Compounding
Compounding is the creation of a particular medication to fit the unique needs of an individual patient. To do this, a compounding pharmacy combines or processes appropriate ingredients in a laboratory environment, customized to specific patient needs. Demand for professional compounding has grown in recent years as both patients and doctors have realized that the strengths and dosage forms of commercially available medications are often unable or unsuited to meet the needs of many patients, and that they may have a better response to customized medications.
How can compounded medications benefit me?
There are several reasons why patients opt for traditional compounding. Many patients are allergic to ingredients in certain medications such as dyes or casein, are sensitive to standard drug strengths, or may have difficulty swallowing the pills or tablets that their medication comes in as standard.
A compounding pharmacist can work with a patient in order to change the strength of a prescribed medication, alter the dosage form to make it easier to take, or even to add a flavor that makes it taste better. Medications can be prepared to use several unique delivery systems such as:
- Sublingual troches or lozenges
- Lollipops
- Vaginal & Special shaped rectal Suppositories
- Nasal Sprays
- Suspensions
- Oral rinses
- Rapidly dissolving tablets
- Medicated treats for pets
- Topical medications in Permeation Enhancing Gel/Cream
Is prescription compounding safe?
Yes, compounding has been a part of pharmacy healthcare since its origins and is still used widely today. A compounding pharmacy must abide by state regulations, as well as section 503A of the Federal Food, Drug, and Cosmetic Act (FD&C Act), and is overseen by the state board of pharmacy. Optimal Wellness Pharmacy is overseen by the CA state board of pharmacy.
Dr. Katherine Diep-Kwei and her dedicated team of pharmacy professionals at Optimal Wellness Pharmacy offers compounding services to the people of Irvine and the wider community in CA.
Menopause and BHRT
Every day, women across the country experience a variety of symptoms associated with menopause and hormone imbalance. These include PMS, hot flashes, anxiety, mood swings, irritability, memory lapses and much more. Thankfully, modern medicines can help to relieve these symptoms. Bioidentical Hormone Replacement Therapy (BHRT) is a cutting-edge solution to a matter facing women every day. It is an alternative to traditional synthetic hormone replacement (HRT) and uses a natural human-identical hormone. The term bioidentical means that the substance that replaces the traditionally utilized synthetic hormone is biologically identical to one made by your own body. These hormones include estrogens, progesterone, DHEA, testosterone, and pregnenolone. Hormone imbalances will vary from woman to woman and a one-size fits all hormone replacement therapy is not optimal. Unlike traditional hormone replacement therapy, the true value of compounded BHRT is that the hormones can be adapted to suit your individual body and hormone levels.
Bioidentical hormones are more readily absorbed by the body and by optimizing the dosage strength the side effects associated with traditional therapies are minimized. This means the hormones work the same way the ones in your body have all your life. BHRT helps women to avoid the typical symptoms of menopause and hormonal imbalance.
- PMS
- Mood swings
- Hot flashes
- Night sweats
- Low libido
- Heart disease
- Osteoporosis
- Weight gain
- Infertility
- Endometriosis
- Painful menstruation
- Fibrocystic breasts
Optimal Wellness Pharmacy has helped many women with hormone-related problems and we can help you. We offer private consultations with our specially trained pharmacists. Private consultations allow you to address concerns or questions about bioidentical hormone replacement therapy. We will work with you and your physician to test your hormone levels and to develop a customized hormone replacement plan that best suits you.
If you are suffering from symptoms of menopause, please contact Dr. Katherine DiepKwei or a member of her pharmacy team on 949-861-3170.
Dental
Oral infections, pain or conditions such as chronic mucositis, may call for specialized treatments and drug delivery methods which may not be commercially available.
We work together with patients and their dentists to create non-commercially available formulations for dental care to increase treatment options helping to minimize patient anxiety and pain.
Mouthwashes and rinses are the most common dosage forms for dental patients. However, other options such as lollipops, gummy bears, troches, sprays, lip balm, oral gel and pastes can all be compounded.
The following are some examples of the dental solutions that Optimal Wellness Pharmacy can provide:
- Presurgical sedation
- Oral pain relief lollipops or lozenges
- Lip balms for viral lesions
- Topical anesthetics
- Crown preparation hydrocortisone gels
- Non-staining antibacterial rinses
- Oral sedation lollipops
- Lollipops for oral thrush
- Mouth rinses for chemotherapy-induced stomatitis
- Lozenges that help to suppress gag reflex
- Difficult to find or commercially unavailable medications.
Dermatology/Scar Management
Dermatology is the branch of medicine that deals with the skin and its diseases. Compounding can help the patient in a variety of ways including topical anesthetics, barrier creams for various applications, and all sorts of skin and wound care formulations that improve results.
