Compounds

Cosmeceuticals, nutraceuticals, pharmaceuticals a full range of compounded medications.

What is Compounding?

Until now, physicians who wanted to customize medicinal therapy for a particular patient found little or no support from manufacturers or pharmacists. The opportunity now exists to initiate that customized therapy through compounding.

Compounding enables specially trained professionals to prepare customized dosage forms that are just what the doctor ordered. Each compounded prescription is created to your physician’s specifications to meet your unique needs. With today’s technology, yesterday’s art, and currently available dosage systems, the possibilities are almost endless.

Compounding helps to provide patients with customized medications when a dosage or form they are able ingest is not commercially available. We provide high quality medications in a variety of forms including: Balms, Capsules, Creams, Gels, Injectables, Lip Balms, Liquids, Lollipops, Lotions, Lozenges, Nasal Preparations, Pastes, PLO Gels, Solutions, Sprays, Suppositories, Suspensions, Transdermals

Our state-of-the-art facility is equipped to compound any medication in any dosage specific to your individual needs. We can customize medications with a variety of flavors to suit any individual, whether the patient is a child, a pet, or an elderly individual.

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Andropause
Bio-Identical Hormone Replacement
Cosmeceuticals
Dentistry
Pain Management
Pediatrics
Podiatry
Sports Medicine
Wound Care
Veterinary

Andropause

Andropause is basically the male equivalent of what women go through during menopause. Women experience hormonal changes during menopause and men go through similar changes in hormonal levels. Some men go through sudden changes in their testosterone levels, while most men have a more gradual hormonal decline of about 1% per year after the age of 40. In addition, during this time, estrogen levels may be increasing. By the age of 54, the average man’s estrogen level is the same as the average 59 year-old woman’s.Testing through a blood or saliva sample is required to check for hormonal imbalances and to determine if testosterone replacement is necessary.

Symptoms of Andropause:

• Erectile dysfunction
• Reduced libido
• Atherosclerosis
• Mood swings
• Memory failure
• Loss of sense of well being
• Depression and anxiety
• Heart disease
• Osteoporosis
• Feeling weak
• Loss of ability to concentrate

Treatment of Andropause

The most common treatment for Andropause is bio-identical testosterone. Transdermal testosterone gel may be rubbed into the skin as a therapy for Andropause. The benefit of using a transdermal gel is that a gel will not irritate the skin like some testosterone patches and it can be applied as little or as much as is necessary for your individual body.

The term testosterone is often used generally to refer to both, synthetic and bio-identical testosterone. There has been some confusion in which form of testosterone is safe and effective in treating Andropause symptoms in men. Synthetic and bio-identical testosterone should not be confused. Synthetic testosterone may be harmful to the liver and is not available in Europe.

Testosterone replacement therapy is contraindicated in patients with prostate or breast cancer. Physicians Compounding Pharmacy can compound just the right medication to help you treat Andropause.

Men’s Hormone Evaluation (pdf form)

Some commonly compounded Andropause medications include:

• Testosterone cream
• Testosterone lotion
• Testosterone gel
• Testosterone PLO gel
• Testosterone cypionate in oil injection
• Chronic gonadotropin injection

Supplements for Andropause:

• Zinc
• Vitamin C

Bio-identical Hormone Replacement Therapy (BHRT)

Women experiencing menopause, PMS, PCO, perimenopause or infertility often find their symptoms relieved by initiating a bio-identical hormone replacement regimen. The bio-identical term doesn’t refer to the source of the hormone, but rather refers to the chemical or molecular structure of the hormone. Bio-identical hormones, sometimes referred to as natural hormones, are those that are molecularly identical to the hormones that are produced in the body. They have the same exact chemical structure as the hormones our bodies produce. Because they have the same chemical structure, bio-identical hormones are able to follow the normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy.

