreen use, tobacco use, and skin type were similar. Rigidity was significantly decreased in HRT users compared to nonusers at both the cheek and forehead. Average wrinkle scores were lower in hormone users than in nonhormone users. The study concluded that long-term postmenopausal HRT users have more elastic skin and less severe wrinkling than women who never used HRT, suggesting that hormone therapy may have cosmetic benefits.

In another study, the dermal collagen of 15 postmenopausal women who had received systemic estrogen replacement was analyzed before and after using a topical 0.01% estrogen treatment. Epithelial and dermal thickness improved after topical estrogen therapy. Facial skin collagen significantly increased after 16 weeks of treatment. Systemic estrogen levels did not significantly increase after topical therapy.[Exp Dermatol. 2004;13 Suppl 4:36-40]

Our compounding professionals can help you solve dermatological issues with customized formulations to meet your needs and preferences.
Hormone Replacement Therapy for Women

Hormone Replacement Therapy for Women

womens-health-mother-daughterStructural differences exist between human, and synthetic and animal hormones. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. There are significant differences between hormones that are natural to humans and synthetic or horse preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer. A patented drug can be profitable to mass produce, and therefore a drug company can afford to fund research as to the medication’s use and effectiveness. However, naturally-occurring substances can not be patented, so scientific studies are less numerous on natural hormones, because medical research is usually funded by drug companies.

Natural hormones include estrone (E1), estradiol (E2), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone. Our compounding specialists work together with patients and prescribers to provide customized hormone replacement therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman’s specific needs. Hormone replacement therapy should be initiated carefully after a woman’s medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and medication adjustments are essential.

Take our short questionnaire to see if you might be a candidate for bio-identical hormone therapy.

Research

The findings of numerous studies on hormone replacement therapy (HRT) conflict and, as a result, have raised serious questions regarding the appropriateness of HRT. Hormone replacement is an approved therapy for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Numerous studies have confirmed that estrogen replacement decreases the risk of colon cancer, estrogen and progesterone decrease fracture risk, and various hormones increase energy levels and enhance libido. Reputable sources offer conflicting reports regarding issues such as memory, Alzheimer’s disease, and stroke.

With the exception of the Postmenopausal Estrogen/Progestin Intervention (PEPI) study, major studies have either failed to distinguish among types and dosages of HRT used in the study, r examined only the use of synthetic HRT preparations (as in the case of the Women’s Health Initiative). The Women’s Health Initiative (WHI) study was designed to identify the potential risks and benefits of HRT. The estrogen-progestin portion of the clinical trial was stopped in 2002 after results showed that a synthetic hormone combination containing conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) increased the women’s risks of developing invasive breast cancer, heart disease, stroke, and pulmonary embolism. The data and safety monitoring board concluded that the risks outweighed the evidence of benefit for fractures and colon cancer. Utilizing data from the WHI, researchers later concluded that synthetic CEE plus MPA does not improve mental functioning and may increase the risk of dementia in women over age 65. They suggest these hormones increase the risk of stroke, which is known to increase the risk of dementia. With regard to the risk of dementia, typical HRT users are in their 50s and the WHI study focused on women aged 65 and over, who have a higher risk for dementia. The “estrogen-only” portion of the WHI study was halted in March 2004 after analysis of data suggested that synthetic CEE alone had no impact either way on heart disease (the main focus of the study), but may increase the risk of stroke.

Many patients and medical professionals are unaware of the availability of alternatives. In reality, women’s experiences and clinical outcomes of HRT differ vastly depending on the dose, dosage form, and route of administration, and also the type of hormone that is used. As a result of concerns and doubts generated by studies that use synthetic hormones, many women who could substantially benefit from customized hormone replacement may never have the opportunity.

Published research delineating the differences between natural and synthetic HRT is now more abundant, but studies of natural HRT will probably never be as plentiful as those dealing with patented synthetic hormones. Our pharmacy welcomes your questions.

Take our short questionnaire to see if you might be a candidate for bio-identical hormone therapy.

Estrogens

Estrogens actually refers to a group of related hormones, each with a unique profile of activity. Under normal circumstances, a woman’s circulating estrogen levels fluctuate based on her menstrual cycle. For Hormone Replacement Therapy, these hormones are often prescribed in combination to re-establish a normal physiologic balance. The three main estrogens produced in female humans are:

  • E1 (Estrone; 10-20% of circulating estrogens) is the primary estrogen produced after menopause.
  • E2 (Estradiol; 10-30% of circulating estrogens) is the most potent and major secretory product of the ovary, and the predominant estrogen produced before menopause.
  • E3 (60-80% of circulating estrogens)

Take our short questionnaire to see if you might be a candidate for bio-identical hormone therapy.

Progesterone

Progesterone is a term that is incorrectly used interchangeably to describe both progesterone which is “chemically identical” to what the body naturally produces, and synthetic derivatives. Synthetic progestins are analogues of progesterone, and have been developed because they are patentable, more potent, and have a longer duration. Medroxyprogesterone acetate, the most commonly used synthetic progestin, was shown in a large study to cause significant lowering of HDL “good” cholesterol, thereby decreasing the cardioprotective benefit of estrogen therapy. Side effects are a frequent cause for discontinuation of HRT. Only about 20% of women who start synthetic HRT remain on it two years later.
Progesterone:

  • is commonly prescribed for perimenopausal women to counteract “estrogen dominance” which occurs when a woman produces
  • smaller amounts of progesterone than normal relative to estrogen levels.
  • alone, or combined with estrogen, may improve Bone Mineral Density.
  • minimizes the risk of endometrial cancer in women who are receiving estrogen.
  • is preferred by women who had previously taken synthetic progestins.

The benefits of progesterone are not limited to prevention of endometrial cancer in women who are receiving estrogen replacement. Progesterone therapy is not only needed by women who have an “intact uterus”, but is also valuable for women who have had a hysterectomy. Vasomotor flushing is the most bothersome complaint of menopause, and is the most common reason women seek HRT and remain compliant. For over 40 years, estrogens have been the mainstay of treatment of hot flashes, but progesterone may be effective as well.