If a patient is allergic to a medication then some preservatives, perfumes or emulsifying agents can be specifically removed and/or replaced by other ingredients with a low potential to cause allergies.
Active ingredients such as; dithranol, capsaicin, estradiol benzoate, thiabendazole, menthol, or polidocanol for example are not commonly found in commercial preparations. A customized version of the medication can be compounded to add such active ingredients.
The preparation’s strength can be customized to treat the patient with increasing or decreasing quantities of the active ingredient, which is especially useful in long-term care treatments.
There are many treatments that are improved by dermatological compounding and available from Optimal Wellness Pharmacy including:
- Acne- multiple drug options, including scar management
- Anti-Aging
- Anti-fungal- multiple drug combination
- Contact Dermatitis
- Eczema, Psoriasis
- Keloids & scars
- Pain (trauma, neuropathic, arthritic)
- Rosacea
- Skin bleaching creams
- Warts and molluscum
- Wounds
- Other- contact our pharmacists for other topical treatments, such as Metformin, Albendazole, and so on as prescribe
Scar Management
After the skin has been damaged from a burn, trauma, or surgery, scars form as a normal part of healing.
Everyone’s scars are different, and it can take up to a year for scars to heal completely.
To speed scar healing and add additional therapy components like pain relief, Optimal Wellness Pharmacy uses a base (Pracasil from PCCA ) with a high concentration of silicones and compounds it with additional medications, for example pain medication.
This compounded medication simultaneously provides pain relief without the side-effects of an oral medication and speeds up scar healing.
Pediatric
Pediatrics is the specialized branch of medical care for infants, children, and adolescents. This is one of the most popular uses for compounded medications since getting a child to take medication can be problematic and commercial dosages have generally been designed for adults.
Commercial medications can often be bitter or unpleasant, and children may be resistant to receiving these medications.
Optimal Wellness Pharmacy can take a bitter tasting medication and add for example a chocolate flavoring to it. Thereby improving the chance that a child will find the medication more appealing. For oral medications, a large variety of different flavors are available such as:
- Chocolate
- Strawberry
- Bubblegum
- Marshmallow
- Mint
- Mixed Fruit
- Raspberry
Because there is a lack of suitable pediatric dosage forms, Optimal Wellness Pharmacy can formulate alternative doses and dosage forms for your child, including syrups, lollipops, gummy bears, lozenges, or transdermal creams.
Dye-Free Medications for Allergies
Allergic reactions are a symptom of the immune system adversely reacting to typically harmless substances. Common symptoms of an allergic reaction may include rashes, red eyes, sneezing, a runny nose, shortness of breath, or swelling.
One of the most beneficial uses of compounded medicines is for patients who suffer from allergic reactions to ingredients found in common commercial drugs. A compounding pharmacy is able to break a medication down into it’s base compounds, recreating it with the same active ingredients either removing/replacing the offending substance or making the medication into something safer and less likely to cause an allergic reaction. For example a
compounding pharmacy may also be able to combine anti-allergens, such as antihistamines, into a medication if needed.
Pain Management
Pain management is among one of the most essential duties of medicine today. Even if the underlying condition is being treated, uncontrolled pain can severely diminish a patient’s quality of life preventing them from working, or taking part in their usual roles in family and society.
Chronic pain has numerous causes, and therefore can be much more difficult to manage than acute pain from a specific injury or condition, and the customized treatment protocols offered by compounded treatments can meet the specific needs of each patient.
Our compounding specialists offer many unique options for pain management. Regardless of origin, and whether the pain is acute or chronic, our efforts are directed at meeting the specific needs of each patient. We work together with patients and their physicians to reach treatment goals. Please contact our pharmacists for non-opioids pain treatment options.
Oral Dosage Forms
Oral dosage forms can also be customized to meet the specific needs of each patient. For example, we can combine numerous compatible medications into a single dose to make medication management. Medicated lollipops, gummy bears, solutions, and suspensions can also be compounded with added flavors to suit.
Nasal or Topical Sprays
Nasal spray delivery can provide quick onset of action and can be used as needed for breakthrough conditions such as pain or anxiety.
Localized topical sprays can be considered for patients with local heightened pain response. Topical delivery is also preferable over oral for better taste tolerance and systemic absorption.
Transdermal Dosage Forms
Transdermal medications are medications that are absorbed through the skin. This is very useful for patients who are unable to take an oral medication or have an aversion to injections. Many types of medication can be compounded into a transdermal gel.
