Cutting Edge Individualized Medical Care Options:
Going Beyond Drug Company Options
I want to recommend compounding specialty pharmacy options I have used for years. They have added tremendously to my medical care. Here are small samples of special compounds that can be made by a compounding pharmacist:
- Promethazine cream--this traditional anti-nausea agent it only available in oral or rectal forms. I have written over 150 prescriptions for this penetrating transdermal cream--even oppositional adolescent boys decided that they wanted to see me after I stopped their nausea with this cream. It is amazing anti-vomiting medications are still given orally and rectally. I am not waiting ten years for the patented patch. This cream has extremely rapid onset of action and this ingredient, like all the ingredients described below, fit FDA approved United States Pharmacopoeia standards. It is often given orally for vomiting. Do not dose excessively because it has side effects. Discuss with your doctor.
- Prescription Joint Pain Transdermals--In my family everyone over 60 has profound arthritis. We use specialty joint pain creams containing ketoprofen (better absorbed than ibuprofen). Ketoprofen cream has no GI upset and is not systemic--just applied to the point of pain. Sample, optional add-ons include amitriptyline, baclofen, clonidine and gabapentin and for profound severe pain, low dose ketamine can be added with no systemic side effects. The good thing about this product is you will not tear up your gut with NSAIDS like Motrin. You will not get micro-inflammation of the entire intestinal wall either.
- Testosterone. Intermittently I find men who have suboptimal or clear hypo-testosterone who are usually grouchy and irritable men with low libido and low motivation. I also find this intermittently with post-reproductive women. The patented testosterone patch causes fairly large abdominal dots from daily patches with sub-optimal blood levels. Special compounders give me very high absorption sublingual testosterone lozenges along with a variety of transdermal creams, which have very rapid absorption and can be dosed exactly through a needleless syringe with doses that can be modified to fit both men and women.
- Bio-identical High Absorption Progesterone--My father, a gynecologist, spent three decades researching and promoting the use of progesterone. The use of progesterone has many advantages, which are often unappreciated due to a bizarre surprising confusion between progesterone and synthetic progestins. Compounding pharmacists special progesterones include a slow release form with profound absorption far above Prometrium's (per my blood assays). One can also use a rapid absorption cream that is dosed exactly in a needleless syringe. I have found the cream particularly useful in preventing progesterone sedation from GI metabolites and also in the treatment of migraines. I have also published nationally on this PLO cream's utility in treating premenstrual dysphoria disorder (an article which was co-authored by Michael Briggs, Pharm.D. and Ben Briggs, RPh.).
- Bio-identical Estrogen--Occasionally physicians may find patients requesting and even insisting on bio-identical estrogen as opposed to using the well known Premarin or Prempro. The Premarin contained in Prempro has over 200 components including horse and human estrogens, progesterones, and androgens (per Klein research and the manufacturer). Some patients insist on bio-identical estrogens and a compounding Pharmacy can make these in any strength.
- Specialty Throat Pain Delivery System--The Professional Compounding Society of American has invented a "mist" delivery system for severe sore throats. I have written for many prescriptions for this and typically write for Lidocaine 10% and Tetracaine at 0.5% strength. Do not dose excessively. Their tiny tub can be placed at the very base of the tongue and a patented tip disperses the pain medication mist throughout the entire throat area very satisfactorily. I personally have looked in the mirror and placed this myself. What a relief.
- Nail Fungus--Some patients complain about nail pain and have resistant fungal infections. Others are concerned that nail fungal infection medications have liver toxicity risks. One option is a combination of Econzaole combined with DMSO-- which drives the Econazole through the nail bed--in a Tea Tree Oil base, which also helps curb fungal infections. Options are useful with tough nail infections.
- Vaginal Probiotic and Pain Treatment for Vaginal Atrophy, Resistant Candida and Vulvadynia-I have successfully prescribed compounded suppositories and cream in patients reporting failure with common treatments from their GYN. I am able to tailor it to each patient utilizing six optional ingredients.
- Co-Enzyme Q10 Lozenges (CoQ10) 200mg. in specialized gelatin base for Sublingual use--Many medications reduce this precursor to the primary energy molecule of the body, e.g., "statin" cholesterol lowering medications. Our center and Lionville Natural Pharmacy in Lionville, PA have published a study on its benefit for Fibromyalgia patients if used daily for over nine days. (Townsend Letter for Doctors and Patients, June, 2001).
- Sinus Infection Anti-fungal Nasal Spray--One major study proposes that some reoccurring sinus infections are fungal (Mayo Clinic).
- Transdermal Imodium- When someone is vomiting and has diarrhea you cannot offer them a diarrhea medicine. Yet you can deliver it through the skin. (Generic).
- Transdermal acetaminophen- When someone is ill they may not be able to swallow medication to reduce their fever. Yet the active ingredient, acetaminophen, can be put into a penetrating cream. Dose with a doctor that understands compounding. (Generic).
- Transdermal alprazalam- Children getting on a plane may have a sour stomach and be afraid, this cream allows then to be calmed and to not have increased nausea. (Generic).
- Sublingual Glutathione-This is a major detoxification agent which is delivered to the blood stream by a lozenge under the tongue. A number of special modifications are made to this form to help the body remove the toxins we all have inside of us.
In conclusion, having attended the world meeting of the International Society of Compounding Pharmacists, I found it was one of the most intellectually rewarding and stimulating conferences of my medical career. The creativity of these special elite pharmacists is commendable and worthy of honor. My patients have found these sample medications--and others not mentioned--extremely helpful. I offer these ideas to you merely as an appeal. I just want physicians and patients to know that some of these options may be available.
James L. Schaller, M.D., M.A.R.
President, Chester County Research Center
Assistance from Ben Briggs, RPh and Michael Briggs, Pharm.D.