Take our short questionnaire to see if you might be a candidate for bio-identical hormone therapy.

Androgens

Androgens are hormones that are important to the integrity of skin, muscle, and bone in both males and females, and have an important role in maintaining libido. Declines in serum testosterone are associated with hysterectomy, menopause, and age-related gender-independent decreases in DHEA and DHEA-sulfate. DHEA (dehydroepiandrosterone) is an androgen precursor from which the body can derive testosterone. After menopause, a woman’s ovaries continue to produce androgens; however, the majority of the androgens produced in the female body, even before menopause, come from peripheral conversion of DHEA. As the body ages, production of DHEA declines so that by the time a woman goes through menopause, the production of DHEA is often inadequate. Additionally, ERT may cause relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement. Recently, attention has turned to the addition of the androgens to a woman’s HRT regimen in order to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes.

Androgens, such as testosterone and DHEA:

  • enhance libido.
  • enhance bone building (increase calcium retention).
  • provide cardiovascular protection (lower cholesterol).
  • improve energy level and mental alertness.

Take our short questionnaire to see if you might be a candidate for bio-identical hormone therapy.

Miscellaneous Information

Treatment for Vulvodynia

In 2002 and again in 2006, the National Institutes of Health characterized vulvodynia (defined as chronic, unexplained vulvar pain or discomfort, characterized by burning, stinging, irritation, or rawness) as a poorly understood and underresearched focal pain syndrome for which optimal treatment remained unclear. Nearly 14 million U.S. women may at some point in their lives experience the symptoms of chronic vulvar burning and pain, and a localized form of vulvodynia involving the vulvar vestibule is thought to be the leading cause of dyspareunia in premenopausal women. Treatment recommendations range from topical therapies to oral medications, physical therapy and biofeedback, and surgical excision, although the latter is reserved for women with localized pain only. Although many of these modalities demonstrate efficacy, many are also associated with adverse effects, require numerous visits to physicians, or are invasive.
A 47% complete response to oral tricyclic antidepressants for the treatment of vulvodynia (both generalized and localized) was reported in 33 women attending a vulvar pain clinic. Amitriptyline is often used as a first line agent, started at an oral dose of 5 mg to 25 mg nightly and increased by 10 to 25 mg weekly, generally not to exceed 150 mg daily.
Gabapentin appears to be very effective in the treatment of unprovoked generalized vulvodynia, and has a very low side effect profile. To evaluate the clinical efficacy and tolerability of topical gabapentin in the treatment of women with vulvodynia, between January 2001 and December 2006, fifty-one women with vulvodynia were treated with 2% to 6% gabapentin prepared by local compounding pharmacists. Patients were instructed to apply a small amount of cream (approximately 0.5 mL, equivalent to the size of a pea) three times daily. After a minimum of 8 weeks of therapy, the mean pain score among the 35 evaluable women was significantly reduced. Sexual function improved. Common adverse effects of oral gabapentin, including dizziness, somnolence, and peripheral edema, were not reported by any of the 50 patients studied. The conclusion: “Topical gabapentin seems to be well-tolerated and associated with significant pain relief in women with vulvodynia.”

    1. References:

 

  1. Journal of Lower Genital Tract Disease 2005;9(1):40–51 The Vulvodynia Guideline.
  2. J Reprod Med 2007 Feb;52(2):103-6 Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked.
  3. National Vulvodynia Association News, Winter 2005 (accessed 06/09) Obstet Gynecol. 2008 Sep;112(3):579-85 Topical gabapentin in the treatment of localized and generalized vulvodynia.

Boric Acid Therapy for Chronic Vaginitis

Recalcitrant vaginal trichomoniasis is extremely distressing for patients and frustrating for physicians. Numerous studies have shown that an increase in vaginal pH creates a better environment for the growth of Trichomonas vaginalis. Vaginal acidification using boric acid has resulted in resolution of recalcitrant Trichomonas vaginalis.1
Patients with diabetes mellitus (DM) are at increased risk of vulvovaginal candidiasis (VVC) due to Candida glabrata. Observational studies indicate that diabetic patients with C. glabrata VVC respond poorly to azole drugs. Women with DM and VVC showed an overall superior mycological cure rate (74% versus 51%) at day 15 with boric acid suppositories given daily for 14 days as compared to fluconazole as a single oral dose of 150 mg. 2, 3

A study done at New York Hospital-Cornell University Medical Center reported the “ineffectiveness of conventional antifungal agents appeared to be the main reason for chronic mycotic infections. In contrast, boric acid was effective in curing 98% of the patients who had previously failed to respond to the most commonly used antifungal agents and was clearly indicated as the treatment of choice for prophylaxis.”4 “A double-blind comparison was made of the use of 14 daily intravaginal gelatin capsules containing 600 mg of boric acid powder versus the use of identical capsules containing 100,000 U nystatin… for the treatment of VVC… Cure rates for boric acid were 92% at 7 to 10 days after treatment and 72% at 30 days, whereas the nystatin cure rates were 64% at 7 to 10 days and 50% at 30 days.”5 Torulopsis glabrata is second only to Candida albicans in frequency of isolation from the vagina in both asymptomatic women and those with yeast vaginitis. In sixty patients with T. glabrata vaginitis, for whom repeated courses of antimycotic therapy with azoles had previously failed, boric acid emerged as a promising modality.”6 Another study concluded “in non-Candida albicans infections, boric acid suppositories achieved the best mycologic cure rate (85%).”7