Bio-identical substances cannot be patented so they are typically not manufactured by drug companies and are made in a compounding pharmacy. One of the many advantages of this is that the dose can be customized to meet each person’s individual replacement needs. One size does not fit all when it comes to hormone replacement therapy.

Testing for hormonal changes/imbalances begins with laboratory tests of hormone levels (known as hormone panels). The physician then prescribes a precise dosage of bio-identical estrogen, testosterone, DHEA, etc to be created at Physicians Compounding Pharmacy. Each patient is then monitored carefully through regular follow-up hormone panels to ensure they obtain symptom relief at the lowest possible dosage. In the initial stages, a hormone panel is often required every three months. Once balance is restored, most physicians require one panel a year at the time of the patient’s annual exam.

Symptoms patients may have when hormones are not in balance:

• Anxiety
• Depression
• Hot flashes
• Loss of bladder control
• Mood swings
• Sleep disturbances
• Decreased libido
• Headaches
• Irritability
• Memory problems
• Night sweats
• Vaginal dryness
• Painful intercourse
• Joint pain

Treatment with Bio-Identical Hormone Replacement Therapy

Therapy with bio-identical hormones typically involves creating a specific combination of hormones that is unique to each individual patient, based on the patient’s unique hormone deficiencies. These are often referred to as custom-compounded hormone products. The major benefit of this type of treatment is that doses are individualized and since the unique combination of products required may not be commercially available, custom-compounding is a great option.

Common forms of bio-identical hormones include: creams, oral, suppository, troches, and/or injections.

There are significant differences between bio-identical and synthetic preparations. Structural differences that exist between bio-identical human, and non-bio-identical synthetic hormones may be responsible for side effects that are experienced when synthetic hormones are used for replacement therapy.

Women’s Hormone Evaluation (pdf form)

List of bio-identical hormones:

• Estrone (E1)
• Estradiol (E2)
• Estriol (E3)
• Progesterone
• Testosterone
• Dehydroepiandrosterone (DHEA)
• Pregnenolone

The term bi-est refers to a combination of estriol and estradiol in a ratio of 80:20 or 50:50, respectively. Tri-est refers to a combination of estriol, estradiol and estrone usually in a ratio of 80:10:10.

We try to combine hormones in combination creams or capsules to help improve compliance and reduce cost.

Every woman is unique and will respond to therapy in her own way, therefore close monitoring and medication adjustments are essential in most cases.

Some commonly compounded BHRT include:

• Progesterone cream
• Progesterone capsules
• Progesterone sublingual drops
• Progesterone injections or suppositories for infertility
• Bi-est cream
• Bi-est capsules
• Estradiol cream
• Estradiol capsules
• Estriol vaginal cream
• Testosterone cream
• Testosterone capsules
• DHEA cream
• DHEA capsules
• Keto DHEA cream
• Keto DHEA capsules
• Pregnenolone capsules
• Pregnenolone cream
• Pregnenolone sublingual drops

Cosmeceuticals

Cosmeceuticals are cosmetic products that are said to have drug-like benefits. Cosmeceuticals are basically a marriage between cosmetics and pharmaceuticals. Like cosmetics, cosmeceuticals are topically applied, but they contain ingredients that influence the biological function of the skin. Cosmeceuticals improve the appearance of skin by delivering nutrients necessary for healthy skin.

Examples of products typically labeled as cosmeceuticals include anti-aging creams and moisturizers containing active ingredients such as vitamins, phytochemicals, enzymes and antioxidants. The most advanced cosmeceuticals are a combination cosmetics and micronitrition.

