What is Compounding?

Pharmacy compounding is the art and science of preparing customized medications for patients. Its practice dates back to the origins of pharmacy; yet, compounding’s presence in the pharmacy profession has changed over the years. In the substantial and 1940s, approximately 60 percent of all medications were compounded. With the advent of drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms.

Within the last two decades, though, compounding has experienced a resurgence as modern technology and innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs.

There are several reasons why pharmacists compound prescription medications. The most important one is what the medical community calls “patient non-compliance.” Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician’s consent, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, or add flavor to make it more palatable. The pharmacist also can prepare the medication using several unique delivery systems, such as a sublingual troche or lozenge, a lollipop, or a transdermal gel or cream that can be absorbed through the skin. For those patients who are having a hard time swallowing a capsule, a compounding pharmacist can make a liquid suspension instead.

Compounding pharmacists have the opportunity to work with a variety of practice specialties, such as hospice, pediatrics, pain management, and OB/GYN, which in turn broadens the scope of their practices and creates other opportunities to provide other pharmacist care services. 

What kinds of prescriptions can be compounded?

Almost any kind. Compounded prescriptions are ideal for any patient requiring unique dosages and/or delivery devices, which can take the form of solutions, suppositories, sprays, oral rinses, lollipops and even as transdermal sticks.

Compounding applications can include:

Bio-identical Hormone Replacement Therapy

Veterinary, Hospice, Pediatric, Ophthalmic,

Dental, Otic (for the ear), Dermatology, Medication

Flavoring, Chronic Pain Management, Neuropathies, Sports

Medicine, Infertility, Wound Therapy, Podiatry,

Gastroenterology AND MANY MORE!!!

Is compounding safe and legal?

Compounding has been part of healthcare since the origins of pharmacy, and is widely used today in all areas of the industry, from hospitals to nuclear medicine. Over the last decade, compounding’s resurgence has largely benefited from advances in technology, quality control and research methodology. The Food and Drug Administration has stated that compounded prescriptions are both ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. In addition, compounding is regulated by state boards of pharmacy.

Will my insurance cover compounded medication?

Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy. However, almost every insurance plan allows for the patient to be reimbursed by sending in claims forms. While you may be paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost.

Does my doctor know about compounding and do I need a prescription?

Prescription compounding is a rapidly growing component of many physicians’ practices. But in today’s world of aggressive marketing by drug manufacturers, some may not realize the extent of compounding’s resurgence in recent years. Ask your physician about compounding.

Yes, most compounded medication require a presciption from a physician, nurse practitioner or a physican‘s assistant.  Reagan's Rx Compounding Pharmacy is committed to providing high-quality compounded medications in the dosage form and strength prescribed by the physician.

This triad relationship between the patient, the physician, and the pharmacist is vital to the process of compounding so all three can work together to solve unique medical problems.

What are some of Reagan's Rx Compounding Pharmacy's specialites?

We can formulate a topical pain gel called Ketoprofen 10% Pain Gel. If you are an avid sports fanatic or just a hard-worker who needs something to help with those aches and pains, we can help. This gel can be applied directly to "tennis elbow" or other affected area to remove pain and inflammation without gastric upset or addictive properties.  Your practitioner can call (318) 382-7948 or fax a prescription to (318) 382-4924. If you prefer we will contact your practitioner directly.
The prescription should read:

               Ketoprofen 10% Pain Gel
                     30 or 60 Grams

Apply to affected area and rub in well every 6 hours as needed

Other Examples of Compounded Prescriptions:

Sports Medicine

*Guaifenesin 20% Speed Gel relieves muscle tightness within seconds. It can be combined with vitamins B5, B6 and ketoprofen to treat deep bruises.

* Ketoprofen 10%, 15% or 20% in PLO or rapid gel to treat sprains, strains and inflammation. A pea-sized amount of the gel is rubbed with a moist fingertip into the skin three to four times daily. An aqueous solution of that drug can also be administered by iontophoresis, or the medication can be prepared as an ultrasound gel for use in phonophoresis.