References
  1. J Obstet Gynaecol Can. 2008 Jan;30(1):55-8 Recalcitrant Trichomonas vaginalis infections successfully treated with vaginal acidification.
  2. J Infect. 2007 Oct;55(4):374-7 Prolonged (3-month) mycological cure rate after boric acid suppositories in diabetic women with vulvovaginal candidiasis.
  3. Diabetes Care. 2007 Feb;30(2):312-7 Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis.
  4. J Reprod Med. 1991 Aug;36(8):593-597 Antifungal agents vs. boric acid for treating chronic mycotic vulvovaginitis.
  5. Am J Ob Gyn. 1981 Sep 15;141(2):145-148 Treatment of vulvovaginal candidiasis with boric acid powder.
  6. Clin Infect Dis. 1997 Apr;24(4): 649-652 Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy.
  7. Am J Ob Gyn. 1995 Sep;173(3 Pt 1):820-823 Chronic fungal vaginitis: the value of cultures.
We welcome your questions and the opportunity to help you. Call our compounding professionals to discuss individualized treatments that meet your needs and preferences.
Hormone Replacement Therapy for Men

mens-health-coupleApproximately 30% of men aged 60-70 years and 70% of men aged 70-80 have low levels of testosterone in forms that the body can use (bioavailable; unbound; free). Hypogonadism is a clinical condition in which low levels of serum testosterone (bioavailable testosterone less than 60 ng/dl) are found in association with specific signs and symptoms, including diminished sex drive and sense of vitality, erectile dysfunction, depression, anemia, reduced muscle mass and bone density, increased fat mass, frailty, and osteoporosis. A man may be considered hypogonadal at any age if total testosterone (bound and free) is less than 200 ng/dl. It is recommended that elderly men with symptoms of hypogonadism and a total testosterone level less than 300 ng/dl be started on hormone replacement.1

When hypogonadism occurs in an older man, the condition is often called andropause, or Androgen Deficiency of the Aging Male (ADAM), because testosterone is in a class of hormones known as androgens.
Bioavailable testosterone levels are significantly lower for depressed men, perhaps because an associated decrease in sexual function results in depression, irritability, and mood swings. Testosterone therapy might improve depressed mood in older men who have low levels of bioavailable testosterone.2,3

Osteoporosis-related fractures occur in 12% of all men over 50 years of age. Twenty-five percent of all hip fractures occur in men, and 33% of these patients die within one year of fracture. Gradual loss of testosterone is one of the major causes of osteoporosis in elderly men. Studies have reported beneficial effects of testosterone therapy on bone in older men, showing an increase in bone mineral density (BMD) and slowing of bone degeneration. Testosterone therapy in older men with low serum testosterone levels also increases lean body mass and decreases fat mass, improving physical performance and strength.4

Testosterone replacement therapy (TRT) has relieved symptoms and improved the quality of life for many men. TRT is well tolerated, and long term TRT appears to be a safe and effective means of treating hypogonadal elderly males, provided that laboratory values and clinical response are frequently monitored. The only absolute contraindication to androgen replacement therapy is the presence of prostate or breast cancer. Guidelines recommend that TRT should not be initiated in older men with PSA serum levels above the normal range. Testosterone should be used with caution in men with severe heart, kidney or liver disease, increased red blood cell counts, and sleep apnea.5 Side effects of testosterone therapy can include mood swings, leg swelling, skin reactions, acne, alopecia, breast enlargement, and infertility. Liver toxicity has not been reported following testosterone administration using transdermal gels in physiologic doses.6 (Toxicity has occurred with methyltestosterone.)

Testosterone is well-absorbed from transdermal creams, gels, and lotions. Compounded preparations can be very advantageous because:

  • the exact amount of hormone needed by each man can be applied as a single dose
  • there is no need to shave the scrotum to apply one or more patches
  • there is no skin irritation from patch adhesive.

A healthy lifestyle is associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.

References:
  1. Am J Med. 2001 May;110(7):563-72.
  2. J Clin Psychiatry. 2009 Jul;70(7):1009-16.
  3. J Clin Psychopharmacol. 2009 Jun;29(3):216-21.
  4. J Clin Endocrinol Metab. 2005 Mar;90(3):1502-10.
  5. Ther Clin Risk Manag. 2009 Jun;5(3):427-48.
  6. Expert Opin Drug Saf. 2004 Nov;3(6):599-606.

Testosterone vs. Synthetics:  What is the Optimal Form of Testosterone for Replacement Therapy?

Testosterone USP is natural bio-identical testosterone that has been approved by the United States Pharmacopoeia and is available as a bulk chemical. Upon a prescription order, compounding pharmacists can use Testosterone USP to prepare numerous dosage forms.

Natural Testosterone Replacement is Central to the Treatment of All Facets of Andropause. The term “testosterone” is often used generically when referring to numerous synthetic derivatives, as well as natural bio-identical testosterone. Confusion is responsible for conflicting data in the medical literature about the benefits and risks of testosterone therapy. Studies must be reviewed carefully to determine the form of testosterone that was used. Natural testosterone must not be confused with synthetic derivatives or “anabolic steroids,” which when used by athletes and body builders have caused disastrous effects. For example, administration of synthetic non-aromatizable androgens, like stanozolol or methyltestosterone, causes profound decreases in HDL-C (“good cholesterol”) and significant increases in LDL-C (“bad cholesterol”). Yet, hormone replacement with aromatizable androgens, such as testosterone, results in lower total cholesterol and LDL cholesterol levels while having little to no impact on serum HDL cholesterol levels. Proper monitoring of laboratory values and clinical response are essential when prescribing testosterone replacement therapy.

The only absolute contraindications to androgen replacement therapy are the presence of prostate or breast cancer. “Although it is known that the clinical course of prostate cancer is accelerated by testosterone, its incidence is not increased by [testosterone] administration… There is even no clear evidence that testosterone replacement accelerates the development of BPH.”

Drugs & Aging 1999 Aug;15(2):131-42

Goals and Therapy

Goals of Testosterone Replacement Therapy in Adult Hypogonadal Men (age 50 or older)

  • Improvement in psychological well-being and mood
  • Improvement in erectile dysfunction
  • Improvement in libido
  • Increased muscle mass
  • Increased strength and stature
  • Preservation of bone mass
  • Possible decrease in cardiovascular risk
Call our compounding professionals to discuss individualized treatments and non-irritating topical preparations.

