Sometimes a custom approach is needed to ensure your medications are right for you. We talked to Noreen Walji, Pharmacy Manager at North Central Co-op in Edmonton, Alta., about how compounded medicines can meet patients’ specific needs.

What is compounding and why is it needed?

Walji told us that compounding is the process of creating a customized pharmaceutical preparation to meet the unique needs of a patient when commercially available products do not. Commercial medicines are made in large-scale production where pre-set formulas, doses and ingredients leave little room for customization, so compounding fills that gap.

According to Health Canada, compounding combines two or more ingredients (of which at least one is a drug or pharmacologically active component) to create a final product in an appropriate form for dosing.

Compounding is useful in the following situations:

• The taste of the product is unappealing. Compounding can add flavouring to the medication to make it more palatable, and take the form of liquids, lollipops, chocolate squares, gummies, lozenges, sublingual or chewable tablets.
• The patient has allergies or intolerances. Compounding can remake the medication without dyes, gluten, lactose, or other additives and ingredients that cause problems.
• The patient has dietary restrictions or religious observations. Compounding can avoid animal-sourced ingredients or additives for patients who are vegetarian or vegan, and ingredients such as gelatin to make medications kosher or halal. Medications can also be made without any alcohol content.
• The commercially available product is unobtainable, recalled, experiencing production delays or has been discontinued.
• A specific dosage or strength is not available. Compounding can customize the strength or dosage of the active ingredient and be done via capsules, suppositories or injections.
• The method of delivery of the medication may need to change. For example, making transdermal formulations if a patient cannot take medications orally or making medications safe to administer via a gastronomy tube.

Does every pharmacy offer compounding services?

“While some pharmacies can offer some basic compounding services, most compounds require specialized equipment, training, and appropriate facilities to make the compounds safely for patients’ and staff involved in production,” said Walji.

If a pharmacy doesn’t offer on-site compounding, they may source preparations from a pharmacy which does have a license to compound and repackage medications. These compounding pharmacies follow strict guidelines concerning clean facilities, appropriate storage and packaging and labelling of all raw ingredients and manufactured medications.

All compounded medications are regulated federally by the National Association of Pharmacy Regulatory Authorities (NAPRA). Provincially, each College of Pharmacists sets standards of practice that each pharmacy must abide by to obtain a license for compounding.

Experienced, knowledgeable, and competent pharmacists, pharmacy technicians or pharmacy assistants with specialized training and equipment ensure the compounded medication is produced safely and accurately. Compounding pharmacies have an audit trail to ensure the patient receives a safe and effective product.

Are compounded drugs covered by insurance?

Depending on the insurance plan, company and circumstances, many compounded medications are covered with a prescribers’ prescription.

If you have questions about compounded medicines, talk to your Co-op pharmacist today!