Dermatologists, physicians and patients face many problems that may be relieved with customized medications or cosmeceuticals, including:

• Acne
• Wrinkles
• Fine Lines
• Dark circles under the eyes
• Loss of radiance
• Thin lips
• Thin skin
• Crows feet
• Fair skin with blotches
• Psoriasis
• Eczema
• Inflamed skin
• Large pores
• Rosacea
• Lichen planus
• Sagging eyelids
• Scarring and keloids
• Traumatized or diseased nails
• Hair loss
• Sunburn

Physicians compounding can work with your physician to compound just the right cosmeceutical for you. We can use our own bases or use your current cream or moisturizer to include some additional ingredients. We can also use fragrances to enhance the cream such as lavender oil or eucalyptus oil. Many products are available for purchase, ranging from those you can purchase in a grocery or drug store to those that are available at high end department stores for hundreds of dollars. We can make cosmeceuticals with the same active ingredients as the high end products for a fraction of the cost.

Some commonly used ingredients in cosmeceuticals:

• Alpha lipoic acid
• Alpha Hydroxy Acids
• Biopeptides
• Coenzyme Q 10
• Dimethylaminoethinol (DMAE)
• Estriol
• Hyaluronic Acid
• Idebenone
• Tocotrienols
• Vitamin A
• Vitamin C Ester
• Vitamin E

Supplements can also make a big difference in skin care. Vitamins and minerals good for your skin include vitamin A, vitamin C, vitamin E, alpha lipoic acid, l-carnitine, coenzyme Q 10, glutamine, grape seed extract, gamma linoleic acid, turmeric and omega 3-fatty acids. Make sure to purchase high quality, pharmaceutical grade supplements. This is especially important for fish oils that require purity certification to ensure a clean final product. Also be sure to get enough sleep, exercise, reduce stress and drink enough water.

Dentistry

In every dental practice, there are some patients that do not respond to conventional treatment or are unable to take commercially available medication because of their unique needs. Physicians Compounding Pharmacy can help these patients. Compounding allows a dentist to prescribe and a pharmacist to prepare a customized medication that is not available commercially, or to place an available medication in a different dosage form to meet a specific patient need and improve compliance.

Since each person has unique teeth, mouths, and lips, it sometimes requires a compounding pharmacist to become problem-solvers by providing specially compounded medications to meet those unique needs.

Compounding pharmacists can work directly with dental practitioners to provide treatment options for:

• Apthous Ulcers
• Dry Mouth
• Pain Relief
• Thrush
• Canker Sores
• Dry Sockets
• Procedural Anxiety
• Tooth Whitening

Physicians Compounding can compound just the right medication for your dental issues.

Some commonly compounded Dental medications include:

• Analgesics
• Antivirals
• Antibiotics
• Topical Anesthetics
• Sedatives
• Dry Socket Mixtures
• Root Canal Paste
• Plaque Removal Solutions
• Oral Rinses
• Adhesives
• Bleaching Gels
• Crown Preps
• Combination mouth rinses for oral ulcers containing a combination of antibiotics, antihistamines, antifungals, anesthetics, corticosteroids, misoprostol
• Transdermal pain gels for neuralgias and temporomandibulary joint disorders (TMJ)
• Dry mouth treatments

Pain Management

Chronic pain is the primary cause of adult disability in the United States. In fact, approximately one in three Americans suffers from some type of chronic pain. Chronic pain impacts not only your daily life, but can also affect your ability to enjoy life to its fullest. Compounded medications should be considered part of your long-term treatment program if your current pain management treatment is inadequate.

Unlike acute pain, which is normally short-term and associated with a specific cause, chronic pain often continues for three months or more and lasts longer than the estimated recovery process. Since chronic pain frequently has numerous causes and perpetuating aspects, it can be a challenge to control and can have psychological or emotional effects on the patient.

The following is a list of pain conditions for which we commonly compound medications:

• Arthritis
• Ankle Pain
• Back Pain
• Burning Foot Syndrome
• Carpal Tunnel Syndrome
• CRPS (Chronic Regional Pain Syndrome)
• Diabetic Neuropathy
• Fibromyalgia
• Foot Pain
• Gout
• Head, Neck, and Facial Pain
• Knee Pain
• Migraines
• Muscle Spasms
• Neuropathic Pain
• Post Herpetic Neuralgia
• Shingles
• Shoulder Pain
• Tennis Elbow
• TMJ/TMD (Temporomandibular Disorders)

Treatment for Pain

Pain management is vital for chronic pain sufferers to live happy and complete lives. Your physician can create an effective plan to help manage your pain. It is important for your physician to check on your progress through regular follow-ups and routine recording of your pain levels.

