• Problems Swallowing?

    Do you or someone you know have problems swallowing?  Dysphagia (difficulty or discomfort in swallowing) is a problem for many people, especially stroke victims, the elderly and people with advanced dementia. Difficulty with swallowing oral medications increases the risk of aspiration (breathing in a foreign object or sucking food or the medication into the airway) which can lead to pneumonia. Also, hospice and palliative care patients often develop complications such as impaired gastrointestinal absorption, nausea, vomiting, delirium, or cognitive impairment, all of which would complicate the ability to take required oral medications. These are some of the reasons why alternative routes of administration, including transdermal or rectal, can be very helpful.  

    Transdermal preparations are applied topically and absorbed through the skin. If a patient has fluctuating or declining liver function, transdermal administration may be advantageous because transdermal meds do not need to pass through the liver before being absorbed, like oral medications do. Transdermal medications can be compounded to treat pain and inflammation, spasms, and nausea/vomiting.

    Pharmaceutical compounding equipment, including a glass pestle and mortar ready for use.

    Ask our compounding pharmacist for more information. We are happy to answer your questions and work together with physicians, patients and their families to compound the most appropriate medication, strength and dosage form for each patient. Bring us your medication problems!

    Consultant Pharmacist. 2016 June; 31(6):313-9.

    August 9, 2016 By JJRX 2016
  • The Burden of Unexplained “Female Pain”

    Frustrated young woman touching her nose and keeping eyes closed while standing in office and near her working placeThis newsletter discusses a subject that is difficult for many women and health care professionals to talk about openly, yet in a recent study in a U.S. urban area was reported by almost 7% of women aged 18-64 years. Women should not suffer needlessly.  It’s a problem we can help with customized medications.

    The problem is vulvodynia, defined as chronic pain in the area around the opening of the vagina (vulva) for which there is no identifiable cause. Vulvodynia can occur in women of any age. The burning or sharp knife-like pain, tingling or itching, or pain on contact can lasts for 3 months or longer, and can be debilitating. Pain or discomfort is typically only on one side and may be most pronounced while sitting, and least prominent when lying down.

    The study revealed that only 3% of women meeting vulvodynia criteria were actually diagnosed with vulvodynia. Most women remain undiagnosed following multiple physician visits. Physicians such as dermatologists, urologists, and gynecologists are largely unfamiliar with chronic vulvar pain not attributable to a specific disorder such as herpes genitalis, lichen planus, cancer (e.g. squamous cell carcinoma), or neurological disease (e.g. postherpetic neuralgia).

    Often, even with thorough testing, no obvious cause can be identified, and ongoing chronic vulvar pain becomes a true mental and physical burden for affected women.

    In a substantial proportion of women, pain can be relieved with appropriate doses of prescription medications including tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, pregabalin, and compounded topical gabapentin cream.

    Contact our compounding pharmacist to confidentially discuss this or other problems. Our compounding pharmacists work together with physicians and their patients to customize medications based on each patient’s unique needs. We welcome your questions.

    Reference: J Pain Res. 2015; 8: 845-849.

    July 12, 2016 By JJRX 2016
  • Have You Heard the Latest on Testosterone Therapy?

    Testosterone Therapy

    As men age, testosterone levels gradually decline. And, low testosterone levels (clinically termed hypogonadism) lead to decreased well-being, increased risk of cardiovascular disease, loss of muscle, increased risk of Type 2 diabetes and other metabolic syndrome diseases, reduced sexual function, and bone loss.

    Benefits of testosterone replacement therapy (TRT) are clearly established: improved sexual function, increase in lean muscle mass and strength, mood and cognitive function, with possible reduction in frailty and osteoporosis. However, recently some questions have arisen regarding the risk of heart attack and stroke in men receiving TRT.

    The cardiovascular issues associated with TRT have been clarified by recent studies showing clearly that increased testosterone levels are associated with reduced mortality. Studies reporting increased risk have been flawed designs with inadequate baseline diagnosis and follow-up testing. An extensive review of the testosterone replacement therapy literature reveals that the majority of clinical studies show that properly administered testosterone replacement therapy, in which estradiol and dihydrotestosterone levels are also controlled, does not increase the risk of cardiovascular events. And, more good news: there is no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia.