* Dexamethasone 0.4% in an aqueous solution for iontophoresis to treat sprains, strains and inflammation. That concentration of dexamethasone can also be prepared in PLO for application immediately after a sports-related injury to minimize inflammation.

* Acetic acid 2% or 4% in an aqueous solution administered by iontophoresis to reduce scar tissue.

* A combination of baclofen 5%, lidocaine 10% and guaifenesin 10% or 20% in PLO to prevent muscle cramps.

* Lidocaine 4%, epinephrine (adrenalin) 0.05% and tetracaine 0.5% (LAT) in a spray or hydroxyethylcellulose gel to treat cuts and abrasions. This preparation is applied immediately after injury.

* Muscle relaxants such as guaifenesin (usually 10% or 20%) in PLO or cyclobenzaprine 0.5%, 1% or 2% in PLO.  Cyclobenzaprine is administered topically or by ultrasound, and guaifenesin in PLO is applied topically three to four times daily until relief is notedd

Electrolyte-balancing preparations that contain a combination of potassium chloride, sodium chloride, magnesium and calcium carbonate. It can be formulated in capsules or as a powder that must be mixed with a liquid. 

Magnesium glycinate- reduces postgame stiffness and soreness and promotes restful sleep.

Wound Care

Phenytoin promotes granulation in a healing wound, decreases exudates, alleviates pain, has antimicrtobial properties and counteracts inflammation. Proven effective in treatment of decubitus ulcers, traumatic wounds, diabetic and burn ulcers. Applied topically twice daily in concentrations of 1% to 10%.

Nifedipine increases vascularization of treated area. Used topically at 5 to 20% concentration and combined in any formula.

Misoprostol aids in the acceleration of wound healing. Used topically at 0.0024% concentrations.

Pentoxifylline increases blood flow and oxygen delivery to the wound site. Used topically at concentrations of 5% (for adjunct therapy) to 15% (to enhance circulation).

Gentamicin / Clindamycin / Polymyxin B (GCP) Topical Gel

  • Gentamicin - most active against aerobic gram-negative rods, but it is also used in combination with other antibiotics to treat Staphylococcus aureus and certain species of streptococcus
  • Clindamycin – anti-anaerobic activity, either bacteriostatic or bactericidal, depending on its concentration at the site of action and on the specific susceptibility of the organism being treated
  • Polymyxin B – spectrum of activity is limited to gram-negative bacteria, bactericidal against most gram-negative bacilli; however, some Proteus and Serratia species may be resistant. Polymyxin B has no in vitro activity against gram-positive organisms or fungi
  • G.C.P. Solution
  • G.C.P. Gel with Nifedipine or Phenytoin

Neomycin

  • Aminoglycoside antibiotic
  • Organisms susceptible to neomycin include Escherichia coli, Klebsiella, and other Enterobacteriaceae
  • Like other aminoglycosides, neomycin is ineffective against anaerobic bacteria

Metronidazole

  • Antibacterial and antiprotozoal agent with effective coverage against many anaerobic organisms Used topically, also provides control of wound odor

 Dexamethasone

  • The anti-inflammatory actions of corticosteroids are thought to control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of the precursor molecule arachidonic acid
  • Applied to surrounding wound area to control inflammation, not applied directly to wound

Non-Steroidal Anti-Inflammatories
(Ketoprofen, Ibuprofen, Naproxen)

  • Used topically, has been demonstrated to inhibit pro-inflammatory enzyme cyclo-oxygenase 2 (COX-2), which in turn reduces scar formation and/or thickness.

