We welcome your questions. Neuropathic pain is a common condition. Peripheral neuropathy is a result of damage to peripheral nerves from traumatic injuries, infections, metabolic problems, inherited causes or exposure to toxins. One of the most common causes is diabetes mellitus. It often causes weakness, numbness and pain, usually in the hands and feet but it can also affect other areas of your body. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling.

Another problem that can progress to chronic neuropathic pain is postherpetic neuralgia (PHN), a complication of shingles. Shingles (medically known as herpes zoster) result from the reactivation of the varicella-zoster virus that is most commonly contracted during childhood in the form of chickenpox. Virus that had remained dormant for decades can re-manifest as a painful, blistering, and vesicular rash. While the characteristic rash of herpes zoster usually clears within 2 to 4 weeks, 20% of people may experience pain in the form of PHN that persists after the rash has healed. The pain is a consequence of peripheral nerve damage caused by the herpes zoster attack, and can persist for years. Risk factors for PHN include advanced age, female gender, chronic disease, immunocompromised condition, and a greater severity of outbreak and pain during the acute phase.

The management of chronic neuropathic pain is challenging and as many as half of patients fail to respond to any conventional (commercially available) treatment. Other patients may experience limited benefits even when taking multiple medications. Health care providers have increasing interest in the optimization and personalization of therapy based upon the underlying cause of neuropathic pain and the patient’s symptoms.

Treatment options to date have mainly been centered on oral therapies, including tricyclic antidepressants, opioid analgesics, and corticosteroids. Therapeutic doses of these oral medications often carry a high risk of side effects and even opioid addiction.

Oral gabapentin is a common treatment for neuropathic pain, although doses that are adequate to provide pain relief usually produce intolerable drowsiness or dizziness. Small studies and case reports have found that topical application of compounded gabapentin gel relieved neuropathic pain without unwanted systemic side effects.

Some people with peripheral neuropathy have benefitted from these complementary therapies:

• Alpha-lipoic acid – be cautious and talk to your doctor because alpha-lipoic acid can affect blood sugar levels (and diabetes is often the cause of peripheral neuropathy).
• Herbs such as evening primrose oil might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so don’t start herbal therapies before discussing with our pharmacist and your doctor.
• Amino acids such as acetyl-L-carnitine might benefit people who have diabetes or who have neuropathic pain following chemotherapy.

Our pharmacist can recommend the product and dose that will be best for you.

Ask our pharmacist how compounded medications and professional quality supplements might help neuropathic pain.

Vaginal atrophy is thinning, drying and inflammation of the vaginal walls due to declining estrogen levels. This occurs most often after menopause and can lead to irritation, itching, burning, distressing urinary symptoms, painful intercourse, and loss of libido.

Administration of intravaginal estrogen is the conventional therapy for vaginal atrophy. The body naturally makes three types of estrogen, each with different actions and potential benefits. Our pharmacist will talk to your doctor about which type of estrogen might be best to treat your specific problem. A compounded preparation containing hyaluronic acid in combination with vitamins A and E in an intravaginal cream may provide an alternative for patients who cannot use hormones.

Our compounding pharmacist will work together with each woman and her physician to customize a prescription medication that is most appropriate to treat her specific problems. We can prepare vaginal creams, suppositories, and even a small vaginal insert with no residual discharge.

We welcome your questions. Call JJ’s Prescription Specialties at 562-7979 for more information.

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Hormone Replacement Consultations

If you would like a personal consultation about Hormone replacement with Bio-Identical Hormone Replacement Therapy, please click on the link below and fill out the HORMONE REPLACEMENT FORM and bring a copy in to our pharmacy.

JJ’s Prescription Specialties
4070 Nelson Road
Lake Charles, LA 70605

Female Hormone Evaluation Form

Compounding is the art and science of preparing customized medications in the best strength and dosage form for each individual. Compounded medications can solve problems that don’t respond to commercially available drugs.

Due to stability concerns and the cost of stocking and distributing numerous formulations of each drug, medications are manufactured in a limited number of strengths and dosage forms that will satisfy the needs of most patients. Using pharmaceutical grade chemicals and specialized equipment not found in most pharmacies, we can compound medications in doses and dosage forms that are not commercially available.

We can compound medications into cosmetically appealing topical or transdermal creams and gels, sprays, and powders. Chemicals from FDA-inspected facilities can be utilized to enhance the absorption of topically applied medications.

Oral dosage forms such as lozenges, lollipops and suspensions can be flavored for each individual. Compatible drugs can be combined into a single dosage form to simplify a medication administration schedule and improve compliance and outcomes. We commonly prepare unique formulations that physicians request to meet specific needs of their patients, or “tried and true” formulas acquired during medical training. Our goal is to optimize the care of every patient. Bring us your medication problems!

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There are a number of advantages of using topical pain creams/gels instead of oral pain relievers in tablet, capsule or liquid form:

• Can be applied locally only on the area where pain relief is needed.
• Fast onset of action.
• Higher concentration of the analgesic in the pain area.
• Low or no systemic drug levels means fewer or no side effects.
• Absence of drug-drug interactions.
• Ease of combining multiple medications into one formulation for synergistic benefits.
• Improvement of compliance.
• No risk of dependency or abuse.
• Combinations of compatible drugs improve the chances of achieving a good therapeutic response. Optimization of a customized formulation by using the proper base/vehicle for topical or transdermal delivery is essential to achieve the best therapeutic response.

If you or a family member or friend are suffering from chronic pain, talk to our compounding pharmacist. We will work together with patient and physician to customize therapies to meet the specific needs of each individual.

Reference: J Pain Res. 2017 Mar 20; 10:635-641.

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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.