    Testosterone replacement therapy should be monitored, and when needed, an aromatase inhibitor such as anastrazole should be added to control estradiol levels that tend to increase with testosterone therapy; as well as an a 5α-reductase inhibitor, such as dutasteride or finasteride to control dihydrotestosterone (DHT) levels.

    At the recommendation of the National Association of Boards of Pharmacy, we suggest that patients should always seek medical attention immediately if symptoms of a heart attack or stroke are present, such as:

    • Chest pain
    • Shortness of breath or trouble breathing
    • Weakness in one part or one side of the body
    • Slurred speech

    Testosterone therapy is available in many forms, and transdermal preparations that are applied to the skin are quite popular. Creams are easy for the patient to use and many health care professionals and patients prefer daily administration of testosterone to long-lasting pellets and injections.

    Another option is compounded troches, which offer these benefits:

    • Decreased risk of cross contamination, i.e., men need not be concerned about others contacting the site of application, such as the arm or leg when a child or pet is held.
    • Rapid buccal or sublingual absorption means the dose can reduced compared to that required for transdermal forms of testosterone.
    • Patients can quickly achieve peak levels when desired.

    Our compounding pharmacists work together with physicians and their patients to customize medications by prescription based on each patient’s unique needs. We welcome your questions.

    Ther Adv Urol. 2016 Apr;8(2):147-60.

    Aging Male. 2015;18(4):205-6.

    Int J Pharm Compd. 2015 May-Jun;19(3):195-203.

    June 15, 2016 By JJRX 2016
  • Topical Pain Formulations – Preferable to Oral Medications?

    Topical and transdermal pain formulations are very popular among health care providers and patients, but unfortunately, not all doctors are familiar with how to best prescribe customized medications. Topical and transdermal preparations are often preferred to oral medications due to decreased side effects and the avoidance of initial breakdown of drug by the liver (first pass metabolism). Dosage forms include creams, ointments, and gels; medication sticks; solutions, and sprays.

    “Topical” and “transdermal” are not interchangeable terms. Transdermal medications are applied topically but not all topical medications are absorbed through the skin and enter the bloodstream to have effects elsewhere in the body. The extent of absorption is dependent on the base and compounding technique. Transdermal preparations can create a greater systemic effect than topical preparations.

    Diabetic Neuropathy

    Compounded topical creams can play an outstanding role in meeting the needs of patients with diabetic neuropathy-associated pain. A recent study showed good to excellent results in relief of pain associated with diabetic neuropathy and relief of other chronic neuropathic pain with the use of compounded creams. Use of the creams resulted in a reduction in the need for oral analgesics and referrals made by physicians to pain specialists.

    We will work together with you and your health care provider to customize medications that meet your unique needs. We typically suggest starting with lower doses and one to two drug combinations and adjusting the dose and choice of medications based on each patient’s response.

    May 11, 2016 By JJRX 2016
  • Testosterone Therapy for Women: Debunking the Myths

    Women's Testosterone Treatment

    Testosterone therapy is increasingly used to treat symptoms of hormone deficiency in pre and postmenopausal women. Testosterone is essential for physical and mental health in women as well as men. Although frequently thought of to increase sex drive, testosterone’s role in sexual function is only a small part of its physiologic effect in women. Receptors for testosterone are located in almost all tissues including the breast, heart, blood vessels, gastrointestinal tract, lung, brain, spinal cord, peripheral nerves, bladder, uterus, ovaries, endocrine glands, vagina, skin, bone, bone marrow, muscle and fat.

    Testosterone declines gradually with age in both sexes. Pre and post-menopausal women, and aging men, may experience symptoms of testosterone deficiency including anxiety, irritability, depression, lack of well being, physical fatigue, bone loss, muscle loss, memory loss, insomnia, hot flashes, rheumatoid complaints, pain, breast pain, urinary complaints, incontinence and sexual dysfunction. According to Rebecca Glaser, MD and Constantine Dimitrakakis, MD, PhD: testosterone is not masculinizing and does not increase aggression or cause hoarseness; testosterone does increase scalp hair growth, is mood stabilizing, and is cardiac and breast protective.

