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Two Years of Providing Compounded Medications in Summerland

It has now been two years since we opened up our medication compounding lab here at the Pharmasave in Summerland.

For folks not familiar with the term “compounding pharmacy” it means we can make up special medications and in dosage forms that are not available from drug manufacturers, and therefore are not carried by other “regular” pharmacies.

If we aren’t a “regular” pharmacy does that mean we are different? Yes I guess it does. But in this case, different is good.

(For more information on what it means to be a compounding pharmacy, see our blog article here.)

Everyone likes to know what is Popular so…

Looking back at the hundreds of different compounded medications we have crafted since we opened the most common ones are (in no particular order):

Diclofenac creams

On a doctor’s prescription we have created Diclofenac creams in strengths ranging from 4% to 20%. There is a drug company that makes a Diclofenac gel (called Voltaren Emulgel) that you can buy without a prescription, but its strength is just over 2%.

We make our Diclofenac creams in a cream base called Lipoderm. This results in a smooth, non-tacky cream that helps deliver the Diclofenac right to the area it’s needed. Yes it costs more, and it isn’t a Pharmacare benefit, but if you haven’t found relief from “over the counter” creams then speak to your doctor about this option.

Estriol Vaginal Gel

After menopause a decrease in estrogen can result in thinning of the vaginal tissue. They call this vaginal atrophy. Not only is this irritating and painful, but it can also increase the risk of urinary tract infections. With a doctor’s prescription we can create low-dose estriol gels that are applied directly to the vagina.

Estriol is a form of estrogen. We often think of estrogen as one single thing, but under the term of estrogen there are actually three main estrogens: estrone (E1), estradiol (E2), and estriol (E3).

• Applying the gel to the vaginal tissue means you are applying a form of estrogen directly to the deficient tissues…so basically right where you need it.

We make our Estriol vaginal gels with a base called Mucolox. Mucolox is an amazing delivery vehicle that “locks to the mucosal tissues” (hence the name). It helps stick to the mucosal tissue of the vagina so the estriol can stay in contact with the tissue longer. We call this increasing the contact time of the medication with the targeted tissue. You may just call it relief.

Bi-Est Hormone Replacement Creams

Remember above I mentioned that the umbrella term of estrogen is actually comprised of three different types of estrogen?

We commonly make up a “Bi-Est” cream which is a combination of two of those estrogens: Estradiol and Estriol. The main reason we do a two-estrogen cream, and not a three-estrogen cream, is that the other estrogen, Estrone, is already the main estrogen women produce after menopause. So it is usually the other two estrogens that a woman may need a little more of.

There are some commercially available estrogen products on the market made by regular drug manufacturers, but sometimes they are not right for all women.

• Doctors who specialize in hormone replacement generally prefer estrogen be administered through the skin or intravaginally instead of orally because taking a pill means more estrogen enters the liver at one time. And this splash of estrogen into the liver doesn’t reflect how human bodies naturally make estrogen.
• Drug manufacturers do make some estrogen patches but some women have skin sensitivity to the adhesive.
• Drug manufacturer’s also make an estradiol gel that you pump onto your skin, but the pump provides a set amount of estradiol (called a metered dose) but that metered dose may not be the right amount for all women.

Because there are some “gaps in the market” for providing hormone replacement products for woman we have made up a variety of different strengths of Bi-Est. And we can put them into a metered dose pump, so that each pump of cream is exactly the dose YOU need…not what “the majority” of women may need.

Progesterone Capsules

On a doctor’s prescription we can create a variety of strengths of micronized progesterone in a capsule form. Why women love this option is because there is a drug manufacturer that makes a progesterone capsule, called Prometrium, but it is only available in one strength: 100mg.

The commercially-available Prometrium is a capsule and cannot be split because it contains oil inside it. But what if a woman only needs 50mg? Or 125mg? Well that is where our compounding pharmacy comes in.

We know that not every woman is the same, they can have different medication requirements, so we provide options.

If you are paying attention you may be asking, “But wait, you just said I shouldn’t take Estrogen by mouth, but now you’re saying I can take Progesterone by mouth?”

Well first off, good for you for noticing that. It is a very good question.  The short answer is that taking Progesterone by mouth is better tolerated than taking Estrogen by mouth. In fact, when you take Progesterone by mouth your body metabolizes it into Allopregnanolone, a molecule that can make you drowsy. That is why oral Progesterone is taken at bedtime: it may help you sleep.

Several of our pharmacists have gone to different hormone replacement conferences over the years, and one thing that comes up repeatedly is discussing patients that say, “I had a hysterectomy so my doctor said I don’t need progesterone.”  Is this true?

And the doctors giving the presentations ask, “Do you only have progesterone receptors on the uterus?” Well the answer is no! There are progesterone receptors spread throughout the body including in the brain, lungs, skin, breast, and bone tissues. So just because a woman’s uterus has been removed doesn’t mean her need for progesterone has been removed too.

For more information about progesterone and progesterone replacement therapy you can check out this website from Dr. Jerilynn Prior at UBC’s CemCOR

We want to thank all the patients and practitioners that have supported our compounding pharmacy services over the first two years. That is two years under our belt helping patients in Summerland, Penticton and beyond, and hopefully many more to come.

Thanks again.  Pharmacy Staff at Pharmasave Summerland