Compounding: making a difference

Compounding pharmacist

Imagine if you could end each work day knowing you had made a real difference in just one person’s life? Marina Holt shares a patient’s story

As pharmacists, our job always has and always will be to help our patients. We dispense and counsel on medicines every day, and give advice on a wide range of health conditions, or provide directions to the local doctor.

Frequently, though, we can find ourselves just dispensing medicines almost by rote. Patients come and get their prescriptions filled, but we are not involved in their lives.

For a compounding pharmacist, very often the reverse happens. Patients come to see the pharmacist, seeking our help. They are hoping that we will be able to offer a solution for a problem that no one else can solve.

Compounding is the traditional method of preparing customised medications to help meet unique physician and patient needs.

Regulatory descriptions include definitions such as “Preparation and supply of a single unit of a product intended for immediate use by a specific patient”.

There is currently a lot of discussion about rules and regulations regarding “simple” and “complex” compounding and what it means in a community setting.

First and foremost, patient safety must be a priority and compounding pharmacists must ensure that they are providing a quality product for the patient.

However, none of these definitions or discussions takes into account the emotional impact that often results when a patient’s has a prescription compounded.

I never really understood the full impact until I had been working in a compounding pharmacy for a couple of years.

I loved the work from the first day – I didn’t get into trouble for spending time speaking with the patients as it was part of the job.

We had been preparing a compounded transdermal pain cream for a patient of ours, a retired lady (Mrs W) who was suffering from trigeminal neuralgia (TN).

TN is a chronic condition which affects the trigeminal nerve on the face, and patients often suffer excruciating pain in silence. The nerve itself carries sensation from the face to the brain, and patients suffer episodes of intense stabbing, electric-shock like pain. Every day.

Many of you probably have patients like Mrs W and don’t know it. They are very likely to be on oral neuropathic pain medication and complain about the side effects. Quite likely they may hold their hands up to their face when they speak with you – a way of protecting their faces from any unforeseen touch which may trigger a worse episode.

It took us a while to “tweak” the formula for the patient. There were many discussions with her prescriber and we added and subtracted various neuropathic pain agents until we came up with the perfect combination for her.

This type of multi-modal pain preparation enables several pain agents – each of which works on a different nerve receptor – combined to give a preparation tailored exactly to the patient’s level of pain.

Of course, our discussions with Mrs W revolved around questions such as: “is the medication working better?” and “how long is it lasting?”

After all, so many of the medications we regularly dispense in the pharmacy are measured just like that – a reduction in cholesterol levels or blood pressure for example.

But a few months later, I was able to spend some more time chatting with Mrs W over lunch at a TN patient support event.

As she started speaking about her condition I listened with great interest about the challenges she faced.

I don’t think that until that time I had really understood the impact that any chronic condition can have on a patient’s life.

Mrs W shared with me:

“I know that I am stuck with this pain forever, and even with the medication there are some days that are really bad.

“But you know, I have two young grandchildren and when they visit they want to sit on Nanna’s lap, and their hands are everywhere and they are pushing and wriggling so much, I am terrified they will accidently brush up onto the nerves on my face.

“I am afraid to hold them. But the medication has made such a difference! I can apply it before they come, and it dulls the pain and now I can hug my grandkids without fear.”

My eyes welled up and I could barely hold back the tears.

This is the difference the compounded medication made!

Whether it is a patient with chronic pain, or a young child who needs a melatonin suspension to sleep at night, compounding pharmacists are making a difference in how patients live their lives with their families.

Although nowadays my role is liaising with pharmacists about formulas and regulators about standards, I am always conscious of the fact that we do make a difference and I am proud to work and continue to strive for high standards in one of the most professionally satisfying areas of the pharmacy profession.

Marina Holt is the Education and Training Manager at Professional Compounding Chemists of Australia (PCCA).

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