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Compounding pharmacist customizes individualized prescriptions

By Cindy Atoji Keene
Mass-produced prescriptions are “one size fits all” and often don’t meet patient’s needs – the dosage might be too strong; there could be potential allergens in the ingredients; or maybe the capsule is too large to swallow. That’s when compounding pharmacies like Johnson Compounding & Wellness Center in Waltham can step in, preparing medicines that are not commercially available or customizing a drug for a specific individual. “I like to compare it to making a cake that’s just right for each person, said Stephen P. Bernardi, a registered pharmacist and co-owner of Johnson Compounding & Wellness Center in Waltham. Six years ago, the pharmacy joined the some 7,500 pharmacies across the country that specialize in providing compounding-only services.

Q: What’s an example of a typical compounded prescription?
A: We have a database of tens of thousands of formulas used over the years – it is ever changing and evolving. There are no simple ‘recipes’ – our formulas are proprietary and usually two to three pages long, including ingredients and detailed instructions outlining USP 795 mandates to be in compliance. These are guidelines from the United States Pharmacopia that provide standards of practice. One example is so-called ‘magic’ or ‘miracle’ mouthwash, a formula that contains a variety of ingredients depending on a prescriber’s preference. It could include an anti-fungal such as Nystatin; steroid such as dexamethasone; antibiotic like Tetracycline; anesthetic like viscous lidocaine and sometimes some Maalox, an antacid. It is used for things like mouth sores as well as radiation burns from cancer therapy.

Q: Do compounding pharmacies like yours step in when there are drug shortages of manufactured medicines?
A: Compounding can help fill the need when a drug is in short supply or has been discontinued. One example that comes to mind is Tamiflu, a flu medicine that always seems to run out every year, especially the liquid form. We can take the capsules and convert into liquid.

Q: We all know what a conventional pharmacy looks like – what would we see if we walked into Johnson’s?

A: Our pharmacy has a ‘transparent’ lab so technicians can be viewed as they compound in the lab. The workers first need to walk into an anteroom, which is immediately outside the pharmacy cleanroom. This is where they scrub and put on booties, gowns, and gloves. They then go into an air-locked lab with various work stations, each with its own utensils. Each station is set up for different purposes; one is for suppositories; another is a vitamin mixer; pediatric liquids; capsules, different kinds of cremes, and so on.

Q: How did the meningitis outbreak at the New England Compounding Center affect your pharmacy?
A: There are some people who lump compounding pharmacies into one category – and not necessarily a good one. But we have a very good track record and are very highly rated. It’s a common misconception that compounding pharmacies are not as well regulated as commercial pharmacies but we are actually more regulated than conventional prescriptions in all respects.

Q: What’s the oddest request you’ve ever received?

A: Sometimes we receive requests to compound drugs for animals – we got one for a pair of ferrets that the owner referred to as boyfriend and girlfriend. We had to get a special liquid base to put the active ingredient in so that they would take their medicine. Another example of a difficult compound to create is a B vitamin methylcobalamin injection that has to be made in the dark because it’s light sensitive.

Q: Compounding pharmacies serve many baby boomers, who are interested in hormone replacement, hair loss formulas, and others. You yourself just turned 60 – how did you celebrate?
A: To celebrate my 60th birthday, I got my very first tattoo. It’s a picture of three cherry blossoms, my initials, my wife’s initials, the year we met, and the infinity symbol. You’re never too old to try something new.

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