Hippocrates' Modern Colleagues
|Compounding and Women's Health at Midlife||
by Michael Goodman
Back in the "old days" all pharmacists compounded. With limited availabilities of commercial pharmaceuticals, many medications and treatments were personally made up and put together --"compounded" -- for the unique needs of each individual. Both dosage, medication (singly or in multiple combinations) and delivery system (pill, capsule, sublingual drop or troche, transdermal gel, lotion, cream, etc.) could be personally compounded by the pharmacist.All pharmacy students still learn compounding in school, but most do not utilize this skill. There are approximately 2,500 compounding pharmacies in the US, compared to +/- 40,000-50,000 "regular" pharmacies. You may locate a compounding pharmacist in your area by contacting the International Academy of Compounding Pharmacists at (800) 927-4227 or at www.iacprx.org, or check with Professional Compounding Centers of America at (800) 331-2498 (www.pccarx.com). There are excellent compounding pharmacies in Davis, Woodland, Sacramento, Gold River and Auburn.
Upon receiving a prescription or consulting directly with a physician and/or the patient, the pharmacist takes the necessary ingredients (frequently bioidenticals derived from plant sources) and compounds (or blends) them to meet the specific needs of the individual.
Many different medications may
be compounded (including medications for pain relief and novel ways of giving
medications to children). For the purposes of this article, I shall only be
discussing those that impact health care for midlife women. These preparations
can include estriol, estradiol, estrone, progesterone, testosterone, DHEA,
pregnenolone and others.
A majority of women do quite well on commercially available fixed-dosage products. Why, then, compound? The reasons are multiple.
Compounding gives the
consumer more choice of delivery systems, limited only by the imagination of
the pharmacist. Creams, lotions, sublingual, troches or drops,
suppositories, salves, gels, capsules, etc. are available.
Compounding can obviously
deliver more exact dosing for the individual. Compounding increases the
choice of medications, with different isomers and compounds (especially
plant-sourced bioidenticals, compounded to be "bioidentical" to
the hormone or substance it is replacing) that may not be available
Compounding gives the
patient (in this case the midlife woman) more choice. With more alternatives
and the individual counseling each patient receives with the compounding
pharmacist, compliance with a therapeutic regimen is more likely with
patients who are more involved with their care.
Compounded products are
also more likely to be metabolized (accepted into the system) by patients
who have had difficulties with commercially available medications.
Additionally, compounding allows for usage of especially designed delivery systems for patients with multiple allergies.
AVAILABLE PRODUCTS FOR WOMEN:
The three estrogens natural to women’s bodies--estriol, estradiol and estrone, may be compounded. Estradiol (which is commercially available as well) is adequate for most women, but many do better with a perhaps more physiologic combination of estriol and estradiol ("BiEst") or all three ("TriEst"). Although concentrations may be individualized, the most common for BiEst is 80% estriol, 20% estradiol, and for TriEst, 80% estriol, 10% estradiol and 10% estrone. A weak estrogen, estriol, may be a "safer" estrogen for long-term use in women, especially for women at risk for breast cancer. Most estrogen products are synthesized in the laboratory utilizing soy as a base, producing the bioidentical hormones.
Just because a medication is "hand fashioned" does not necessarily mean that it costs more, although this frequently is the case. Because of economic factors and the inability of managed care organizations to make low-cost "deals" with individual pharmacists, many managed care plans (HMOs) do not pay for compounded preparations, although compounding is covered by many PPOs. As in everything else in medicine (as elsewhere), "you get what you pay for..."
Dr. Goodman’s office "Caring for Women" is in Davis, California. Dr. Goodman is the author of the recently released "The Midlife Bible: A Woman’s Survival Guide", available at bookstores or on his website, www.caringforwomyn.com.
(Please note: Articles that appear on this web site may not reflect the opinion of the editorial staff.)