    A source of confusion concerning the safety of testosterone therapy in both men and women is the extrapolation of adverse events from high doses of oral and injectable synthetic anabolic steroids to therapy using the bio-identical form of testosterone in doses that simply restore normal physiologic levels. Bio-identical testosterone is the same substance that is naturally produced by the human body. In England and Australia, testosterone is licensed and has been used in women for over 60 years. In the United States and Canada, compounding pharmacies can customize testosterone in doses that are appropriate for women.

    Ask our compounding pharmacist for more information about testosterone and other bio-identical hormones. We work together with practitioners and patients to create hormone balance, and have successfully relieved symptoms in patients who have not responded to or who have experienced intolerable side effects using commercially-available hormones.

    April 12, 2016 By JJRX 2016
  • March 2016

    Restoring Balance—Thyroid Hormone TherapyHormoneBalance

    More than half of all people with thyroid disease are unaware that they have a thyroid problem. Individuals with low levels of thyroid hormones (hypothyroidism) may have several of the following symptoms, but may not be diagnosed for years:

    • PMS, Irregular menstrual periods
    • Lack of exercise tolerance
    • Weight gain (especially in the stomach)
    • Hypoglycemia (low blood sugar)
    • Fatigue
    • Irritability – low self esteem
    • Low sexual desire
    • Infertility
    • Dry skin, eyes and/or hair
    • Yellowed skin
    • Loss of eyebrows
    • Constipation
    • Headaches, migraines
    • Depression, apathy and anxiety
    • Memory and concentration impairment
    • Fluid retention – face, legs, eyelids and abdomen
    • Slowed metabolism and slowed heart rate
    • Cold and heat intolerance – cold hands and feet
    • Enlarged tongue, deep voice and swollen neck

    Both men and women can have stress, exposure to environmental toxins, or suboptimal nutrition, all of which increase the risk of hypothyroidism. However, women are more vulnerable to thyroid imbalances due to hormonal changes throughout their lifetime (puberty, birth control pills, pregnancy, menopause, HRT).

    Hormone replacement therapy often is focused on other hormones such as estrogens, progesterone, DHEA and testosterone, but optimal hormone balance cannot be achieved without correcting thyroid hormone imbalances. Many symptoms of hypothyroidism and menopause overlap. It is especially important for menopausal women who decide to use hormone replacement therapy (HRT) to have their thyroid function tested, because oral estrogens can lower the amount of bioavailable thyroid hormone. This means that if a woman is already on thyroid treatment, and begins oral estrogens, her thyroid dose may need to be increased.

    If you have some of these symptoms, ask us or your doctor about thyroid testing. Our compounding professionals work together with patients and their health care providers to customize medications in the specific strength and dosage form that is most appropriate to meet each patient’s specific needs and solve medication problems.

    We welcome your questions.

    March 9, 2016 By JJRX 2016 ,
  • February 2016

    Customized Hormone Replacement Therapy

    Today’s women prefer natural hormones. In a national survey of 1,009 women aged 40 and older, 83% said they would prefer to use hormones that are similar to their own body’s hormones.

    Goals of Customized, Natural HRT

    • Alleviate the symptoms caused by the natural decrease in production of hormones by the body
    • Give the protective benefits which were originally provided by naturally occurring hormones
    • Re-establish a hormonal balance

    The three types of hormones typically prescribed for customized hormone replacement therapy are estrogens, progesterone, and androgens. The precise components of each woman’s therapy need to be determined after physical examination, medical history, and laboratory testing are considered. Close monitoring is essential to ensure that appropriate dosage adjustments are made.