TriMix for Erectile Dysfunction

Erectile Dysfunction (ED; formerly referred to as “impotence”) is estimated to affect 40% of men at age 40, and almost 70% of men at age 70. However, ED has many treatable causes, and does not need to be an inevitable consequence of aging. While treatment with oral medications known as PDE-5 inhibitors (Viagra™, Cialis™, and Levitra™) is very popular, some patients are unable to take these medications because of drug interactions (ie, sildenafil and nitroglycerin) or a lack of response. In addition, these agents can be associated with adverse effects and are not as effective in patients who have undergone radical prostatectomy (removal of prostate) or who have severe vascular disease, which is a common complication of advanced diabetes. Consequently, PDE-5 inhibitor therapy is associated with a high rate of discontinuation.

Self-injection (intracavernosal injection-into shaft of the penis) is a well-accepted and popular therapy for ED from many causes, and is considered “the most effective medical therapy for diabetic erectile dysfunction.” 1 Tri-Mix is a combination of medications (papaverine/phentolamine/prostaglandin) that work in various ways to produce and maintain an erection. Men with ED who used Tri-Mix by self-injection and who changed to oral sildenafil (Viagra™) found they had a greater preference than expected for triple therapy and the erection quality was better with TriMix than with sildenafil.2 Fear of pain with self-injection therapy may discourage some men. Yet, in the majority of ED patients, findings from a Cleveland Clinic study show that discomfort is minimal, which may help to alleviate the fear of injection in those who may benefit from this therapy.3

Early intracavernosal injections following radical prostatectomy facilitated early sexual intercourse, patient satisfaction and potentially earlier return of natural erections, according to a study from the Glickman Urological Institute, Cleveland Clinic Foundation.4 While studies have shown that the highest percentage of positive response in men with erectile dysfunction is achieved with TriMix, the professional compounders at Key Compounding Pharmacy will work together with each patient and his physician to customize doses and combinations of medications to meet specific needs.

Tri-Mix injection requires a prescription from your physician and should be filled only by a pharmacy experienced in sterile compounding, such as Key Compounding Pharmacy.

References
  1. Expert Opin Pharmacother. 2008 Feb;9(2):257-66
  2. BJU Int. 2003 Aug;92(3):277-80
  3. J Sex Med. 2005 May;2(3):428-31
  4. Int J Impot Res. 2006 Sep-Oct;18(5):446-51. Epub 2006 Feb 16
Anti-Fungal Therapy

podiatry-feetWe commonly prepare unique formulations that prescribers develop to meet specific needs of their patient population, or “tried and true” formulas acquired during professional training. Penetrant enhancers can be added to improve the extent of absorption of topically applied medications. Numerous compatible medications can be combined into a single dosage form for ease of administration. Also, a synergistic effect can be achieved when certain medications are used concomitantly.

Anti-Fungal Therapy

Yeast and bacterial infections of the nails are usually the result of microscopic damage to the nail plates. The nails will have either a white, thin discoloration at the tip of the nail that starts to extend toward the cuticle, or may have a greenish-black color to the nail. A mixture of 4% thymol in alcohol used twice daily until the affected area has grown out is excellent for this condition.1 Thymol is an antibacterial and antifungal, and alcohol also reduces moisture in skin folds and cuticles.

For treatment of onychomycosis, penetration of the topical antifungal agent through the nail plate from the surface of the nail and diffusion of the systemic antifungal drug through the nail bed may increase the total amount of antifungal activity at the site of infection. Results from an initial study in patients with onychomycosis suggest that this approach can enhance the overall efficacy of therapy. Using a combination of antifungal drugs in this manner may potentially reduce the duration of therapy and allow a reduction in dose of the oral agent, which may reduce systemic adverse effects. Physicians may also consider combining topical antifungal therapy with topical urea. Urea degrades protein, including keratin — a major component of the nail plate. Potentially, urea can soften the nail plate, making it more porous and penetrable to topical antifungal drugs.2 Urea ointment (40 to 55%) can be applied to the nail twice daily for two weeks. Then, topical formulations such as clotrimazole 2% and ibuprofen 2% in DMSO USP (“apply to affected nails BID for 6 weeks”)3 or butenafine 2% and tea tree oil 5% cream can be applied to the affected nail.

A randomized, double-blind, placebo-controlled study examined the clinical efficacy and tolerability of 2% butenafine hydrochloride and 5% Melaleuca alternifolia (tea tree) oil incorporated into a cream base to manage toenail onychomycosis. Sixty outpatients (39 M, 21 F) aged 18-80 years (mean 29.6) with 6 to 36 months duration of disease were randomized to two groups (40 active therapy and 20 placebo). After 16 weeks, 80% of patients using medicated cream were cured, as opposed to none in the placebo group. Four patients in the active treatment group experienced subjective mild inflammation without discontinuing treatment. During follow-up, no relapse occurred in cured patients and no improvement was seen in medication-resistant and placebo participants.4

References:

  1. Audrey Kunin, M.D. http://www.dermadoctor.com/article_Nail-Fungus_57.html (accessed June 19, 2009)
  2. http://www.medscape.com/viewarticle/452687_8 (accessed September 16, 2008)
  3. Timothy J. Scott, DPM, FACFAS, Clarion, PA
  4. Trop Med Int Health. 1999 Apr;4(4):284-7. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream.

Transdermal therapy to decrease side effects

Medications that relieve pain, reduce inflammation, and relax muscles can have side effects that are detrimental to athletic performance, such as drowsiness. However, when these medications are administered transdermally, the therapeutic benefit can be enhanced while significantly reducing the risk of adverse effects.

For example, research has shown that topically applied ketoprofen provides a high local concentration of drug below the site of application but decreases systemic exposure and significantly reduces the risk of gastrointestinal upset or bleeding. When properly compounded into an appropriate base, tissue concentrations of ketoprofen were found to be 100-fold greater below the application site (knee) compared to systemic concentrations. Muscle relaxants can be similarly prepared to minimize the risk of drowsiness.

