Compounding pharmacies have recently received a lot of bad publicity in the wake of a multistate fungal meningitis outbreak. That's because the source of the contaminated steroids responsible for the illnesses and deaths was a so-called compounding pharmacy. But unlike traditional compounding pharmacies that create customized medications-one at a time, according to a physician's prescription-this pharmacy was mass-producing them.

Even though the meningitis outbreak has been tragic, legitimate compounding pharmacies that create customized medication do play an important role in the practice of medicine. With about 3,000 compounding pharmacies now operating in the US, when is it appropriate to use one? In my practice, for example, I often recommend compounding when a patient needs a…

  • Low-dose medication. If a patient requires hormone replacement with testosterone or estrogen, for instance, I often send him/her to a local compounding pharmacy with a customized prescription for that individual. This approach allows me the flexibility to prescribe very small or unusual doses that are not available commercially in conventional pharmacies.
  • Non-pill preparation. Liquid or sublingual (under-the-tongue) preparations often are required for patients with swallowing or absorption problems. For example, the sleep hormone melatonin is commercially available as a pill. However, I often find that a sublingual melatonin preparation, available from compounding pharmacies, is better for patients who have swallowing difficulties.
  • Preparation with a short shelf life. Some natural medicines, such as glutathione (a powerful antioxidant), have a short shelf life (depending on the preparation, it can be as short as 10 days). Compounding pharmacies can produce such preparations with fresh medicinal ingredients.

Of course, you don't need to go to a compounding pharmacy for every medication, and compounded drugs are not always better than ones that are commercially manufactured. In some cases, compounded drugs are more expensive than their commercially made counterparts. The decision to use a compounded medication is usually made by your physician. However, if you have unique needs that you think could be better addressed with a compounded medication, be sure to discuss them with your doctor and ask if a compounded medication would be best for you.

Surgery Preparation Myth

Is there any truth to the "nothing by mouth after midnight" rule when preparing for surgery?

Decades of research have shown that having a light breakfast, such as black coffee and dry toast, six or more hours before surgery is safe for most healthy patients. So is drinking clear liquids two or more hours before surgery. In fact, surgical patients who drink clear liquids are less thirsty and hungry, less worried about surgery and less likely to get a headache from forgoing their morning coffee. Surgical patients should just be sure to first check with their doctors.

Those facing surgery should also ask their doctors about carbohydrate loading. Several European health organizations now recommend drinking a carbohydrate-rich, clear liquid, such as Clearfast, the evening before and the morning of surgery. It can ease recovery by reducing some of the negative side effects of surgery, such as nausea, vomiting and impaired insulin response.

Compounding pharmacies operate in a variety of ways-as small, individual stores limited to compounding...within a conventional locally owned pharmacy...or as sections of large commercial pharmacy chains. Like regular pharmacies, compounding pharmacies are regulated by individual states, though the oversight may be expanded in the wake of the recent meningitis Outbreak. Pharmacists who work in compounding pharmacies are licensed just as those who work in traditional pharmacies are licensed. Your doctor should be able to recommend a reputable compounding pharmacy in your area.

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