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The right Rx?
What you need to know about compounding pharmacies

Compounded hormones: Pros and cons

To fit a woman’s individual needs, hormone replacement drugs are sometimes compounded or custom-mixed using hormones chemically identical to those made by the body. They may be formulated in a dose or a preparation, such as lozenges, not commercially available.

However, no evidence shows these so-called bioidentical hormones are safer or more effective than standard hormone replacement therapy. Because they’re made to order (meaning every drug can be slightly different) dosing may be inconsistent.

One size doesn’t fit all—and medicine is no exception. That’s one reason why you’ll find pharmacies offering “compounding” services. Compounding involves taking a drug and—with a doctor’s instructions—having a pharmacist alter its composition to create a specialized drug product. For example, when cherry flavoring is added to a child’s antibiotic, that’s compounding. When a pill is crushed with a mortar and pestle and mixed into a liquid, that’s compounding, too. But are compounded drugs safe and effective? And are the pharmacies that sell them qualified to change the makeup of a drug? Don’t swallow a bitter pill—read on to learn what you need to know about drug compounding.

Q: Why would a drug be compounded in the first place?

A: A prescribed drug might be custom made for a patient for many reasons. For example, some people are allergic to the dyes, preservatives and fillers used in medications, so a doctor may prescribe a drug without those additives. In other cases, a medication may be manufactured only in a pill form, yet some patients—especially children and the elderly—find it easier to swallow a liquid. Or, a medication may not be manufactured in the dosage a patient needs, so a pharmacist can reformulate it in a custom dose.

Q: Are compounded drugs safe?

A: All drugs carry risks. But a compounded drug may be a safer alternative to a commercially available product if a patient has allergies or swallowing difficulties. On the other hand, most doctors use compounded drugs only as a last resort, preferring commercially manufactured drugs that have been scientifically tested, approved by the Food and Drug Administration (FDA) and quality controlled.

Q: How do I find a pharmacy skilled in compounding?

A: Most pharmacies do at least some simple compounding, like adding flavoring to medicine. But the more you change a drug’s makeup, the more important it is to choose a pharmacy skilled in compounding with the proper equipment. Look for a pharmacy that adheres to Pharmacy Compounding Accreditation Board standards. These pharmacies are reviewed yearly and inspected every three years. Ask whether the materials the pharmacy uses to compound drugs come from licensed FDA-registered manufacturers. In addition, make sure that any pharmacy you use follows the standards set by the National Association of the Boards of Pharmacy and the United States Pharmacopeia.

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