We welcome your questions and the opportunity to help you. Call our compounding professionals to discuss individualized treatments that meet your needs and preferences.
Dentistry

Mouth care We work together with dentists and their patients to solve problems using customized medications. Upon a prescription order, we can compound:

  • lip balms for viral lesions
  • topical muscle relaxants/analgesics
  • topical anesthetics
  • non-staining antibacterial rinses
  • oral sedation in lollipops and freezer pops
  • lollipops for oral thrush
  • mouth rinses for aphthous ulcers or chemotherapy-induced stomatitis
  • mouth rinse to stop oral bleeding during dental procedures for patients who take anticoagulants
  • dry socket preparations
  • “mucosal bandages” to cover ulcerated, infected, or tender mucosa lozenges that help to prevent gagging
  • and many more unique preparations and novel delivery systems

Medications are manufactured in a limited number of strengths and dosage forms that will satisfy the needs of most patients due to stability concerns, and the cost of stocking and distributing numerous formulations of each drug. Using pharmaceutical grade chemicals and specialized equipment not found in most pharmacies, we can compound medications in doses and dosage forms that are not commercially available. We want to optimize the care of every patient. Just let us know what you need!

We welcome your questions and the opportunity to help you. Call our compounding professionals to discuss individualized treatments that meet your needs and preferences.

Perio Protect

dentistry-perioprotectPerio Protect® is a comprehensive method that is customized for individual patients to help manage biofilms, communities of bacteria, growing in the spaces or pockets between teeth and gum tissue. The overall goal of the Perio Protect Method™ is to manage oral biofilm with minimally invasive dentistry for lasting oral health.

The Method is a combination of treatments, including a non-invasive chemical debriding therapy used in conjunction with traditional mechanical debriding procedures. The chemical therapy involves a tray delivery of doctor-prescribed solutions to chemically debride biofilm from the periodontal pocket and alter the pocket’s microbiological environment to disrupt biofilm growth.

The standard cleaning procedures in dental offices (e.g. scaling and root planing) help remove plaque and tartar and help reduce bacteria, but unfortunately bacteria reproduce quickly and biofilms regenerate very easily, so it is difficult to control them between office visits.

With the Perio Protect Method, you can place prescribed solutions into periodontal pockets with an appropriately formed, customized dental tray between office visits to help manage biofilm. Although a dentist must choose the most appropriate solution for individual patients, the most commonly prescribed solution with the Method has oxidizing and oxygenating agents. Oxidizing agents debride (chemically remove) the slimy protective coating of a biofilm and its underlying layers and also cleanse the oral wounds.

Dentists may choose to treat the oral wounds with the chemical debriding and cleansing agents before mechanical debriding procedures to help reduce bacterial populations and thus reduce the risk of introducing bacteria into the bloodstream during mechanical debridement.

For most people following the Perio Protect Method, the placement of prescribed solutions into a periodontal pocket via a customized prescription tray requires only minutes each day. Patients describe the tray delivery as comfortable and appreciate its non-invasive technology.

The actual combination of mechanical treatment, chemical therapies, and prescribed treatment plan is determined by a dentist evaluating your specific conditions. To find a dentist knowledgeable about the Perio Protect Method or to get more information about Perio Protect, click here.

Pain Management

BackachePain management is essential because even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient.

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such as dextromethorphan and ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44]

By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used. Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.

We work together with patient and practitioner to solve problems by customizing medications that meet the specific needs of each individual. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.

Neuropathic Pain

Combinations of synergistic drugs can be customized for the patient with chronic pain, and topical or transdermal formulations offer excellent alternatives, sometimes with fewer side effects compared to the same drugs when taken orally.

NSAID Therapy

To avoid the risks of COX-2 inhibitors, our pharmacy can compound topically applied NSAIDs such as ibuprofen and ketoprofen. Topical NSAIDs have a safety profile which is superior to oral formulations. Topical NSAID administration offers the advantage of local, enhanced delivery to painful sites with a reduced incidence of systemic adverse effects. Topical preparations can be customized to contain a combination of medications to meet the specific needs of each patient.

Call our compounding professionals to discuss individualized treatments and non-irritating topical preparations.
Pharmacists helping Vets and Pets

Compounding allows veterinarians to broaden their prescribing abilities and to offer dosages and dosage forms that are patient-specific in strength and formulation. Therefore, the goal of compounding for the veterinary patient is to enhance the veterinarian’s ability to treat patients in a more effective and efficient manner.

Our pharmacy can prepare:

  • Flavored medication
  • Medicine in ideal size, strength, and dosage form
  • Transdermal medications
  • Unavailable medications
  • Combinations to improve compliance
  • Novel devices and delivery systems

Compounding is actually a means to an end. We work together with veterinarians to solve medication problems by compounding specialized medications that meet the unique needs of each animal - pets, exotics, horses, or zoo animals.

Transdermal Medications

Have you ever thought about applying a transdermal preparation to the inside of an animal’s ear or another hairless area as an alternate route of systemic administration? It’s quick and easy, and many medications are compatible with transdermal bases. Transdermal delivery is particularly useful for animals who should not be stressed due to cardiovascular or hypertensive illness. Also, it is appreciated by owners who no longer have to deal with an animal who resists being medicated. We can also prepare topical medications for application at the site of inflammation or infection.

Advantages of Transdermal Dosage Forms

Various alternative dosage forms permit medication to be absorbed via non-oral routes to meet an animal’s specific needs. Although the parenteral and rectal routes are traditional alternatives to oral administration, transdermal absorption offers many advantages.

For example:

  • When medication is absorbed directly into the bloodstream without first entering the gastrointestinal system, a smaller amount of active ingredient may be required for therapeutic effect.
  • Direct application and absorption at the target site can mean higher tissue levels and lower blood levels of various medications. Side effects such as GI irritation can be eliminated.
  • Various types of drug interactions may be avoided when one or more interacting medications are administered transdermally.

A substantial number of references exist in human medical literature with regard to the efficacy of transdermal administration of non-steroidal anti-inflammatory drugs and other types of analgesics, antiemetics, and other medications. We can compound transdermal and topical medications using a suitable 3 base, and add penetrant enhancers if desired.

We welcome your questions and the opportunity to help you and your pet. Call our compounding professionals to discuss individualized treatments that meet your pets needs and preferences.

Compounding for Veterinarians & Animal Owners

Your pets are special. Why not give them customized care?

Compounding for Veterinarians & Animal Owners

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As a pet owner, you want your pet to receive the highest-quality veterinary care.

