February 2005 | Whole Health
Clean Living
An Alternative Breed of Pharmacist
by Rebecca Ephraim, R.D., C.C.N.
I’ve heard a lot about compounding pharmacists. How are they different from regular pharmacists and why would I use one?
Pharmacist Christopher Turf is seeing huge interest in compounding since the painkiller Vioxx and other COX-2 inhibitors were cited for increasing the risk of heart attacks. Turf, director of compounding and medical outreach for Pharmaca, a chain of U.S.-based integrative pharmacies, says more people are seeking alternatives to COX-2s with their horrific risk and another side effect that often leads to distressing stomach irritation.
“More people are looking for alternatives, and one great option is using a topical pain agent in a gel and applying it directly to the area where it’s needed,” the Denver-based Turf says enthusiastically. “Very little of the drug enters the blood stream and, since it’s not taken orally, it doesn’t cause stomach problems.”
Compounding pharmacists like Turf prepare custom medications for patients who may have a number of concerns about regular prescription drugs. Aside from just wanting to avoid one-size-fits-all drugs and their fierce side effects, patients may be allergic to preservatives or dyes in the mass-marketed drugs or sensitive to standard drug strengths. A compounding pharmacist can prepare a drug to alter its strength, eliminate the allergens or make it more digestible or palatable and avoid dangerous side effects.
Although exact numbers are hard to come by, the International Academy of Compounding Pharmacists (IACP) estimates there are probably as many as 5,000 pharmacists practicing compounding techniques in the U.S. A small subgroup — possibly no more than a few hundred — is breaking free of a role they consider frustrating and unhealthy.
Larry Frieders, who’s been a practicing pharmacist more than 30 years, is one of them. Eight years ago, Frieders, who owns a pharmacy in Aurora, Ill., began specializing in compounding methods. “I’ve removed all the standard prescription items and now I dispense only those things that I can compound...that I think have merit or value...[things like] pain medications for unrelenting pain and [natural] hormone medications for women who want to rebalance their hormone structure.”
One of Frieders’ specialties is a compounding alternative to conventional HRT and its controversial side effects. It’s technically referred to as “bio-equivalent hormone replacement therapy” as the hormones used (estrogens, progesterone and testosterone) are identical to the body’s natural hormones but derived from wild yam and soy plant sources. Patients, doctors and pharmacists find that when these are used in place of the commercially available synthetic HRT and tailored to the individual woman’s specific needs, side effects such as bleeding, mood swings, breast tenderness, skin eruptions and weight gain are minimized or nonexistent.
Compounding pharmacists, like their conventional counterparts, need a prescription from a physician before dispensing drugs. So working with conventionally trained M.D.s, who base much of their practice on invasive pharmaceutical drugs, can be a sticky wicket for natural-minded compounding pharmacists. However, most of their compounding business is patient driven. In other words, patients who learn about the virtues of compounding over mass-produced drugs tell their doctors they’d like to pursue this avenue. Frieders says, “When a patient comes to me and says ‘I’ve tried and tried and Dr. XYZ just won’t agree with me,’ [I tell them] there are other doctors. We help them find [physicians] who will be more supportive of them.”
Pharmacist Turf says because prescriptions are needed for compounded drugs, health insurance usually covers them. In order to find a compounding pharmacist near you, the IACP offers a referral service at its Web site: www.iacprx.org .
Rebecca Ephraim is a registered dietitian and certified clinical nutritionist.
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