Compounding pharmacies are at the heart and soul of individualized medicine. I could not do much of my functional and integrative medicine without them and you’ll soon understand why you may want to convert some of your prescriptions over to a compounded formulation. We as people and as patients have unique DNA, environments that influence our genetic expression, tolerances and allergies, as well as philosophies of our spiritual and lifestyle ideologies. The standard pharmacy dispenses commercial medications that have been manufactured with pre-set doses on a large, industrialized scale. The active ingredients are consistently formulated as well as the binding fillers. I think we all have experience with going to a local pharmacy and picking up a prescription manufactured from a large pharmaceutical company and filled at the pharmacy. How many of you have had side effects or intolerances to those prescriptions supplied to you? Here’s where compounded prescriptions may be right for you, and why some of us functional medicine physicians have had great success in helping our patients.
Let me clear the air and remind everyone that compounding pharmacies are run by licensed pharmacists, and they are regulated by the FDA, United States Pharmacopeial (USP) Convention, and DEA when controlled substances are formulated. While each medication is considered novel and “not FDA approved” the component parts which make up the formulation are FDA approved. Clearly one of the biggest advantages to customize medication is to specifically adjust the strength or dosage of a medication. This improves tolerance and the benefits of the medication helping the condition. As I have been using compounded medications for so many years, I’ve also found that the first medication may actually need to be fine-tuned and tweaked as we are trying to optimize a patient’s condition. Compounded thyroid medication and bio-identical hormones come to mind with this approach.
I deal with all age brackets and conditions that may preclude someone from being able to swallow pills and have heavily relied upon the knowledge and creativity of a compounding pharmacist to help change the form of a medication. A traditional medication may only be available in a tablet. Our compounders can create the same medication in a capsule, liquid, transdermal gel, suppositories, or other doses to suit the unique needs of the patient. Children may need to flavor a medication or get a lollipop version to enhance tolerance. The specific enhancement of the dosing is also very important in pediatric management to create a product that is dose-specific and tolerable.
Since functional medicine deals with a patient base with chronic illness, autoimmunity, hormone health, and natural approaches for wellness, compounded medications notoriously reformulate a drug to exclude unwanted fillers and ingredients. Medications can easily be made lactose-free, gluten-free, dye-free, and allergen-free. Most of the compounding medications that I’ve prescribed work with the plant-based compounds instead of animal-based products (bio-identical medications come to mind), and this certainly resonates with the vegan and animal friendly clientele. Plus, our bodies also process the plant-based formulations far better than animal-based or highly synthesized products since they are bio-identical or bio-similar to our own innate compounds. Our liver and kidney and detoxifying mechanisms can break down these products far better than many traditional manufactured medications.
Most of the compounding pharmacies I’ve worked with have the added benefit of ordering hard-to-find medications or older ones that don’t make much money for a large pharmaceutical company, and therefore, no longer manufactured. In the pandemic we have seen the compounding pharmacists coming to the forefront to help their communities by making dose-specific medications from powders shunned or unavailable at large pharmacies. The local and neighborhood feel of a compounding pharmacy just simply cannot be replicated by large pharmaceutical companies whose executives seem nameless and faceless.
Custom formulations sound expensive, right? In actuality, most compounded medications are very reasonable. There sometimes are discounts for “large batch” amounts, but to be clear, most prescription benefits seem to exclude compounded prescriptions, and therefore, most compounded pharmacies are cash-based because of that. These medications are true medications as well, so a prescription is needed for each one. The beauty of custom formulations is that it incorporates the three-way relationship of the compounder, the patient, and the prescriber. I’ve had great collaboration with the pharmacist and patient to enhance absorption with difference cream bases, allergenic considerations, flavor considerations, and brand new creations tailored to combine several medications in one vehicle, to cut down patients’ cost and intolerances. I am not a veterinarian, but compounding has been used for many, many years to help our furry patients achieve their optimal health as well!
The preparations that lend themselves so well for the compounded pharmacy approach included: bio-identical hormone replacement, peptides, low-dose naltrexone (LDN), thyroid treatment (particularly autoimmune based), adrenal health products, pediatric reformulations, allergy-free, products, dermatology creams of many types, nasal rinses, and hard to find anti-bacterial and anti-fungal preparations. The best approach is to contact a functional medicine physician well-trained in prescribing compounded prescriptions and established with compounding pharmacists.
