FIP 2009: Pharmacists should not write off compounding just yet

by Lin-Nam Wang and Pamela Mason

Compounding in community pharmacy is experiencing a resurgence in many developed countries, according to Gene Lutz, a community pharmacist from Iowa, US, during the 69th World Congress of Pharmacy and Pharmaceutical Sciences.

This contrasts with the situation in developing countries where growth is slow. Mr Lutz reported that in the US, about 5,000 pharmacies (one in 10) do a significant amount of compounding: “Compounding makes up about 5 per cent of dispensing. The margins are higher, largely because, in most cases, the patient pays then attempts to get the money reimbursed from their health insurer.”

What is the reason for this renewed growth? Mr Lutz said that in the distant past, compounding was pharmacy. Then, during the mid 20th century, it gave way to commercially prepared pharmaceuticals with the availability of many strengths and dosage forms.

“However, economics has changed all that,” he said. The manufacturers’ one-size-fits-all approach means they have stopped producing some less profitable lines, resulting in discontinued medicines, shortages and limited availability of certain strengths and dosage forms.

Other factors encouraging the resurgence of compounding include the use of orphan drugs for rare diseases. Patients cared for in hospices as well as those receiving home health care and children may also benefit from therapeutic formulations and dosages not available off the shelf.

Veterinary compounding is also growing. “Although compounded medicines may cost more, people are often more willing to pay for medicines for their pets than for themselves,” he commented.

Compounding is expected to have a growing impact on healthcare world-wide, he continued. Moreover, it will become more “high tech” to include compounding of biotechnology, pharmacogenomic and nano-technology preparations.

Traditional compounded dose forms, such as tablets, capsules and emulsions may gradually give way to newer compounded dosage forms, such as gummy gels, oral pastes, lollipops, mini troches, pluronic gels (for delivery of chest cavity antibiotics), implantable beads and sponge discs, he suggested.

However, challenges include regulation and quality, with requirements for laminar flow cabinets, clean rooms and so on.

Aygin Bayraktar, of the department of pharmaceutical technology at Hacettepe University, Turkey, highlighted a US study which showed that community pharmacists who provide compounding services do so because they believe it is an integral part of pharmaceutical care.

Most pharmacists in this study described having a closer relationship with patients receiving compounded preparations than with patients receiving only manufactured products, she added.

Citation: The Salvadore URI: 10980663

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