November 23, 2014

Medicine Customized for You

For years, kyle neven lived a nightmare that few can imagine—mysterious, painful muscle spasms that no conventional medicine or treatment could cure. “The muscles were spasming out of control all the time,” says the Lehigh Acres woman. “It was like severe charley horses. They went across my back and neck and shoulders. If you touched my back, the muscles were as hard as a rock, and they never released.”

Doctors tried muscle relaxants and pain relievers. Neven had Botox injections in her neck and back. Nothing worked. Worse yet, many of the treatments she tried left her fatigued and so groggy she couldn’t think straight.

Finally, a new doctor suggested Neven turn to a compounding pharmacy that could custom-make a medicine specifically for her, a topical pain reliever applied directly to the muscle spasms. It worked, relieving her back and neck spasms while leaving her alert. “It really gave me my life back,” she says.

Most people have heard of compounding pharmacies but rarely go to them. Most of us continue to troop to the big chain drugstores that seem to dot nearly every major intersection in Southwest Florida. I’ll admit the only time I ever went to a compounding pharmacy was when my infant son needed a specific pediatric dosage of an antacid. The pharmacist was able to mix the precise amount my boy needed so we could administer it with a dropper.

Turns out, helping patients with special needs or preferences in medicine is exactly what compounding pharmacies are all about. Like apothecaries of old, these specially trained pharmacists and technicians mix and match medicines in ways the big chain stores can’t or won’t. “Compounding is a unique art,” says Jeff Steele, a compounding pharmacist and the owner of Myerlee Pharmacy in south Fort Myers. “If you have a prescription that is hard to find, if you need medicine customized in a unique dosage form, you have options.”

Steele took over his store in 1991, when it was a traditional retail pharmacy. However, he soon noticed that many customers were asking for “oddball” things they couldn’t find elsewhere. He saw an opportunity and took his entire staff to Houston for advanced training in compounding. Today, Myerlee Pharmacy has a thriving business despite the big chain drugstores in the area.

People turn to compounding pharmacies for a variety of reasons. For patients who have trouble swallowing pills, a compounding pharmacist can create a different delivery system for the medicine. This may include liquids, lozenges, suppositories, topical ointments or gels, even lollipops that patients can lick to receive the medicine they need. Children often need specialized dosages because of their small size, and compounding pharmacists can also make them in child-friendly formats, including special flavorings. Some specialized pharmacies can even make “gummy” medicines that look and taste like candy.

“We can make anything,” says Allison Drew, a technician at Sunshine Pharmacy in Naples. “Say your doctor wants you to take 37.8 milligrams of a specific medicine and it only comes in 20-, 50- or 100-milligram doses. We can make any strength the doctor would like.”

Some patients have an intolerance of preservatives or dyes used in a medicine. For example, the filler in many medicinal capsules contains lactose, which can cause stomach discomfort for people who are lactose intolerant. A compounding pharmacist can make medicines without the offending ingredients.

I had no idea the reasons for going to such a pharmacy were so varied, but it’s easy to see that there’s a need.

Many compounding pharmacies say a big part of their business is the creation of bioidentical hormones for patients undergoing hormone-replacement therapy. Many commercially available hormone treatments come in set dosages and combinations, and most include synthetic ingredients. That’s why the demand for compounded bioidentical hormones with nothing synthetic in them has grown. “When we make a bioidentical, we combine it in a ratio that naturally occurs in the body,” Steele says. “A doctor and a compounding pharmacist can help a woman mimic what her body has been doing for years, the naturally occurring hormones in the body. You are customizing the exact hormone replacement for that exact patient.” Steele estimates bioidentical hormones make up 25 percent of his business today.

Compounding pharmacies may present insurance challenges for some customers. Pharmacists say prices for compounded medicine is often comparable to the big chains, but private pharmacies may not submit claims to insurance companies, leaving that up to the patient. Another hitch is that medicines from big pharmaceutical companies come with a national drug code. Compounded medicines created for a customer may not have this code, and some insurance companies may pay only for medicines that do.

Still, when you or your loved ones are sick and need specialized medicine to feel better or get better, you’ll likely go that extra mile without hesitation. “We have people that come in tearing their hair out. They don’t know what to do,” Drew says. “We can put a smile on their faces. You can basically solve any medication problem with prescription compounding.”