What is a Compounding Pharmacy?

I get asked this question a lot.  In the simplest terms, a compounding pharmacy is a pharmacy that makes medicine on location in the pharmacy.  If you would like to know more than a simple definition, I will use the rest of this blog to simplify the complex process of making medications in a pharmacy.

How do you make medicine in a pharmacy?

When explaining the compounding process, I use the analogy of baking a cake.  To bake a cake, we must first buy the raw ingredients, measure each ingredient, and follow a recipe to mix and bake the ingredients.  Each part of this process is essential for making a great cake.  If we don’t have quality ingredients, the cake will turn out bad.  If we don’t measure out the ingredients correctly, the cake won’t taste or look right.  Lastly, if we don’t follow the recipe perfectly, our cake will be ruined.  Compounding pharmacies make medicine similar to baking a cake but in a scientific, precise, and regulated process.  We start by buying ingredients called Active Pharmaceutical Ingredients (API’s) from wholesalers, usually in powder form.  For example, we can purchase estrogen from our wholesaler, and it will arrive at the pharmacy in pure powder form.  We will then follow a calibrated and detailed recipe, called a formula, to measure and create the custom compounded medication.

We don’t just make medication on a pharmacy countertop. Just like a bakery has a specialized room to make cakes, we have a specialized and dedicated room to compound medication. In our compounding room, we have specialized and specific lab equipment.  Our lab has equipment like highly sensitive Ohaus Scales, special mixing machines like the Maz Mixer, double HEPA filtered AirClean vent hoods, Unguators, and many other specialized lab equipment. All this expensive equipment is there to ensure the precision and quality of the compounded medication.  After about 45 minutes of compounding work using the estrogen API, we will have a new batch of topical estrogen cream made to the exact specifications of the prescribing physician.

Are all compounding pharmacies the same?

No, not all compounding pharmacies are the same because they tend to specialize due to the sheer number and types of compounds they can create.   Let’s go back to our bakery example to understand why not all compounding pharmacies are the same.  Are all bakeries the same? No, because bakeries can specialize in cakes, breads, cupcakes, retail bakeries, countertop bakeries, food truck bakeries, etc.  Similarly, for compounding pharmacies, there are thousands of different compounds we can make.  This extensive list of compounds typically can be grouped into two main categories: sterile compounds and non-sterile compounds.  Most compounding pharmacies will have a focus or an area of expertise in one of these two broad categories.  For most pharmacies, there are simply too many types of compounds to focus on them all effectively.  At Pure Life Pharmacy, we specialize in non-sterile compounds such as creams, lozenges, lollipops, troches, gels, capsules, suppositories, tablets, and veterinary chewables (for our special furry friends).  All these forms of compounds are forms of medications that will not be inhaled, injected, or dropped in the eye where sterility is mandatory.

What does a compounding pharmacy do?

A compounding pharmacy makes medicine that cannot be found in the market due to a drug shortage or is simply not made by a drug manufacturer.

“Drug shortages can occur for many reasons, including manufacturing and quality problems, delays and discontinuations,” as stated on the FDA website for Drug Shortages.  When these shortages happen, physicians will reach out to us to make the medication that is no longer on the shelves of the traditional pharmacy due to short supply.

Another critical role we play in our community is making medications for a patient when the patient requires a personalized medicine that is not manufactured. For example, if a child or an elderly adult cannot swallow a capsule or tablet, they may require the same medication and dose in a liquid form. We will take that same medication and, through a compounding process, convert the medication from a capsule or tablet into a liquid.  At Pure Life Pharmacy, we go to great lengths to flavor it to make it more palatable for the patient.

Another common example of a necessary compound would be when a physician decides their patient needs a minimal amount of estrogen and progesterone to feel better.  The physician will send us a prescription for the three hormones and inform us of the exact amount of each hormone they would like the patient to have per dose.  The physician may also tell us to put the estrogen and progesterone in a troche (a small sublingual) that dissolves under the tongue.  Or maybe the physician thinks the patient would do better with a cream instead of a troche and tells us to put these hormones in a cream to be rubbed on the wrists.

Final Thoughts

Compounding pharmacies are an essential part of any community health system by maintaining the supply of drugs and providing personalized medications for an individual.  We have the unique ability to make medication on location to treat patients when there is no available or viable option.  People are uniquely made, and our problems may need a personalized medication solution.  At Pure Life Pharmacy, we take great pride in providing unavailable medications or customized medical solutions to those in the community who have these unique needs.

~Jeffrey
Jeffrey O. Hoover is the Founder and Owner of Pure Life Pharmacy. Learn more about Jeffrey.