Pharmacy compounding is now more important for the following reasons

1. LIMITED DOSAGE STRENGTHS

The pharmaceutical industry supplies only limited strengths of drugs. One size does not fit all and it is often necessary to change the strength of a drug for patients, through compounding.

2. LIMITED DOSAGE FORMS

The pharmaceutical industry supplies only limited dosage forms; generally only an oral solid (tablet or capsule) and/or injection are manufactured. This does not address the needs of children, premature infants, the elderly, and special needs patients.

3. DISCONTINUED DRUGS

The pharmaceutical industry has discontinued thousands of drug products over the past 25 years, many due to economic considerations. These were very effective and important medications. The only way they are now available is through pharmacy compounding.

4. HOME HEALTH CARE

A significant percentage of the needs of home healthcare patients are satisfied by compounded medications, including, as an example, total parenteral nutrition (intravenous fats, sugars, and amino acids) necessary for the healing of colon disorders post-operatively. These patients cannot be satisfactorily medicated or sustain a nutritional status needed for healing with manufactured dosage forms.

5. DRUG SHORTAGES

With over 70% of all bulk drug chemicals being imported from China or India for the U.S. and EU pharmaceutical industries, and these industries then supplying Australia, commercially manufactured drugs become unavailable for various reasons. In many cases, these can be compounded to help “bridge the gap” until the commercial product comes back on the market.

6. HOSPICE and PALLIATIVE CARE PATIENTS

End-of-life therapy involves the compounding of many, many different and unique dosage forms to allow patients to live out their lives free of pain and discomfort. Many combinations of drugs are used for these patients who cannot swallow medications and who don’t have the muscle mass that is required to receive multiple injections each day. Other methods include compounded medications for oral inhalation, nasal administration, topical/transdermal, and rectal use.

7. ORPHAN DRUGS

When physicians prescribe drugs that are not on the market, they may be available as orphan drugs, either commercially or compounded.

8. INTRAVENOUS ADMIXTURES IN HOSPITALS

Many, if not most, of the lifesaving intravenous drugs given in hospitals and clinics are compounded. This saves the hospital personnel time and the patient multiple injections or administrations. It is hard to imagine being in the hospital without intravenous admixtures being available.

9. CLINICAL STUDIES

Pharmacists compound drugs that are not commercially available that are used in various clinical studies.

10. SPECIAL PATIENT POPULATIONS

Included here would be pain management patients, bioidentical hormone replacement therapy (BHRT) patients, sports injury patients, dental patients, dermatological patients, environmentally and cosmetic sensitive patients, and other patients who are being treated successfully with compounded medications prescribed by physicians. In fact, cancer treatment often involves compounded “cocktails”, or mixtures of cancer drugs that would be unavailable if they could not be compounded. Specialty compounded drugs for eye surgery, bone surgery, etc. would not be available.

11. NEW THERAPEUTIC APPROACHES

If a physician desires to use a medication that is successfully used in other countries but is not commercially available here, that physician can prescribe a compounded formulation of the medication for patients. A TGA-approved oral therapy prescribed as a topical gel for arthritis treatment to avoid gastric bleeding could reduce the overall cost of healthcare by avoiding hospitalisation from a gastric bleed.

12. VETERINARY COMPOUNDING

Animals can be grouped into various categories, including small, large, herd, exotic, and companion groups. There are actually relatively few medications available for animals, and those medications that are available are for specific species and diseases. In most cases, for an animal to be satisfactorily treated, a compounded medication may be necessary.