Most pharmacists spend their days dispensing pills -- but some are mixing up their own remedies the way pharmacists used to do in mortar-and-pestle days.
It's making for some interesting results.
Eric Holgate, one of a handful of compounding pharmacists in Augusta, spikes lollipops with painkillers for tonsillectomy patients. Austin Gore puts medicine in the icing of an Oreo cookie for children who refuse to take a pill.
"Millions of Americans have unique health needs that off-the-shelf prescription medicines cannot meet," said Laura Hosny, a spokeswoman for the International Academy of Compounding Pharmacists, a trade association. "For them, a customized, compounded medication prescribed by licensed physicians or veterinarians and mixed by trained, licensed compounding pharmacists is the only way to better health."
Though many retail pharmacies still offer compounding, changes in the pharmaceutical industry during the 1950s and '60s transformed pharmacists from mixologists to pill dispensers. Today, just 1 percent of the 4 billion prescriptions written last year were compounded, according to the U.S. Food and Drug Administration.
That leaves many patients who need more than a one-size-fits-all prescription. Some have allergies to preservatives, dyes or binding agents, while others require medications in different strengths and forms -- a liquid instead of a pill.
Mr. Gore, a clinical pharmacist and the owner of Clinical Specialties in Augusta, makes compounded prescriptions full time. He works closely with doctors.
"We have a lot of doctors who call us and say, 'I've got this patient, and this is what I've tried. Do you have any other options?' " Mr. Gore said. "A lot of the things that we do are not commercially available."
Mr. Gore said 50 percent of his work involves hormone replacement. An additional 20 percent is in making medications for children and sports medicine, physical therapy and hospice patients. He also compounds veterinary medicines for animals.
On a physician's request, he has made a migraine medication without acetaminophen (Tylenol), because the doctor didn't want his patient consuming too much of the active ingredient.
He also has made promethazine gel, which can be applied to the wrist, for patients with nausea.
He has even launched his own hand cream, Outdoor Hands, which he sells commercially at grocery and retail drugstores in Augusta. He developed the product when his wife was unable to find relief for her dry hands.
Mr. Holgate, of DuraMed Medical Specialties, works full time as a compounding pharmacist. He started almost 20 years ago as an intravenous therapy pharmacist and enjoyed the challenge of compounding.
"You're solving problems, and you're also getting to work closely with the physician and patient, which was how pharmacy was set up," Mr. Holgate said.
Each week, he consults with hormone replacement and hospice patients, and he works closely with ear, nose and throat doctors to make custom ear drops and other medications.
Mr. Holgate has 2,500 female patients who consult with him for hormone replacement. On average, he said, he and his staff make 40 to 50 prescriptions a day, compared with the 250 prescriptions a day at retail pharmacies.
Mr. Holgate has formulated lollipops to help people quit smoking and has created his own product, MagPro, a topical muscle relaxer that is being used by professional sports teams such as the New England Patriots and Tennessee Titans.
Because pharmacy students receive only brief compounding instruction in school, Mr. Holgate and Mr. Gore have opened their doors to teach students the profession.
Vanessa Hoffman, a compounding pharmacist at Barney's Pharmacy Inc. in Augusta, entered the profession in 2005. She learned about compounding in pharmacy school and enjoys it because it is "patient-specific."
She makes pediatric suspensions (items not commercially available for children), hormone replacement creams and suppositories for pregnant women trying to prevent preterm labor.
Karen Powell, a pharmacist at Parks Pharmacy in North Augusta, has worked in the field for 22 years. Among her compounded prescription orders, she makes topical creams for hospice patients and people with muscular dystrophy because they often have difficulty swallowing pills. She finds the profession rewarding.
"I enjoy it," she said. "You know when they come to a compounding pharmacist, the traditional venues are exhausted."
Reach LaTina Emerson at (706) 823-3227 or firstname.lastname@example.org.
- The International Academy of Compounding Pharmacists represents 2,000 compounding pharmacists nationwide, with 61 members in Georgia and 35 in South Carolina.
- Compounding pharmacists are trained, licensed pharmacists who specialize in compounding or making custom prescriptions.
- They fill prescriptions for millions of Americans with unique health needs that off-the-shelf prescription medicines cannot meet.
- The practice is regulated by state boards of pharmacy that monitor licensing and training.
- Compounding pharmacies can apply for accreditation under the Pharmacy Compounding Accreditation Board.
Source: International Academy of Compounding Pharmacists
- Tetracaine lollipops (all flavors) -- for numbing and relieving painin post-tonsillectomy patients
- Oreo cookies with medicine in icing -- for children who refuse to take their medicine
- Gels or creams for hormone replacement, sports medicine, nausea or hospice patients
- Suppositories for pregnant women trying to prevent preterm labor
- Medications for animals (cats, dogs, horses and rabbits) -- such as seizure drugs or mixing prescriptions inside of a peanut butter patty
Sources: Austin Gore, Clinical Specialties; Eric Holgate, DuraMed Medical Services; Vanessa Hoffman, Barney's Pharmacy Inc.; and Karen Powell, Parks Pharmacy.