After a thorough analysis of your pain, your physician will work directly with Physicians Compounding to create a personalized medication program to help manage your chronic pain. Physicians Compounding will develop customized dosage forms based on your prescription from your physician. This balanced approach to pain management can help improve your chronic pain and help you lead a fuller and more active life.

Transdermal vs. Topical Drug Delivery in Pain Management

Many medications used to manage pain, decrease inflammation, and ease muscles also carry the risk of adverse side effects. If these medications are applied topically, however, therapy can be achieved and side effects can be reduced significantly.

Topical Delivery

• Peripheral tissue activity
• Systematic side effects are less likely
• If analgesic, applied directly over painful site
• Insignificant serum levels

Transdermal Delivery

• Systemic activity
• Potential for adverse side effects
• If analgesic, may be applied away from painful site
• Serum levels necessary for effect

Physicians Compounding can compound just the right medication to help you manage your pain.

Some commonly compounded Pain Management medications include:

• Topical anesthetics

- such as bupivacaine or lidocaine

• Topical non-steroidal anti-inflammatory drugs (NSAIDS)

-such as ketoprofen or ibuprofen

• Amitpriptyline
• Baclofen
• Clonidine
• Dexamethasone
• Dextromethorphan
• Gabapentin
• Ketamine
• Concentrated capsules
• Combination medications in creams, gels or capsules
• Extended release capsules
• Mouth rinses
• Suppositories

Pediatrics

Children pose many challenges when it comes to taking medication; they may oppose having to take a medication in general, have an aversion to the taste or texture of a medication, have difficulty swallowing pills or capsules, or are afraid of injections. In addition, most medications are not labeled for pediatric use, and when a medication is not approved for use in infants and children, it usually is not available in an appropriate pediatric dosage form.

Since many children have trouble swallowing tablets or capsules, your pediatrician and Physicians Compounding can work together to find alternative dosage forms for your child. These include pleasantly flavored suspensions lollipops, syrups, freezer pops, lozenges, gummis, suspensions or rapid dissolve tablets. With a choice of many flavors, we can make just about any medication taste better! Some drugs can even be compounded into transdermal gels that can easily be applied to your child for absorption through the skin.

These alternative formulations will likely improve your child’s medication therapy compliance and we know that greater medication compliance leads to improved medical outcomes for your child. Physicians Compounding can compound just the right medication for your children.

Some commonly treated pediatric conditions:

• Acne
• ADD/ADHD
• Autism
• Diaper rash
• Fungal infections
• Head lice/scabies
• Nausea/vomiting
• Pain

Some commonly compounded Pediatric medications include:

• Methylcobolamin injections, nasal sprays or SL drops
• Promethazine transdermal gel
• Topical anesthetic creams or gels

Podiatry

Since you spend a lifetime on your feet, you are bound to have a problem with them at some point. In fact, more than 75% of Americans will experience foot problems at some stage in their lives. Your feet are your basis of support and stability; and when they hurt your quality of life can suffer. Your physician will help determine the best possible treatment program to get back on your feet and back to the active lifestyle you enjoy.

In recent years, more and more podiatrists and physicians have depended on compounding pharmacies to help treat a variety foot-related problems and diseases.

Compounding pharmacists can work directly with podiatrists to provide treatment options for:

• Athelete’s Foot
• Nail Removal
• Heel Pain
• Excessive Perspiration
• Diabetic Neuropathy
• Foot Odor
• Foot Pain
• Circulation Improvement
• Nail Fungus
• Skin Care Treatments
• Plantar Fascitis
• Warts
• Hyperhidrosis
• Inflamation
• Wound Healing
• Calluses

Physicians Compounding can combine numerous compatible medications into a single dosage form for easy administration. Plus, when certain medications are used in unison, a positive effect is often achieved, improving your treatment program.