You want them to have treatment as sophisticated and compassionate as you might receive yourself. You’re not alone. Today’s veterinarians realize that pet owners are very knowledgeable, and expect a more advanced level of care.

Why should you consider compounding as a solution for your pet’s medical problems?

That can be answered with another question: how hard is it to get your cat to swallow a pill?

Veterinary compounding – making medication a treat for your pet.

illus-veterinary-compounding

The practice of pharmacy compounding is becoming a popular solution to veterinary problems. Compounding is the art and science of preparing customized medications for patients. Its resurgence in recent years extends valuable benefits to today’s pet owners. Animals often have variations of the same diseases humans can have, including skin rashes, eye and ear infections, heart conditions, cancer, and diabetes. Medicating pets presents unique problems that often are best dealt with through compounding.

The Compounding Solution

As any pet owner is well aware, animals can be extremely difficult to treat with medications. Cats are notorious for refusing to swallow pills, and usually will eat right around one disguised in food. Dosages can be very tricky with dogs – a dose of medication that works for an 80-pound Golden Retriever may be far too much for a six-pound Yorkie to handle. Large and exotic pets pose many unique medication challenges. A compounding pharmacist is equipped to help them all!

  • Cats
  • Dogs
  • Horses
  • Rabbits
  • Birds
  • Ferrets
  • Reptiles
  • Even animals in zoos and aquariums!

Flavored Medicine

The pet who refuses to take medication because of the taste is a prime opportunity for compounding. Cats don’t like pills, but they do like tuna. Dogs don’t appreciate a traditional solution of medication being squirted into their mouth, but they’ll take it gladly when it’s flavored with meat or part of a tasty biscuit or treat. Birds cannot take large volumes of liquid medication, but they will accept a small dose of a tasty, fruit-flavored, concentrated solution. By working closely with your veterinarian, a compounding pharmacist can prepare medicines in easy-to-give flavored dosage forms that animals happily devour, whether your pet is a cat, dog, bird, ferret, or snake.

8 Warning Signs of Vein Disease and Compression Therapy

How Vein Disease Develops

As a result of their upright stance and sedentary lifestyles, human beings are the only life forms that suffer from vein disease. A lack of exercise and too much standing or sitting places considerable pressure on the venous system for many hours of the day. Heredity and age are contributing factors, as is pregnancy. The muscle-pumping action no longer adequately supports the return transport of the blood. If your veins become distended, the valves can no longer close, due to their increased diameter. The blood flows backwards and the superficial veins, which are not held in place by muscles or bone, appear as snaking varicose veins

vein-disease-factors

Compression Therapy

The concept of compression therapy relies on a simple and efficient mechanical principle: the application of an elastic garment around the leg. By compressing the limb with graduated compression - strongest at the ankle and decreasing going up the leg - the compression stocking helps the venous return, decreases venous pressure, prevents venous stasis and deterioration of venous walls, and efficiently relieves aching and heavy legs by aiding the body in moving blood up the leg against the pull of gravity.

Compression stockings are used to treat phlebitis, thrombosis and aftercare following surgery, sclerotherapy, and also to relieve all conditions of chronic venous disease (heavy legs, varicose veins, oedemas, leg ulcers). It can also be used to prevent venous issues during pregnancy and long distance travel.

Depending on the condition, compression therapy can be applied in different forms: socks, stockings, pantyhose or bandages. These come in a variety of new textures and fashion designs.

8 Warning Signs of Vein Disease

Tired, heavy-feeling legs - One of the first signs of vein disease is your legs feeling chronically tired and heavy in the evenings. This is a clear indication that the return
flow of blood from the legs to the heart is impaired. The main cause is gravity. After
a long day of standing on your feet, your weakened veins are less able to carry the
blood back up to your heart efficiently. The result is oxygen depletion in your legs, giving
you that heavy, tired feeling.

Leg pain from prolonged sitting or standing - The muscles in your legs play an important role in massaging the veins and helping them “pump” blood. During long periods of sitting or standing, when the muscles are at rest, blood may collect in the legs and ankles. The leg veins stretch easily and may become enlarged by the pressure of the pooled blood. This in turn can cause dull, aching pain.

Swollen ankles at night - Thick, swollen ankles are definite signs that blood or other fluid is congested in the leg and/or leg veins. Over time, damaged vein walls can become even more stretched out and permeable, allowing fluid and protein to filter from the veins into surrounding leg tissue, which causes the swelling. When you lie down at night, the pressure from gravity is equalized across your leg.

Varicose or spider veins, especially during or after pregnancy - One of the main factors contributing to vein disease is pregnancy. During pregnancy, the amount of blood greatly increases throughout the body to almost double the normal volume, stretching leg veins far beyond their normal capacity. Even though the visible signs of varicose veins may disappear after birth, the damage done to veins during pregnancy is permanent and may cause pain and discomfort later in life. These problems can be avoided if compression therapy is prescribed during pregnancy. Women with a history of vein disease in their family or who experience any swelling or pain in their legs during pregnancy are strongly urged to talk to their doctors about medical compression therapy.

Tingling, numbness, burning, or cramping in legs and feet - Since vein disease can cause serious circulation problems, your lower legs and feet may not be getting the oxygen they need. In essence, they may be “falling asleep” more often than usual, or suffering from muscle cramps.

Discoloration of the skin - Over time, leakage of blood into the area surrounding the veins can cause tissue to die. The resulting pooling of blood in the tissue causes a darkening of the skin. It is at this stage that the skin is actually stained by your own blood.

Open sores or ulcers on the lower leg - When Chronic Venous Insufficiency reaches its most serious point, ulcers may appear on the lower leg. These are the result of blood leaking into the leg tissue and damaging the skin.

History of vein problems in the family - There are many causes of vein disease, but the main one is heredity – the condition runs in families. If someone in your family suffers
from serious vein problems, you are at a higher than average risk. The earlier you take precautions and treat the problem, the better chance you have of avoiding serious complications.