Rectal Dosage Forms
Formulations can be delivered as suppositories, solutions and gels. In addition, there is a specialized delivery system which simultaneously applies the medication internally and externally.
Podiatry
Podiatric medicine is the branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle, and lower extremities.
Penetrant enhancers can be added to topical medicines to improve absorption and compatible medications can be combined into a single dose.
Compounding can be of great help in the treatment of many podiatric conditions:
- Inflammation and Pain
- Diabetic Neuropathy
- Non-Surgical Nail Removal
- Warts
- Nail fungus (Onychomycosis)
- Calluses
- Hyperhidrosis
- Decubitus ulcers
- Transdermal anti-inflammatory agents
- Skin softeners & moisturizers
- Transdermal treatments for neuropathy
- Keratinolytic agents
- Wound Care
- Plantar fasciitis (Heel Spurs)
- Anti-fungal foot powders
- Muscle & joint pain
How to write a compounding script?
The prescription should be started with Compounded Medication. Details in the example below. If you are a physician and would like to talk to a pharmacist about formulations or writing a script, please call Optimal Wellness Pharmacy on 949-861-3170 and ask for Dr. Katherine Diep-Kwei.
Palliative Care
Palliative care is the treatment of patients whose disease or condition is nonresponsive to curative treatment. It focuses mainly on providing relief from symptoms, pain, and mental stress.
Because palliative care is so unique to each individual patient, it benefits enormously from compounded medicines that can address the patient’s specific needs and care plans while allowing the caregiver to do their job more efficiently.
While every individual is unique, common symptoms and problems include:
- Pain Management
- Nausea and Vomiting
- Severe Constipation
- Diarrhea
- Decubitus Ulcers
- Shortness of Breath
- Anxiety
Optimal Wellness Pharmacy can compound medications which can help with all the above problems, and in a range of forms tailored to suit the patient such as:
- Transdermal
- Extended-release capsules
- Troches
- Gummy bears
- Suppositories
- Lollipops
Thyroid and Adrenal
Hypothyroidism:
Hypothyroidism is a disorder caused when the body’s thyroid gland does not produce enough thyroid hormone. This can cause a person to feel constantly fatigued, cold, and to gain weight. Hypothyroidism is extremely common, but often goes undetected because standard blood tests miss the majority of low thyroid patients. A number of health conditions are shown to be caused by or associated with low tissue thyroid levels, including:
- Insulin resistance
- Depression
- Chronic fatigue syndrome
- Fibromyalgia
- Autoimmune disease
- Iron deficiency
Hyperthyroidism:
Hyperthyroidism is the opposite of hypothyroidism, and is a disorder caused when the body’s thyroid gland produces too much thyroid hormone. This can cause a person to suffer anxiety, insomnia, sweating, and weight loss among other symptoms that can occur when bodily functions speed up due to excess thyroid hormones. A number of serious health conditions can be caused by or associated with excess thyroid hormones, including:
- Heart problems
- Eye problem
- Brittle bones
- Red, swollen skin
- Thyrotoxic crisis
Adrenal Fatigue:
Adrenal fatigue is a term applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems caused by the body’s adrenal glands not performing well enough due to stress, bacterial/viral infections, or hormonal imbalance. People who suffer from Chronic Fatigue Syndrome, Fibromyalgia, as well as premenopausal and menopausal women are particularly susceptible to this.
Compounded medications are available to help treat and/or alleviate all these conditions, please consult with us on 949-861-3170 and ask for Dr. Katherine Diep-Kwei or a member of her team today.
Veterinary
Veterinary compounding is a specialty service that helps veterinarians broaden their prescribing abilities and to offer dosage forms and strengths that can treat pets in a more effective manner.
Our compounding pharmacy can prepare:
- Flavored medication
- Medication modified by size, strength and dosage form
- Unavailable medications
- Combinations of medications to improve compliance
Flavored medication
Getting animals to accept medication can sometimes be a struggle, but a compounded medication can be flavored which may help a dog to accept a beef-flavored tablet or a cat to eat a liver-flavored chew.
Differing medication strengths
Many animal medications come in a standard size, even though different animals even of the same species can vary enormously. For example, with the average Maltese weighing under 7lbs whereas the average Labrador Retriever weighs 10 times as much. Compounded medications allow the veterinarian to scale the dose to suit a pet’s specific size and weight.
Dosage Forms
Many pets don’t like taking pills, however with veterinary compounding a veterinarian is able to vary the dosage form depending on the medication. Chewable treats, eardrops, liquid concentrations and transdermal medications are available.
Men's Health
Men experience many hormonal changes during their lifetime. As men age, the amount of testosterone produced by their body can decrease. Testosterone is the hormone responsible for sperm production, red blood cell production, muscle growth, libido, energy levels and male sex characteristics such as a deep voice and body hair.
