Las Vegas Review-Journal (Sunday)
Compounding of medications makes a comeback
Utah mother credits practice for survival of 11-year-old son
LOGAN, Utah — At the age of 2, Colby Amundsen of Logan suffered a stroke, robbing him of his physical functions and ability to talk. His mom, Erin, is his chief caretaker and makes sure he gets food and the medications he needs.
Now 11 years old, Colby is down from taking 14 medications when he was born to only six, but some of the doses require such small amounts of specific ingredients that they need to be made by compounding, the Herald Journal reported. Colby needs 0.8 milligrams of artane in each dose — which he takes four times a day, whereas a pill typically contains two milligrams.
“They’re such tiny pills that even if I cut them in half, I’d never know if I got the exact dose, so by compounding, I can give him the exact dose he needs,” Amundsen said, noting if she could not get the drug compounded, it could lead to all kinds of side effects for Colby.
“I don’t have to worry about an overdose or an under dose; (compounding) makes his medication consistent, and that’s what he needs — consistency.”
Amundsen is one of an increasing number of people in Utah and elsewhere taking advantage of compounding — the pharmaceutical science of making a drug tailored to the individual patient’s needs by combining, mixing or altering ingredients.
“To me, that’s the art versus the medicine,” said D’Anne Moon, a nurse midwife who works at the Cache Valley Women’s Center in Logan. “The art of medicine is taking the science you know and applying it to each individual person because every person is unique. Compounding is really the art of medicine and figuring out how to make this work with individual patients.”
INCREASING POPULARITY
Compounding used to be popular in the past before major drug companies started manufacturing “cookie-cutter” medications, according to Shaun Klomp, a technician at Spence’s Pharmacy in Logan.
But now, he said, compounding is making a comeback to help solve medical issues that those one-sizefits-all medications cannot — and Klomp is seeing that trend in Cache Valley.
“In the last decade, compounding use has grown tremendously as more physicians and patients look for solutions to problems not easily solved by commercial drugs,” Klomp said. “Many medical disciplines that involve hormone therapy, pain therapy, dermatology, pediatrics, even veterinary have included compounded medications as a common prescribing practice.”
Medications from compounding can come in all different forms: capsules, creams, ointments, gels, nasal sprays, eye drops, sterile injections.
Klomp said compounding is ideal when standardized medications don’t work for patients.
“One size does not fit all; everyone has specific needs,” Klomp said. “A lot of the time (commercial) medications work. However, there’s a lot of people out there that need something that’s customized to them.
“What about those specific patients where a pallet doesn’t work for them? There can be certain issues and problems with the patient and the doctor wants to try a different route to make therapy more effective,” Klomp said.
REGULATION AND RISK
Moon said compounded medications are not approved by the Food and Drug Administration, so that’s why it’s important to work with a “reputable pharmacy” that has technicians that understand compounding and how to do it.
Lyndsay Meyer, a press officer with the FDA, said compounded drugs are “not approved by the agency, and the FDA does not verify the safety, or effectiveness of compounded drugs.” Compounded drugs, she said, also “lack an FDA finding of manufacturing quality before such drugs are marketed.”
Meyer said state boards of pharmacy will “continue to have primary responsibility for the day-to-day oversight of state-licensed pharmacies that compound drugs in accordance with the conditions” of agency regulations.