Compounding is the method of preparing customized medications by combining individual ingredients in the exact strength and dosage form required to help meet each patient’s unique needs. There are numerous formulations, ranging from creams and eye drops to mouthwashes and suppositories.

Medications are compounded for many different reasons. This process provides access to discontinued medications and drug strengths that are not commercially available. For some patients, medical reasons mean they need a medication to be made in a different form, like a tablet or liquid, or to avoid an ingredient they are allergic to. Compounding can also help when there is a shortage of raw materials, or an increased demand for a certain drug.

Here are some of the most common applications of compounding at Sunnybrook’s outpatient pharmacy:

Pain Management

Pain relievers have long been available commercially to address chronic pain. Compounding has now made it possible for patients to have medications tailored to their particular needs to help provide targeted relief through specialty creams, gels, sprays and capsules.

Dermatology

Many people suffer from skin problems like rosacea, eczema, acne and psoriasis. To help reduce the risk of unpleasant side effects like redness and irritation, medications can be compounded by carefully selecting ingredients for each patient’s skin type.

Pediatrics

It’s not uncommon for children to refuse to take medications because they don’t like the taste or have a hard time swallowing pills. Doses catered specifically for children may contain dyes and preservatives that cause allergy or sensitivity, or be unavailable. In these cases, compounding can individualize the treatment into a child-friendly format that’s easy to administer, like a liquid or suppository.

Geriatrics

Needing several different medications for various health issues is increasingly common as we age. Conditions like dry mouth, however, can make it hard to ingest tablets and capsules. By compounding, multiple drugs can be combined into one easy to swallow preparation. Medication strengths can be lowered if necessary, and ingredients causing sensitivity can be avoided.

Hormone Replacement Therapy

Hormones play an important role in our overall health, but their levels can fluctuate as we age. Common symptoms include mood changes and hair loss. Compounding allows for customized hormone replacement delivered through applications like creams, capsules, vaginal suppositories and topical solutions.

Sports Medicine

Sports injuries impact both seasoned athletes and those who are new to exercise. They reflect damage from a diverse range of activities that can flare up issues like inflammation, muscle spasms and fungal infections. Compounding solutions provide the ability to alter and deliver the exact strength and application of prescribed medications.

If you have questions about compounding, be sure to check in with your pharmacist.

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The Answer: This is the kind of question doctors hear all the time and highlights some of the dangers of being on multiple drugs, particularly from multiple doctors and especially multiple pharmacists. There is no guarantee any of these health professionals are talking to each other and the risk of a dangerous drug interaction – when one drug changes the response to another medication – is high.

“There are literally thousands of drug interactions out there,” said David Juurlink, head, division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre. “If I have a patient in the emergency department on 8, 10 drugs, there’s a very good chance we will find at least one, and possibly several, potentially dangerous interactions.”

According to Dr. Juurlink, “drug interactions are largely predictable and, as a result, largely avoidable.”

Some drugs are particularly prone to interactions. They include common cholesterol drugs (statins), antibiotics, anticoagulants and lithium – all of which, when taken with other medications, can cause potentially dangerous reactions.

Though it is rather well known, it is worth repeating that taking grapefruit juice can amplify the effect of certain drugs because more drug is absorbed from the gut. This is particularly true with statins – lovastatin, simvastatin and atorvastatin – used for the treatment of high cholesterol. Grapefruit juice taken with those drugs will cause too much of the active ingredient to enter the blood stream, resulting in side effects such as muscle damage.

The post Dangerous Drug Interactions and How to Stop Them appeared first on Your Health Matters.

It’s getting nasty, folks. In one corner, (big) pharmacy, duking it out with the Ontario government in the other. It’s all over proposed changes to the province’s prescription drug system. But long before this battle got brewing, Sunnybrook Health Sciences Centre was piloting a broader solution. Call it, thinking inside the box.

Imagine a large green bank machine, but instead of money, this one dispenses medications (about 300 of the most commonly prescribed drugs). It’s the latest convenience in a long line of predecessors, including remote controls and cell phones. How did we live without them? Well, we could soon be saying the same thing about PharmaTrust Med Centres.

It’s an idea with long legs. As a parent, I know I’ve been stuck driving around looking for a 24-hour pharmacy on more than one occasion. With the current conflict between pharmacies and government, that could become even more difficult. This so-called “virtual pharmacy” is hoping to fill a void, especially in more remote communities.

How it works is pretty simple. After receiving your prescription from your doctor, you scan it into the machine itself. That information is transmitted to a remote pharmacist who pops up onto a television screen in front of you. You pick up the phone connected to the Med Centre and have a discussion with the pharmacist, just like you would in person, to make sure the medication is safe and appropriate. Once that’s determined, you can pay on site using your debit or credit card. And within a few minutes, the machine dispenses your medication, along with prescribing information.

The first one located in a downtown Toronto hospital is currently at Sunnybrook’s Holland Orthopaedic and Arthritic Centre. It’s also been piloted at Sunnybrook’s Bayview campus, with a thumbs-up response. Informal analysis finds most people would use it again, or recommend it to a friend.

PharmaTrust won’t replace your local or hospital pharmacy, especially for patients who would rather speak with an expert in person, but it is another choice. And it’s an innovative one that may be the future.

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