Lowered levels of testosterone can be characterized by symptoms such as:
- Depression
- Erectile dysfunction
- Loss of libido
- Lethargy
- Declining muscle tone
- Osteoporosis
- Tiredness
- Irritability or mood swings
If you have been diagnosed with decreased levels of testosterone, then there are many compounded medications that may help you. In consultation with your doctor and our compounding pharmacist, Optimal Wellness Pharmacy can customize hormone replacement medications. For example, a transdermal gel can be compounded to deliver testosterone which can be absorbed more readily than other dosage forms.
LDN
Low Dose Naltrexone, also known as LDN, is an increasingly popular treatment option for autoimmune conditions, fibromyalgia, pain control and even cancer.
Naltrexone was developed in 1965 and oral Naltrexone (50mg) was approved to treat alcohol use disorders 1984. Naltrexone reduces both the rewarding effects of alcohol and craving for it.
Endorphins are opiate-like molecules produced naturally in the body and are important regulators of cell growth, and therefore the immune system.
Naltrexone works by causing the body to increase its production of endorphins and by making the body’s cells more receptive to the available endorphins.
A low dose of Naltrexone (LDN) takes advantage of Naltrexone’s impact on the body’s endorphins but does so for a short period before being metabolized. This method of autoimmune support boosts the natural defenses of one’s own system by helping to increase endorphin production. The elevated levels of endorphins in turn assist in regulating cell growth and immunity.
LDN is used to treat conditions such as:
- Autoimmune diseases
- Chronic fatigue syndrome
- Fibromyalgia
- Crohn’s disease
- Central nervous system disorders
- thyroid-related conditions
- Alzheimer’s Disease
- Multiple Sclerosis
- HIV/AIDS
- Cancer
If you have been diagnosed with an autoimmune disease or cancer and are looking for support, many patients with autoimmune conditions report significant improvements in their symptoms. Patients report improvement in fatigue, pain and mood after taking LDN.
This is done most commonly by taking a dose before bed, LDN then blocks the production of endorphins for several hours thus prompting your body to increase production and the resulting increase in available endorphins benefits the body’s immune system.
LDN is easy to administer and virtually free of side effects.
The exact low dose differs by patient and condition. Typically, the dose is in the range of 0.5mg to 3.5mg. Achieving an optimal strength for your body and condition is critical.
At Optimal Wellness Pharmacy, we help you find the correct dose of Naltrexone and are then able to compound the correct dose of LDN to suit you.
Allergic Reactions
Allergic reactions are a symptom of the immune system adversely reacting to typically harmless substances. Common symptoms of an allergic reaction may include rashes, red eyes, sneezing, a runny nose, shortness of breath, or swelling.
One of the most beneficial uses of compounded medicines is for patients who suffer from allergic reactions to ingredients found in common commercial drugs. A compounding pharmacy is able to break a medication down into it’s base compounds, recreating it with the same active ingredients either removing/replacing the offending substance or making the medication into something safer and less likely to cause an allergic reaction. For example a compounding pharmacy may also be able to combine anti-allergens, such as antihistamines, into a medication if needed.
Dosage Forms
The dosage form describes the physical form in which the medication will be delivered into the body.
Common dosage forms include tablets, oral suspensions, syrups, capsules, drops, troches, suppositories, inhalation, injections and transdermal patches.
Most common medications have only a handful of dosage forms. For example a tablet and suspension. And may contain filler allergens.
At Optimal Wellness Pharmacy, we can offer a much broader range of dosage forms than commercial medications, which is useful for many patients who may have difficulty taking traditional commercial forms.
Working with you and your doctor, our compounding pharmacist breaks a medication down into its basic compounds and recreate it in a new dosage form that may be easier to take or even more effective than the original.
There are many different dosage forms available to choose from including:
- Transdermal creams
- Capsules
- Gummy Bears
- Suppositories
- Lollipops
- Capsules
- Suspensions
- Lozenges
- Syrups
Not all dosage forms are suitable for all medications and conditions, please consult with Dr. Katherine Diep-Kwei to work out which one will be right for you.
Shortages
Drug shortages are unfortunately still common. Shortages can occur for many reasons including quality, production delays, and discontinuations.
The FDA publishes a list of drug shortages on its website. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
In order to minimize the impact on physicians and patients, FDA allows compounding pharmacies to compound commercial medications that have been discontinued or are on shortage.
If your medication is on the FDA drug shortage list, please call Dr. Katherine Diep-Kwei at Optimal Wellness Pharmacy on 949-861-3170.