How Compression Garments Help

compression-stockingsIt is easy to explain how a compression garment works: the pressure of the garment constricts the diameter of your vein. The venous valves can close again, thus reducing
the amount of blood flowing back down into your legs. The smaller diameter of the veins means that the blood flows more quickly again, which prevents the formation of blood clots or thrombi. The medically prescribed drop in pressure from the foot up to the thigh
accelerates the flow of blood back to the heart. When you move your leg, the garment
forms an external barrier for the muscles, which makes for a more effective muscle-
pumping action.

Wearing compression garments is generally not unpleasant. If you wear correctly fitted garments, they immediately have a noticeable pain relieving effect and help your legs stay healthy.

How to Get Started

Call our Nutrition Center today to find out more about our line of compression garments and whether compression therapy might be right for you.

Personalized medication delivery just for you

Don’t know what to do with those expired or unused medications? Here are a few solutions that may be able to assist you with choosing how to dispose of those unwanted medications.

TakeAway Environmental Return System

A unique method for disposal of unused patient medications. You just fill it, seal it, and return via USPS or drop off at a nearby Post Office.

We carry the 11″ x 8″ envelopes in the pharmacy for $3.99 per “No Postage Necessary” envelope. Ask a pharmacy representative for more details or click here to visit the TakeAway website.

National Drug Take-Back Days

The Drug Enforcement Administration (DEA) has been coordinating National Drug Take-Back Days for a few years. According to the DEA, over 3.5 million pounds of prescription medications have been removed out of circulation in their six Take-Back events, including their latest one held in April 2013. State, local, and tribal law enforcement agencies partner with the DEA to make this a successful event.

For more information about these events, please click here to visit the National Take-Back Initiative web page.

Other Resources

Here are some other resources that may assist with properly disposing of your unwanted medication.

How to Dispose of Unused Medicines - FDA
How to Dispose of Medicines Properly - EPA

The A1C Test & Diabetes

What is the A1C test?

The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research.

How does the A1C test work?

The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.

Can the A1C test be used to diagnose type 2 diabetes and prediabetes?

Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes. 1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes.

Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis.

Why should a person be tested for diabetes?

Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and lifelong disease.

Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.

Has the A1C test improved?

Yes. A1C laboratory tests are now standardized. In the past, the A1C test was not recommended for diagnosis of type 2 diabetes and prediabetes because the many different types of A1C tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1C tests.

The NGSP certifies that manufacturers of A1C tests provide tests that are consistent with those used in a major diabetes study. The study established current A1C goals for blood glucose control that can reduce the occurrence of diabetes complications, such as blindness and blood vessel disease. 2

How is the A1C test used to diagnose type 2 diabetes and prediabetes?

The A1C test can be used to diagnose type 2 diabetes and prediabetes alone or in combination with other diabetes tests. When the A1C test is used for diagnosis, the blood sample must be sent to a laboratory that uses an NGSP-certified method for analysis to ensure the results are standardized.

Blood samples analyzed in a health care provider’s office, known as point-of-care (POC) tests, are not standardized for diagnosing diabetes. The following table provides the percentages that indicate diagnoses of normal, diabetes, and prediabetes according to A1C levels.

* Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.
Diagnosis* A1C Level
Normal below 5.7 percent
Diabetes 6.5 percent or above
Prediabetes 5.7 to 6.4 percent

Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may be retested each year. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes. Those with prediabetes are likely to develop type 2 diabetes within 10 years, but they can take steps to prevent or delay diabetes.

Is the A1C test used during pregnancy?

The A1C test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy—known as gestational diabetes. After delivery, women who had gestational diabetes should be tested for persistent diabetes. Blood glucose tests, rather than the A1C test, should be used for testing within 12 weeks of delivery.

More information about diagnosing and treating gestational diabetes is provided in the NIDDK health topic, What I need to know about Gestational Diabetes or by calling 1–800–860–8747.

Can blood glucose tests still be used for diagnosing type 2 diabetes and prediabetes?

Yes. The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetes-the fasting plasma glucose (FPG) test and the OGTT—are still recommended. The random plasma glucose test, also called the casual glucose test, may be used for diagnosing diabetes when symptoms of diabetes are present. In some cases, the A1C test is used to help health care providers confirm the results of a blood glucose test.

Can the A1C test result in a different diagnosis than the blood glucose tests?

Yes. In some people, a blood glucose test may indicate a diagnosis of diabetes while an A1C test does not. The reverse can also occur—an A1C test may indicate a diagnosis of diabetes even though a blood glucose test does not. Because of these variations in test results, health care providers repeat tests before making a diagnosis.

People with differing test results may be in an early stage of the disease, where blood glucose levels have not risen high enough to show on every test. Sometimes, making simple changes in lifestyle—losing a small amount of weight and increasing physical activity—can help people in this early stage reverse diabetes or delay its onset.

More information about diagnosing diabetes and prediabetes is provided in the NIDDK health topic, Diagnosis of Diabetes and Prediabetes, or by calling 1–800–860–8747.

Are diabetes blood test results always accurate?

All laboratory test results can vary from day to day and from test to test. Results can vary

  • within the person being tested. A person’s blood glucose levels normally move up and down depending on meals, exercise, sickness, and stress.
  • between different tests. Each test measures blood glucose levels in a different way. For example, the FPG test measures glucose that is floating free in the blood after fasting and only shows the blood glucose level at the time of the test. Repeated blood glucose tests, such as self-monitoring several times a day with a home meter, can record the natural variations of blood glucose levels during the day. The A1C test represents the amount of glucose attached to hemoglobin, so it reflects an average of all the blood glucose levels a person may experience over 3 months. The A1C test will not show day-to-day changes.

The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.

Blood Glucose Measurements Compared with A1C Measurements Over 4 Days

Blood glucose chart
Note: Blood glucose (mg/dL) measurements were taken four times per day (fasting or pre-breakfast, pre-lunch, pre-dinner, and bedtime).

The straight black line indicates an A1C measurement of 7.0 percent. The blue line shows blood glucose test results from self-monitoring four times a day over a 4-day period.

  • within the same test. Even when the same blood sample is repeatedly measured in the same laboratory, the results may vary due to small changes in temperature, equipment, or sample handling.