Physicians Compounding can compound just the right medication for all of your podiatry needs.

Some commonly compounded Podiatry medications include:

• Bactroban/lidocaine combination creams and PLO gels
• Bupivacaine 0.5%, clonidine 0.2%, gabapentin 6%, ketamine 10% PLO gels
• Clonidine 0.2%, gabapentin 6%, ketamine 10% PLO gels
• Itraconazole 1%, ibuprofen 2% in DMSO nail polish
• Keotprofen 20% PLO gel
• Ketoprofen 20%, piroxicam 2% PLO gel
• Nifedipine 4%, pentoxyfylline 4% PLO gel
• Nifedipine 4 8% PLO gel
• Nitroglycerin 0.2% topical ointment
• Salicylic acid combinations
• Squaric

Sports Medicine

Whether you’re a professional athlete getting injured on the field or a non-professional sports enthusiast attempting to ease muscle aches, compounding can provide enormous benefits for every type of athlete. When an athlete is hurt, the secret the pros use to achieve a speedy recovery is utilizing pharmaceutical compounding, and the best news is that it’s available for everyone pros and non-pros alike. Athletes recover from muscle inflammations more rapidly by using topical agents prepared by compounding pharmacists; working in conjunction with their trainers

Compounding medications can provide huge benefits for every type of athlete. Compounding enables pharmacists to work closely with both the athlete and their physician or trainer to prepare customized dosage strengths, potency and delivery systems to provide the maximum effect in therapy.

Athletes, coaches, trainers, team physicians, physical therapists, and sports enthusiasts are faced with problems such as:

• Acute Pain
• Inflammation
• Muscle Spasms
• Fungal Infections of the skin and nails (athlete’s foot, jock itch, and onychomycosis)
• Hemorrhoids
• Excessive Perspiration

Our compounding specialists can help with these problems and more, with customized medications that contain the correct ingredients in the best form to most effectively supply the required medication to the affected area.

Transdermal vs. Topical Drug Delivery in Sports Medicine

Many medications used to manage pain, decrease inflammation, and ease muscles also carry the risk of adverse side effects. If these medications are applied topically, however, therapy can be achieved and side effects can be reduced significantly.

Topical Delivery

• Peripheral tissue activity
• Systematic side effects are less likely
• If analgesic, applied directly over painful site
• Insignificant serum levels

Transdermal Delivery

• Systemic activity
• Potential for adverse side effects
• If analgesic, may be applied away from painful site
• Serum levels necessary for effect

Physicians Compounding can compound just the right medication for all of your sports medicine needs.

Some commonly compounded Sports Medicine medications include:

• Clotrimazole in DMSO solution
• Cyclobenzaprine / Ketoprofen transdermal gel
• Dexamethasone iontophoresis solution
• Fluconazole / Ibuprofen topical gel
• Ketamine / Gabapentin transdermal gel
• Ketoprofen 10% / 20% transdermal gel
• LAT topical gel
• NSAIDs
• Nutritional Supplements
• Pregame Rubs with emu oil and anti-spasmodic drugs
• Rehydration Drinks
• Topical therapies for Hyperhidrosis

Wound Care

A wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds are usually caused by cuts, scrapes, surgery, illness, or disease. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Your physician can help determine the most appropriate therapy for your particular wound.

Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some scarring. The object of proper wound care is to minimize the possibility of infection and scarring.

Compounding medications for wound care often involves several approaches and applying medications topically. The goals of your particular medication or therapy may vary. Some of the medications are designed to stimulate new tissue growth, reduce pain, and discourage bacterial overgrowth. While others are designed to increase blood flow to the wound and are applied to the skin that borders the wound.

