Compounding in the 21st century is much less common, but maintains a vital role in medication customization for high-risk patient populations and as a tool within integrative medicine. 

The process of compounding a preparation for the purpose of healing is as old as the human race. Ancient compounders, found throughout hunter-gatherer societies, knew that the medicinal properties of animals and plants within their environment greatly increased survival. The discoveries and practices of the earliest compounders drove the creation of the modern pharmacy profession and the principles of pharmacy compounding. However, the birth of the pharmaceutical industry led to replacing pharmacy compounding with mass production of medications in order to decrease cost and meet larger demands.

Many of the patients treated with customized compounded medications do so to address a particular need, such as a severe allergy to an ingredient in a medication, an inability to take the form in which the medication is available (cannot swallow tablets), and many others. Medications available at a regular pharmacy are manufactured to include the active ingredient (the drug the doctor prescribed) and inactive ingredients. Doctors typically utilize compounding pharmacies in situations where the drug is medically essential to the treatment plan, but the patient is allergic to an inactive ingredient in the commercially available medication. For example, a patient needs thyroid supplementation but is allergic to fillers (inactive ingredients) such as corn, gluten, lactose, or dyes; therefore, a compounding pharmacy prepares the medication without said inactive ingredient.

Most of the medications available at a pharmacy are produced as tablets or capsules for ease of administration. However, some patients are unable to swallow due to age, certain conditions and even loss of consciousness. The ability of a compounding pharmacy to provide alternative forms of a drug plays a crucial role in allowing these patients access to medications necessary for their conditions. Infants, for example, that require medication to stabilize a condition such as a seizure disorder, do not easily swallow tablets or capsules. Instead, a doctor would task a compounding pharmacy with turning the tablet/capsule into a liquid allowing the caregiver to administer the medication with little trouble.

Compounding provides a tool for practitioners to meet patients’ needs without compromising their health. Many practitioners prefer compounding for its ability to tailor the medication specific to each patient. In particular, integrative medicine practitioners utilize compounded medications to customize conventional and alternative medications when treating the “whole person”.

Integrative medicine utilizes all treatment options ranging from referring patients to specialized doctors to homeopathy and acupuncture. Integrative practitioners are experts at determining what combination of therapy (conventional and alternative) provides the best outcomes for the patient’s overall health. Many times integrative practitioners find it necessary for a patient to be on a compounded medication because every patient has different sensitivities to the amount of medication they need and can handle. Both integrative medicine and compounding pharmacy complement each other well, because of the focus on personalization whether it is for the treatment plan or the actual medication.

Compounding pharmacy may not be as common as it used to be, however it remains a staple within the profession of pharmacy. The current approach of one size fits all within our healthcare system is losing steam. More patients as well as practitioners are starting to favor the personalized approach for overall health. Compounding pharmacy will not replace pharmaceutical drug manufacturing (nor should it), but as with the ancient compounders, it will employ all the resources available in order to treat any patient’s specific ailment.

Mohammed Hassoun, Pharm.D., RPh, is a pharmacy compounding fellow at Johnson Compounding and Wellness, in Waltham, and assistant professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences University. For questions about compounding, call 781-893-3870 or visit NaturalCompounder.com.