    • are often prescribed in combination to re-establish a normal physiologic balance
    • relieve menopausal symptoms, including vaginal thinning and dryness
    • may increase HDL “good” cholesterol and decrease LDL “bad” cholesterol
    • help to decrease blood pressure and reduce plaque formation on the arterial walls
    • reduce the risk of colorectal cancer
    • may improve mood, energy levels, and sleep patterns
    • may reduce the risk of developing or the severity of type 2 diabetes
    • may improve memory and cognitive function
    • reduce bone loss


    • is commonly prescribed for perimenopausal women to counteract “estrogen dominance”
    • alone, or with estrogen, may improve Bone Mineral Density
    • minimizes the risk of endometrial cancer in women who are receiving estrogen
    • is preferred by women who had previously taken synthetic forms of progesterone known as progestins, according to one Mayo Clinic study
    • may enhance the beneficial effect of estrogen on lipid and cholesterol profiles in post-menopausal women (in contrast to synthetic medroxyprogesterone acetate)

    Androgens, such as testosterone, are prescribed for women to:

    • enhance libido
    • provide cardiovascular protection (lower cholesterol)
    • enhance bone building (increase calcium retention)
    • improve energy levels and mental alertness

    Recently, attention has turned to the addition of the androgens testosterone and dehydroepiandrosterone (DHEA) to estrogen replacement therapy to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes.

    Every woman is unique. Therefore, it is a sensible approach for the patient to work together with health care professionals to customize hormone replacement therapy. HRT can be customized in the needed strength and dosage form and administered via the most appropriate route to meet each woman’s individual needs.

    © Storey  Marketing. All Rights Reserved.

    February 9, 2016 By JJRX 2016
  • January 2016

    Natural Progesterone Can Slow Breast Cancer

    A large team of scientists have determined that natural progesterone has the potential to slow the growth of many breast cancer tumors or even shrink them, unlike synthetic progestins which increase breast cancer risks. 

    It has long been known that tumors with estrogen receptors (ER) and progesterone receptors (PR) – termed ER/PR double positive – have the best clinical outcome. A study conducted by researchers from prestigious institutions including the Cancer Research UK Cambridge Institute; University of Adelaide, Australia; University of Texas, Southwestern Medical Center at Dallas; and University of North Carolina at Chapel Hill explain why double positive breast cancer patients have the best chance of survival. The finding could benefit up to half of all breast cancer patients.

    Scientists know that when activated by most forms of estrogen – especially estradiol and its metabolites – estrogen receptors turn on genes within cancerous cells that program those cells to multiply rapidly and stay alive rather than die off as normal, healthy cells do. When activated by progesterone, progesterone receptors attach themselves to estrogen receptors. Once this happens, estrogen receptors stop turning on genes that promote the growth of the cancer cells. Instead, they turn on genes that promote the death of cancer cells (apoptosis) and stimulate the growth of healthy, normal cells.

    The researchers pointed out that only natural, bio-identical progesterone slows the growth of breast cancer. Conversely, synthetic progestins (molecularly altered forms of progesterone including medroxyprogesterone acetate and other progesterone derivatives found in birth control pills) have been shown to increase rather than decrease breast cancer risks.

    This is exciting news for women who are diagnosed with ER/PR positive breast cancers. If such women have healthy progesterone levels, or when progesterone levels are increased through natural progesterone supplementation, treatment outcomes may improve significantly.

    Hormonal imbalances have reached epidemic proportions in most developed countries over the last several decades. Due to poor diets, lack of exercise, a rise in obesity levels, the widespread use of hormone-altering chemicals, and other factors, many women suffer from chronically higher than normal estrogen levels and much lower than normal progesterone levels.

    In their book What Your Doctor May Not Tell You About Breast Cancer, John R. Lee, M.D. and David Zava, Ph.D. noted that women with progesterone levels that are low relative to estrogen levels are more likely to get breast cancer and have poorer treatment outcomes. They concluded that estrogen dominance causes estrogen receptors to activate genes such as BCL-2 that are known to promote the rapid growth of cancer cells. They theorized that chronic states of estrogen dominance contribute to high rates of breast cancer, and their theory has been validated with this latest research.

    Ask our compounding pharmacist for more information about the benefits of balancing hormones using natural progesterone. We will work together with you and your health care provider to customize medications in the proper dosage to meet your unique needs.

    Nature 2015; 523; 313-317.
    Pharmaceutical Journal, 17 Jul 2015.
    John R. Lee, M.D.; David Zava, Ph.D.; and Virginia Hopkins. “What Your Doctor May Not Tell You About Breast Cancer.” 2002


    © Storey  Marketing. All Rights Reserved.

    January 13, 2016 By JJRX 2016 , , ,
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