Health care providers take these variations into account when considering test results and repeat laboratory tests for confirmation. Diabetes develops over time, so even with variations in test results, health care providers can tell when overall blood glucose levels are becoming too high.

Comparing test results from different laboratories can be misleading. People should consider requesting new laboratory tests when they change health care providers, or if their health care provider’s office changes the laboratory or clinic it uses for blood testing.

How accurate is the A1C test?

The A1C test result can be up to 0.5 percent higher or lower than the actual percentage. This means an A1C measured as 7.0 percent could indicate a true A1C anywhere in the range from ~6.5 to 7.5 percent. Health care providers can visit www.ngsp.org to find information about the accuracy of the A1C test used by their laboratory.

The drawing below illustrates the range of possible true values when an A1C is 7.0 percent on the lab report. This range is based on the inherent variability of the laboratory test, often referred to as the coefficient of variation. Different degrees of laboratory variability result in different ranges of possible true values. The range illustrated is the maximum allowed by test methods approved by NGSP.

Blood Glucose Range 5 percent
Courtesy of David Aron, M.D., Louis Stokes Department of Veterans Affairs Medical Center

To put the A1C test into perspective, an FPG test result of 126 mg/dL obtained from a laboratory test accounting for typical variability within an individual person could indicate a true FPG anywhere in the range from ~110 to 142 mg/dL. This variation will be even greater if the blood sample is not processed promptly or is not put on ice, causing blood glucose levels in the sample to decrease. The drawing below illustrates the range of possible true values for an FPG of 126 mg/dL.

Blood glucose range from 110 mg/dL to 145 mg/dL
Courtesy of David Aron, M.D., Louis Stokes Department of Veterans Affairs Medical Center

Can the A1C test give false results?

Yes, for some people. The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results. Interference should be suspected when A1C results seem very different from the results of a blood glucose test.

People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant, that can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin.

Not all of the A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test for measuring their average blood glucose level. The NGSP provides information for health care providers about which A1C tests are appropriate to use for specific hemoglobin variants at www.ngsp.org .

More information about problems with the A1C test and different forms of sickle cell anemia is provided in the NIDDK health topics:

False A1C results may also occur in people with other problems that affect their blood or hemoglobin. For example, a falsely low A1C result can occur in people with

  • anemia
  • heavy bleeding

A falsely elevated A1C result can occur in people who

  • are very low in iron, for example, those with iron deficiency anemia

Other causes of false A1C results include

  • kidney failure
  • liver disease

How is the A1C test used after diagnosis of diabetes?

Health care providers can use the A1C test to monitor blood glucose levels in people with type 1 or type 2 diabetes. The A1C test is not used to monitor gestational diabetes.

The American Diabetes Association recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels have the A1C test twice a year. Health care providers may repeat the A1C test as often as four times a year until blood glucose levels reach recommended levels.

The A1C test helps health care providers adjust medication to reduce the risk of long-term diabetes complications. Studies have demonstrated substantial reductions in long-term complications with the lowering of A1C levels.

When the A1C test is used for monitoring blood glucose levels in a person with diabetes, the blood sample can be analyzed in a health care provider’s office using a POC test to give immediate results. However, POC tests are less reliable and not as accurate as most laboratory tests.

How does the A1C relate to estimated average glucose?

Estimated average glucose (eAG) is calculated from the A1C. Some laboratories report eAG with the A1C test results. The eAG number helps people with diabetes relate their A1C to daily glucose monitoring levels. The eAG calculation converts the A1C percentage to the same units used by home glucose meters—milligrams per deciliter (mg/dL).

The eAG number will not match daily glucose readings because it is a long-term average rather than the blood glucose level at a single time, as measured with the home glucose meter. The following table shows the relationship between the A1C and the eAG.

Relationship between A1C and eAG

Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supp 1):S14–S80, table 8.
A1C eAG
Percent mg/dL
6 126
7 154
8 183
9 212
10 240
11 269
12 298

What A1C target should people have?

People will have different A1C targets depending on their diabetes history and their general health. People should discuss their A1C target with their health care provider. Studies have shown that people with diabetes can reduce the risk of diabetes complications by keeping A1C levels below 7 percent.

Maintaining good blood glucose control will benefit those with new-onset diabetes for many years to come. However, an A1C level that is safe for one person may not be safe for another. For example, keeping an A1C level below 7 percent may not be safe if it leads to problems with hypoglycemia, also called low blood glucose.

Less strict blood glucose control, or an A1C between 7 and 8 percent—or even higher in some circumstances—may be appropriate in people who have

  • limited life-expectancy
  • long-standing diabetes and difficulty attaining a lower goal
  • severe hypoglycemia
  • advanced diabetes complications such as chronic kidney disease, nerve problems, or cardiovascular disease

Will the A1C test show changes in blood glucose levels?

Large changes in a person’s blood glucose levels over the past month will show up in their A1C test result, but the A1C does not show sudden, temporary increases or decreases in blood glucose levels. Even though the A1C represents a long-term average, blood glucose levels within the past 30 days have a greater effect on the A1C reading than those in previous months.

Points to Remember

  • The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months.
  • The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months.
  • In 2009, an international expert committee recommended the A1C test be used as one of the tests available to help diagnose type 2 diabetes and prediabetes.
  • Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes.
  • In the past, the A1C test was not recommended for diagnosis of type 2 diabetes and prediabetes because the many different types of A1C tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1C tests. Blood samples analyzed in a health care provider’s office, known as point-of-care (POC) tests, are not standardized for use in diagnosing diabetes.
  • The A1C test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy—known as gestational diabetes.
  • The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetes—the fasting plasma glucose (FPG) test and the OGTT—are still recommended. The random plasma glucose test may be used for diagnosing diabetes when symptoms of diabetes are present.
  • The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results.
  • The American Diabetes Association recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels have the A1C test twice a year.
  • Estimated average glucose (eAG) is calculated from the A1C to help people with diabetes relate their A1C to daily glucose monitoring levels.
  • People will have different A1C targets depending on their diabetes history and their general health. People should discuss their A1C target with their health care provider.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you .

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov .

September 2014

Alternate Versions

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

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