Compounding: A core competence for pharmacists

Joel ClaycombThis past October I had the opportunity to attend the International Pharmaceutical Federation (FIP) Congress in Dusseldorf Germany. The theme of this year’s Congress was "Better practice - science-based, evidence-driven." Among the sessions I took part in, one addressed the topic of pharmaceutical compounding internationally, and its role in patient care.

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When many community pharmacists in the United States think of compounding, we picture a simpler time in pharmacy practice; perhaps we visualize the local druggist mixing medications with a mortar and pestle. For me and many of my chain-pharmacy contemporaries, since our university days, the most complex compounding we’ve done is combining two ointments into a single product, or perhaps making “Magic Swizzle.”

Internationally, compounding tends to play a more significant role in day-to-day practice.

The Netherlands

Lauren Schulpen, a pharmacist from The Netherlands, explained that nearly 25% of community pharmacists in his country still compound for their patients. In addition, 4% of all dispensed prescription medications are compounded products.

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Their reasons to compound may include shortage of a specific product, the need to make a product with unique therapeutic value, or improvement of patient compliance.

In The Netherlands, pharmacists follow a feasibility standard to determine whether a product can be compounded and also whether it should be compounded. A few of the criteria for reasonable use include the availability of raw materials, the stability of the final product, and the safety risk of the product. Ultimately, the goal of compounding is to meet the customized needs of the patient, while adhering to appropriate quality and safety requirements.

Switzerland

Andreas Schmid from Switzerland detailed the protocols for compounding and dispensing opioid-replacement therapy in his country. The goal of therapy in treatment is harm reduction for the patient, and the gold standard in most European countries programs is methadone.

Typically methadone is available in an oral, concentrated form that is diluted and compounded specifically according to the needs of the individual patient. In order to safely supply these patients with medication, two individuals will verify the measurements during preparation, while a third person will ultimately verify the compounded methadone before releasing it.

Portugal

An important aspect to compounding medications is realizing the relationship between the parties involved.

Maria Carvalho, a pharmacist from Portugal, explained that optimal outcomes depend on collaboration between prescriber, pharmacist, and patient. When all three parties work together, the resulting relationship forms the foundation for pharmaceutical compounding.

Some of the ways pharmacists can develop such relationships include establishing connections with local prescribers, exhibiting best practices, and demonstrating passion and willingness to be of service. Because the pharmacist plays the role of intermediary between patients and doctors, effective communication skills are essential in conveying information appropriately to each party. In addition, each participant must recognize and respect the professional duties and skills of the other members, said Carvahlo, and realize that each plays a critical role in the patient’s care.

The future of compounding

While many aspects of the pharmacy profession have changed over the years, compounding still plays an important role in pharmacy practices the world over. For example, the past few years have seen an ongoing crisis of drug shortages challenge the United States and beyond. Compounding can play a pivotal role in filling the void.

As an activity that distinguishes the pharmacy profession, compounding deserves not only to be preserved but further developed, according to appropriate standards and protocols for those compounded products that require specialized conditions and high levels of sterility.

There is still very much of a future for pharmacists and practices that are willing and able to provide high-quality compounded products.

A frequent contributor to Drug Topics, Joel Claycombspecializes in reports from far-flung locations. Contact him at jcclaycomb@gmail.com.