Another useful dosage form is the polyox bandage which can be puffed onto a wound and will adhere even if exudate is present. A polyox bandage can be compounded to contain the active ingredients of your choice.

At times physicians also recommend medications for patients who do not currently have wounds, but who have very poor circulation to an extremity. If your wound is not healing correctly or you have a limb with poor circulation, please contact us and we would be happy to provide you and your doctor with additional information about our wound treatment protocols.

Physicians Compounding can compound just the right medication for your wounds.

Examples of medications used in wound care products:

• Aloe Vera
• Antibiotics
• Ketoprofen
• Lidocaine
• Misoprostol
• Pentoxifylline
• Phenytoin
• Sucralfate
• Verapamil

Veterinary

Pets are important members of our families and when they aren’t feeling well we want to do everything we can to help them feel better. In addition, we want our pets to receive the highest quality of care possible. Today, by using a customized plan that incorporates compounded medicines, we can help.

Compounded medications have become lifesavers for pets and are quickly becoming a popular solution to all types of veterinary problems. When your veterinarian works closely with the professional pharmacists at Physicians Compounding Pharmacy, together we can help to improve the health, happiness and well-being of your pets.

Giving medication to your pet can often be stressful to both you and your pet. Perhaps your cat finds it difficult to swallow a human-sized pill or your dog will only take her medicine when it is hidden in a treat. We can help to take the stress out of medicating your pets, allowing you to go back to being best buddies!

Just like you, all animals are unique. Not all commercially available medicines are suitable for your pet. They often do not come in the dosage or form needed for your pet. Custom medication compounding allows you to give your pet the exact dose they need in a dosage and form that works best for you and your pet.

Compounding veterinary medications also allows us to flavor pet medicines making them easy for you to administer and easier for your pet to take. We can prepare your pet’s medicines into delicious flavors like tuna for cats, liver for dogs, and banana for exotic pets. We carry a variety of flavors to suite all types of pets.

Nearly every type of medication your pet may need can be compounded, including:

• Antidotes and treatments for accidental poisoning
• Anti-fungal inhalation for birds
• Combination or fortified ophthalmic formulas
• Concentrated solutions for birds and reptiles matching the dose to the animal’s size
• Custom shampoo to treat rain-rot, a fungal infection, in horse
• Difficult to lick off protective medicated coatings for wounds or stitches
• Discontinued, combination, custom-formulated products
• Hairball remedy for cats
• Hard-to-find medication for urinary incontinence
• Inhalation therapy
• Injections and liquids for metal toxicities
• NSAIDS transdermally that avoid the gastrointestinal tract
• Transdermal, anti-inflammation gel for torn ligaments
• Transdermal anti-motion sickness medicine that is applied to the outer ear surface
• Vitamins and tonics

Veterinary Transdermal Medications

Transdermal gels are one of the easiest ways to administer medication to your pet. Transdermals are typically applied to the inside of an animal’s ear. Transdermals are a quick and easy route for systemic absorption. In addition, since transdermal medications are absorbed through the skin, they avoid the GI tract, allowing less stomach upset. Many medications are compatible with transdermal bases just ask us.

Physicians Compounding can compound just the right medication for your pets.

Some commonly compounded Veterinary medications include:

• Aluminum Hydroxide oral suspension
• Atenolol oral suspension
• Cyclosporin 2% ophthalmic ointment or in oil
• Diltiazem bead capsules
• Doxycycline oral suspension or capsules
• Famotidine oral suspension or capsules
• Fluoxetine oral suspension
• Methimazole topical gel
• Metronidazole oral suspension
• Potassium bromide capsules or oral suspensions
• Prednisolone oral suspension
• Prendisone oral suspension
• Sotolol capsules

Commonly used flavors for veterinarian compounding

• Beef
• Chicken
• Fish
• Salmon
• Tuna