Dealing with medications can be a hard pill to swallow — both literally and figuratively. It’s challenging to contend with atypical doses, allergies or unusual ingredients. In a return to yesteryear, some people are seeking out compounding services at independent shops, such as Everett’s Shiraz Pharmacy.
“All local pharmacies compounded medications back in the day,” said Michelle Heue, Shiraz’s director of sales. “It changed with the advent of manufacturing so that medications became commercially available.”
Compound pharmacies mix and combine individual ingredients to customize prescriptions to the customer’s needs. An exact number is unknown, but the International Academy of Compounding Pharmacists (IACP) estimated in 2012 that 7,500 U.S. pharmacies offer advanced compounding services.
While the U.S. Food and Drug Administration (FDA) has long regulated mass manufacturing of medications, prior to 2014, individual states were the primary regulators for compounding pharmacies. In December 2013, the Drug Quality and Security Act was signed into law beefing up federal compounding regulations and imparting the FDA with more oversight to ensure safety.
Compound pharmacies, such as Shiraz, offer services that are unavailable at national chains and box-store pharmacies. The latter purchase medications in set doses and patients are beholden to what’s available.
“Some people need an amount between two commercially-available doses. You find yourself trying to cut pills in half or quarters and aren’t exactly sure what you’re getting,” said Laura Fletcher, manager and pharmacist at Shiraz. “For some medications, such as thyroid, it’s really important to get a very accurate amount each time.”
Likewise, compounding is a boon for many parents. When children require something typically prescribed to adults, it can be challenging to find readily-available, child-appropriate doses.
“It ends up with a stressed-out mom in the middle of the night trying to measure medications,” Fletcher said. “We do the prescription for the exact amount in a way that’s easy to understand.”
Compounding can also address some allergy and sensitivity issues. Ingredients such as preservatives can sometimes be eliminated or reduced since compounded medications often don’t require the shelf life of mass-produced versions. Artificial coloring and flavoring can be omitted or substituted — trade mint for tutti frutti — either for health reasons or personal preferences. There are even gluten-free options in some cases.
“I started having a reaction to a prescription cream,” said Bonnie Grisim, longtime Shiraz customer. “The doctor asked for a list of the ingredients and tested all of them. It turned out I was allergic to the base cream, so the pharmacy changed it and I was fine to continue using it.”
Even a medication’s method of delivery can be changed. For those with difficulty swallowing pills, such as children or hospice patients, capsules can be turned into something absorbed under the tongue, liquids or even into lollipop form.
“It’s really all about the customer service,” Grisim said. “I’ve had hour-long conversations and even texted them if they’re out of office to discuss my medications.”
Shiraz also compounds veterinary medications for pets. Fletcher estimates that half their business is dedicated to animal prescriptions.
“People are treating their pets more like family and they want the best for their health, too,” Fletcher said. “However, a lot of the medications aren’t available in animal doses. You might need it for a 30-pound dog, but the standard is based on a 100-pound human.”
For Fido, Shiraz even provides beef- or chicken-flavored options to help the medicine go down.
Competing with box stores can be a struggle since many customers assume they provide faster and cheaper service. Others don’t even know compounding options exist.
“A lot of people think compounding must be very expensive, but it’s really not,” Fletcher said. “Look at the whole picture and weigh the options. You can get your medication in the proper dose you really need, in a way you can actually take and tolerate. In the long run, that alone saves you so much in terms of being healthy.