Peripheral Neuropathy

  • Ketoprofen 10% / Pentoxifylline 5% Gel
  • Ketoprofen 10 % / Lidocaine 5% / Baclofen 10%/ Pentoxifylline 5% Gel
  • Ketamine 10% / Ketoprofen 10% / Gabapentin 6% / Clonidine 0.2% Gel  

Nail Fungus

  • Lamisil 25 mg / mL in Fungoid Tincture
  • Clotrimazole 1% in Tea Tree Oil 10%
  • Thymol 4% / Ibuprofen 2% / Oil of Oregano 1% / Tea Tree Oil 1% / 50:50 Propylene glycol / ethoxy
  • Fluconazole 2% / Itraconazole 2% / Ibuprofen 2% / DMSO

Migraines

  • Dihydroergotamine Mesylate (DHE) Spray 0.25%
  • Dihydroergotamine Mesylate (DHE) and Metoclopramide 5 mg Troche (Lozenge)
  • 4% Lidocaine Nasal Drops or Spray
  • Headache Prevention: Riboflavin (B2) 400 mg + Magnesium 400 mg + Feverfew 100 mg (po qhs)
  • Sumatriptan Nasal Spray
  • Ergotamine 2 mg SL tabs
  • Tizanidine 2% / Magnesium Chloride 10% / Ketoprofen 10% 4038 Gel
  • Migraine Away Caps: Ibuprofen 200 mg / Riboflavin 200 mg / Caffeine 30 mg / Ginger Root 11.5 mg

Topical Pain Management

Inflammation

  • Ketoprofen 10% / Pentoxifylline 5% Gel
  • Piroxicam 2% / Pentoxifylline 5% Gel
  • Ketoprofen 10% / Lidocaine 5% / Baclofen 10% / Pentoxifylline 5% Gel
  • Ketoprofen 5% / Cyclobenzaprine 0.5% / Guaifenesin 10% / Diphenhydramine 10% Gel

 

Trigger Points

  • Amitriptyline 2% / Ketoprofen 10% / Magnesium Chloride 10% in Lipoderm
  • Pentoxifylline 5% / Ketoprofen 10% / Magnesium Chloride 10% / Glucosamine 15% in Lipoderm (lower back pain)
  • Ketoprofen 10% / Magnesium Chloride 10% in Lipoderm


Neuropathy 

  • Ketamine 100mg / mL Nasal Spray
  • Ketamine 10% / Ketoprofen 10% / Gabapentin 6% / Clonidine 0.2% Gel
  • Ketamine 10% / Ketoprofen 10% / Lidocaine 5% / Diphenhydramine 10% / Clonidine 0.2% Gel
  • Ketoprofen 10% / Amitriptyline 2% / Clonidine 0.2% / Diphenhydramine 10% Gel
  • Ketoprofen 10% / Gabapentin 10% / Lidocaine 5% / Loperamide 10% / Amitriptyline or Carbamazepine 2% to 6% / Acyclovir 5% (Shingles Free Gel)
  • Ketamine 5% / Ketoprofen 10% / Lidocaine 5% / 2 deoxy-D-glucose 0.2% / Acyclovir 5% in Lipoderm
  • Shingles Free - Pain Gel: Ketoprofen 10% / Gabapentin 10% / Lidocaine 5% / Loperamide 10% / Amitriptyline 2% / Acyclovir 5% / 2-DDG 0.5%

Trigeminal Neuralgia

  • Ketamine 5% / Ketoprofen 10% / Gabapentin 6% / Clonidine 0.2% / Diphenhydramine 10% / Lidocaine 5% Gel
  • Ketamine 5% / Clondine 0.2% / Lidocaine 5% / Gabapentin 6% Gel

 

Pediatrics

Analgesics / Anesthetics

  • Acetaminophen Suppositories
  • Ibuprofen Suppositories
  • Tolmetin Suspension
  • Magic Mouthwashes
  • Tetracaine Lollipops 0.25%
  • Lidocaine / Epinephrine / Tetracaine Topical
  • Bupivacaine / Lidocaine / Tetracaine Topical

Diaper Rash

  • BUTT Paste (Peruvian Balsam, Zinc Oxide, Boric Acid, Castor and Mineral Oil)
  • Happy Hiney w/ LIDOCAINE (HC, Nystatin, Zinc Oxide, Neomycin, Lidocaine)
  • Cholestyramine 10% in Aquaphor

