Saturday, November 14, 2009

Hint hint, nudge nudge...

Anyone into compounding?

I've done my share...actually, much more than the average. I'm trained in non-sterile and aseptic compounding, and I really enjoy it.

There's much more brain cells being used with each prescription compounded than a typical rx filled. I mean, there's calculations, technique, stability, sterility, QA, etc. etc. Not just count, check, counsel. I feel more complete and more professional satisfied when I've actually done something that requires my expensive brain cells. I mean even a good DUR identification is better than just checking an inhaler refill. Wait, unless you're at the tail end of a 14 hour shift and you're feeling light headed because all the blood has rushed to your feet from standing forever.

So compounding, for those who don't know is the art of customizing medications for the patient to suit their needs. In Canada, its much less of a big deal than in the States. We only have "guidelines", nothing legislated about the standards a pharmacy must maintain if/when compounding. So yes, that means no USP 795 or USP 797. But like most things, Canada (or each province one-by-one) will eventually adopt the US standards and call it slightly different (just so people think they thought of it on their own).

What does that mean right now. It means compounding in Canada is like the Wild West! Anyone can do whatever the heck they want under any circumstance - although most don't. There are some who are pushing the envelope. Most pharmacists have enough respect for their patients that they do follow the guidelines, but some don't and think its okay to bend the rules once in a while and enter the gray area.

What is the gray area? Well, it's kind of gray.

So, compounding pharmacies aren't as prominent as in the US, but I foresee it going that way. Should I hop on that train? I'd love to, but it would be nice to have someone who has done it before and has the experience and $$ to help.

Know anyone?

1 comment:

  1. I think the gray area comes in when pharmacists start to use compounding as a means to an end, or advertise that what they 'do' is better or more special than what other pharmacies do to patients, like when coming up with specially prepared 'natural' hormones as an alternative to Premarin. The science for the benefits of these 'natural' hormones wasn't even there, and here were druggists compounding and advertising to lure customers to their service.

    As far as I know, compounding something is introduced in the pharmacy school curriculum so it's not like pharmacists cannot do it, but it's inconvenient use of time to stop and whip up a batch of rose cream if there's a perfectly adequate manufactured supply available that ascribes to good manufacturing practices.

    Working in the hospital, in my pharmacy I like to take a few minutes if it's slow, to mix up Mary's Magic Mouthwash (tetracycline, hydrocortisone, nystatin, in diphenhydramine liquid), but when required, I'm not going to make up a gallon, and market it to my docs for every patient that has a sore throat!