When we hear someone say lollipop, we often think of candy, but did you know that a lollipop can be a good way to take your medicine? Compounded medicated lozenges and lollipops are commonly used to treat problems such as infections and inflammation of the mouth. Topical preparations are often preferable to oral medications because a lollipop or lozenge can be held in place to numb a sore area, help to reduce swelling, or to provide an antibiotic or antifungal directly to the site of the infection. However, the benefits of these customized dosage forms are not limited to the mouth; they also can be used to treat nausea, generalized pain and other conditions.

Since a lollipop or lozenge dissolves in the mouth where there is an excellent blood supply, it can have a more rapid onset of action than oral medications that need to be absorbed and transported through the bloodstream to the affected area.

These compounded medications taste pretty good, so they should be stored in child-resistant containers to prevent accidental use or overdose by a child, and also kept away from pets.

Cleansing and moisturizing is often not enough to keep your skin looking its best. Over time, sun exposure can lead to areas of hyperpigmentation. Known as age spots, sun spots or liver spots, these flat dark brown or grayish areas are commonly found on the hands, face, shoulders, and other areas frequently exposed to the sun. The brown pigment in age spots is lipofuscin, a complex mixture of fats, proteins, and metals, especially iron. It is waste from worn-out cellular structures that the body cannot easily eliminate, and it piles up inside cells. In the skin these accumulations create a cosmetic problem.

Because there are many types of hyperpigmentation and many possible causes, treatment can be challenging.  Over-the-counter preparations rarely help. Common skin treatments such as laser therapy or chemical peeling may worsen some conditions. Therefore, one of the most popular treatments is a compounded topical skin lightening cream, which can be customized for each patient’s skin type and problem. Medications can be compounded to be free of allergens, dyes, fragrances and preservatives. Our pharmacist will work with you and your doctor to formulate the best preparation to treat your specific condition.

It can also help to take antioxidants such as vitamin C and vitamin E in appropriate doses. Ask our pharmacist which supplement and dose is best for you.

Other types of skin spots, such as freckles or birthmarks, may be present at birth or develop over time. Medical conditions can also cause dark areas of skin. Even if you decide to live with your age spots, it’s a good idea to see a dermatologist to be sure they are not precancerous or cancerous lesions that have to be removed for medical reasons.

Our compounding pharmacist can work with your doctor to provide the best remedy for difficult-to-treat dermatologic problems.

We have found that many people actually want to take their medicine as directed but don’t because they can’t swallow or their prescriptions cause intolerable side effects.

Our compounding pharmacy can help! Customized medications can help people to receive the medications they need and get better faster. Here are some of the problems that interfere with therapy, and how our compounding pharmacist can help:

• Gastrointestinal upset caused by oral medications: we can usually compound the needed medication into  a transdermal gel so that the medication can be absorbed systemically but bypasses the GI tract.
• Bad taste or texture: we can flavor medication in a solution, suspension, lollipop, or lozenge.
• Difficulty swallowing or nothing permitted by mouth: medications can be compounded into dosage forms that are not commercially available, such as a topical/transdermal cream or gel, or a rectal suppository.
• Difficulty breaking tablets or measuring a dose: we can compound medications in the dose that is most appropriate for a specific patient.
• Allergies or sensitivities to dyes, lactose, sugar, alcohol or preservatives: our specially trained professionals can compound medications that are free of problem-causing excipients.

We work together with physicians and other health care professionals and their patients, and customize medications to meet each patient’s unique needs.

Did you know that there are various types of baldness, and the treatments differ? About half of men and women show some degree of balding by the age of 40. Androgenetic alopecia (AGA) is the most common form of hair loss in both men and women. In men, AGA is known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes and hair thins on the top of the head, which may progress to partial or complete baldness. In women, the pattern of hair loss differs: the hair becomes thinner all over the head often beginning with the part, and the hairline does not recede. AGA in women rarely leads to total baldness.

Due to the progressive nature of AGA, treatment should be started early and continued indefinitely, since the benefit will not be maintained when therapy is stopped. FDA-approved treatment of AGA includes topical minoxidil for men or women, plus oral finasteride for men. Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT). When DHT concentrations are decreased in men taking finasteride, there is a progressive increase in hair count. Women may benefit from hormone therapy, and the medication spironolactone may be used as an antiandrogen in women, as opposed to oral finasteride.  

However, there are other treatment options that target the different pathophysiologic causes of AGA, which can be compounded with a prescription from your doctor. Studies have shown that compounded topical finasteride 0.25% solution also reduces scalp DHT levels and in comparison with oral finasteride, the topical solution may minimize sexual side-effects linked to a systemic DHT reduction caused by oral finasteride.

Topical melatonin was also found to be a promising treatment for AGA based on laboratory and human research. Clinical studies showed positive effects of topical melatonin solution in the treatment of AGA in men and women. Patients had few side effects, and the topical solution did not raise serum melatonin levels.

Other forms of hair loss are treated differently than androgenetic alopecia, and include:

• Hair shedding (telogen effluvium) which may develop after medication intake, illness, childbirth, and crash dieting.
• Patchy balding (alopecia areata) is found in about 1.7% of the population. Most cases or alopecia areata start during childhood or adolescence and last throughout life.

Therapy for androgenetic alopecia or alopecia areata can be personalized for each individual based on their response to treatment. Our compounding pharmacist will work with each patient and his or her doctor to customize medications to make them easier to use and potentially reduce side effects. Your questions are welcome.

References:

Dermatol Ther. 2016 Jul 18.

Int J Trichology. 2012 Oct;4(4):236-45.

Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/hair-disorders/  

Early detection of breast cancer often improves the outcome of treatment. Therefore, make sure you and the women you know do self-exams each month, report any unusual bumps or changes in size of the breast, and are regularly screened for breast cancer. Ask our pharmacist how various types of hormones may affect your risk of breast cancer. We know that survival is the goal but often not the end of a woman’s journey with breast cancer. Quality of life is so important, and treatment may cause ongoing unpleasant side effects, plus cancer survivors often live in fear of recurrence. Women who have had breast cancer may be suffering but don’t want to complain because they are grateful to be alive. If you or someone you love has ongoing problems after chemotherapy or radiation (such as discomfort, weight gain, fatigue, mental cloudiness, mood swings or gastrointestinal upset), talk to our pharmacist. We recommend reading “The Definitive Guide to Thriving After Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health” by Lise Alschuler, ND, which emphasizes a comprehensive approach needed for optimal health and recurrence prevention. 

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.

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.

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.

This 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.

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.

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.