Head Lice

  • Ivermectin 0.8% Créme Rinse

Eczema

  • Eczema Lotion  (biotin / tranilast)

Alopecia

  • Minoxidil 5% Gel
  • Finasteride 0.25% Gel

Anesthetics

  • Quadcaine Cream (prilocaine, bupivacaine, tetracaine, lidocaine)
  • Tricaine Cream (prilocaine, lidocaine, tetracaine)
  • B.L.T. Cream (benzocaine, lidocaine, tetracaine)
  • Lidocaine 2 - 10% Gel

Acne

  • Nicotinamide 4% Gel
  • Niacinamide 4% Gel
  • Spironolactone 5% Gel

 

Fever Blisters

  • Acyclovir 5% / 2- DDG 0.2% Ointment
  • L-Lysine may be added to formula or dosed orally for prevention

Warts

  • 2-DDG 0.2% / Cimetidine 2% / Ibuprofen 10% / Beta Glucan 1%
  • Podophyllum 10% (pediatrics) or 20% (adult) in Benzoin Tincture
  • Salicylic Acid 40% / Acetic Acid 3% in Flexible Collodian

 

Erectile Dysfunction / Sexual Health

  • Sildenafil (Viagra®) Troches

  • Vardenafil (Levitra®) Troches

  • Tadalafil (Cialis®) Troches

  • L-Arginine 333 mg Capsules (Premature Ejaculation)

  • B.L.T. Gel (Premature Ejaculation or anesthetic)                                                                                                                                                   

Hormone Balance

  •  DHEA SL Troches 10-25 mg
  • Testosterone Troches

Urethral and Bladder

  • Diethylstilbestrol (DES) 1 mg, 5 mg (Capsules) 
  • Bethanechol 5 mg, 10 mg, 25 mg (Capsules)

OB-Gyn

Bio-Identical Hormone Replacement Therapy

The following hormones are available for customized replacement, and may be compounded individually or combined in any desired dosage form.

  • Estriol
  • Estradiol
  • BIEST ( Estriol / Estradiol ) Common ratios: (80 / 20); (70 / 30); (50 / 50)
  • TRIEST ( Estriol / Estradiol / Estrone ) Common ratios: ( 80 / 10 / 10); (70 / 20 / 10); (90 / 7 / 3)
  • Progesterone
  • Androstenedione
  • Testosterone
  • DHEA
  • Pregnenolone

Women's Sexual Health

  • Testosterone Libido Cream or Gel 2% (20 mg / mL) Recommended use: 2 -3 times per wk PRN
  • Estriol 1 mg /Testosterone 0.25 mg / gram in VersaBase® Gel (vaginal atrophy, dryness, pain)
  • Scream Cream (aminophylline 3% / ergoloid mesylate 0.05% / nitroglycerin 0.2%)
  • DHEA 5-25 mg Sublingual Troches
  • Testosterone 2 mg, 4 mg, 5 mg Sublingual Troches

Vaginal Health

(atrophic changes, lubrication, pain, chronic UTI's, chronic bladder infections, incontinence, chronic yeast)

  • Estriol 0.3% Cream
  • Estradiol 0.01% / Estriol 0.05% / Testosterone 0.025% Gel
  • Estriol 1 mg /Testosterone 0.25 mg / gram in VersaBase® Gel
  • Boric Acid 600 mg Suppositories (chronic yeast)
  • Testosterone 1 mg / mL Cream
  • Estriol / Loperamide / Lactobacillus Vaginal Capsules

Post Leep Cervical Healing Therapy

  • Cervical Amino Acid Cream (Urea 8.3% / Methionine 0.83% / Cystine 0.35% / Inositol 0.83%)

 

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Reagan
Minden, LA Natural Health Practitioners
1118 Homer Rd
Minden, LA 71055
(318) 382-RX4U
(318) 382-7948
(fax)
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  Business Hours
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