Drug Shortages - We Can Help!
While drug shortages have always existed, the problem has escalated and more than 200 important medications are now unavailable. Current shortages are often the result of a drug company’s decision to halt production of older drugs that are less costly in favor of manufacturing newer, more profitable products. However, in many cases the medications that are pulled from production are life-sustaining, such as electrolyte solutions, chemotherapy, and drugs used during resuscitation. While the decisions made by pharmaceutical manufacturers may be in the best interest of their stockholders, patient care is suffering and many critical drugs are now indefinitely backordered. In many cases, we can help by compounding the needed medications. We have the resources to help practitioners and hospitals deal with these shortages, and we can also compound medications that have been discontinued for reasons such as declining usage, reduced profitability, short shelf life, or inability to source an ingredient used in the commercial product.
A list of drugs that are in short supply or completely unavailable can be found at http://www.ashp.org/shortages or
http://www.fda.gov/Drugs/DrugSafety/DrugShortages .
Contact our compounding pharmacist if a medication that you need is not comercially available!
Diabetic Foot Ulcers
Complications of foot ulcers are a leading cause of hospitalization and amputation in people with diabetes. Diabetic foot ulcers result from neuropathy (loss of protective sensation) or ischemia (decreased blood flow and poor oxygenation that leads to tissue breakdown). Autonomic neuropathy causes dryness of the skin by decreased sweating and therefore vulnerability of the skin to break down. Necrotic (dying) tissue is laden with bacteria apt to grow in such an environment, so infections often complicate existing foot ulcers. Protective footwear and properly fitted diabetic shoes help to reduce the development of foot ulcers in people with diabetes. Every effort should be made to prevent diabetic foot ulceration and treat existing ulcers by multidisciplinary teams in order to decrease amputations. Relieving pressure on the ulcerated area is necessary to allow healing. Even when healed, diabetic foot ulcers should be regarded as a life-long condition and treated accordingly to prevent recurrence. Applying a cream containing the amino acid L-arginine to the feet has been reported to improve circulation in the feet of people with diabetes, which might be helpful in preventing foot ulcers.
Ask our compounding pharmacist for more information.
Chronic Sinus Congestion?
If unresponsive to treatment with decongestants and antibiotics, the cause of your chronic sinus congestion may be Allergic Fungal Sinusitis (AFS). Symptoms include blocked nasal passages, sinus pain, runny nose, and frequently pressure around the eyes. Systemic antifungal drugs have not been effective for treatment of AFS, primarily because the drugs are not secreted into the nasal secretion. Conventional treatment consists of sinus surgery, but AFS has a high rate of recurrence. At New York Presbyterian Hospital, a study showed that a compounded antifungal (fluconazole) nasal spray improved the disease and decreased swelling of the nasal passages, without significant side effects. A second study showed that treatment with topical fluconazole as either a nasal spray or an irrigation solution can significantly reduce the rate of recurrence of AFS after surgery. Ask our compounding pharmacist for more information.
Customized Medication for Warts, Plantar Warts, and Molluscum
Cantharidin is a medication that has been used by dermatologists as a treatment for molluscum contagiosum and warts since the 1950s. Following topical application, cantharidin is absorbed by the fat layers of the skin. Topical cantharidin treatment causes formation of blisters within 24 to 48 hours. Healing is complete in 4 to 7 days without scarring.
Hormone Therapy for Wellness and Disease Prevention
Hormones are needed for all types of bodily functions. Our hormone levels change in response to our environment, thought processes, stress levels, food intake, and medications. We know that when hormone levels decline as part of the normal aging process, problems with health arise. Hormone therapy can relieve symptoms of menopause, improve quality of life, prevent chronic illnesses, and maintain wellness. Because each woman has unique biological needs which change as she ages, we compound hormone therapy in the most appropriate dose and dosage form to meet individual needs. We work together with each woman and her healthcare provider (physician, physician’s assistant, or nurse practitioner) to customize hormone therapy based on the results of laboratory testing. And we monitor each woman’s symptoms as well as follow-up lab results, to recommend changes when needed. The type of hormone therapy that is selected “is what makes the difference and must be carefully considered,” according to Erika T. Schwartz, MD, and Kent Holtorf, MD, leading experts in hormone therapy. We recommend bioidentical hormones, which are molecularly identical to hormones found in the human body.
Hormones in Wellness and Disease Prevention: Common Practices, Current State of the Evidence, and Questions for the Future
By: Erika T. Schwartz, MD, and Kent Holtorf, MD.
This article was published in the journal Primary Care [2008 Dec:35(4):669-705]
As of this writing (Aug. 24, 2011), the article can be found in its entirety at www.drerika.com/Files/ServicePageFiles/ 9ad83a4d-247f-47b4-8d99-96bf19f19b10.pdf
We compound customized preparations of bioidentical hormones for women and men in the most appropriate strength and dosage form to meet individual patient needs, based on a prescription from a licensed practitioner.
Effective Treatment for Chronic and Cancer Pain – Dispelling the Myths
Pain is among the most common reasons Americans use the health care system and the leading cause of disability. Chronic pain (pain that lasts more than six months) can be caused by a variety of injuries and diseases, including nerve damage and cancer, and most commonly affects the lower back and legs. Chronic pain may be intermittent or continuous, and it prevents many people from working, eating properly, participating in physical activity or enjoying life. Left untreated or under treated, chronic pain may cause significant physical and emotional disability.
Cancer is a major cause of both acute and chronic pain. Most people with cancer will experience pain at some point during their course of treatment, and some will continue to have pain after the treatment ends. The vast majority of people with cancer are treated for pain by practitioners who are not pain specialists. As a result, they are at high risk of under-treatment for pain.
The World Health Organization (WHO) has developed guidelines for the treatment of cancer pain with opioid medications (previously referred to as “narcotics”), which are considered the mainstay approach for all people with cancer who have moderate to severe pain. However, non-opioid medications, psychosocial interventions, rehabilitative techniques and other pain treatment options should be part of the treatment plan. Application of the WHO approach suggests that satisfactory control of pain is possible in 75 percent to 90 percent of cases.
Men's Health: Restoring Vitality
Beginning at approximately 40 years of age, a man’s testosterone levels slowly decline. Approximately 30% of men aged 60-70 years and 70% of men aged 70-80 have low levels of testosterone, a condition often called “andropause” because testosterone is in a class of hormones known as androgens. Androgen deficiency is strongly associated with common medical conditions including metabolic syndrome, obesity, diabetes, hypertension and atherosclerosis; as well as elevations in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Androgens may provide a protective effect against the development and/or progression of atherosclerosis in men, and emerging evidence indicates that appropriate therapy can relieve or partially reverse the progression of these problems in testosterone-deficient men.
Unavailable, Discontinued or Hard-to-Find Medications
WE CAN HELP!!
Medications may be commercially unavailable for a variety of reasons, the most common being:
Drugs Used to Improve Bone Density
May Actually Increase Risk of Fractures
Bisphosphonates are a class of drugs commonly used to treat osteoporosis, and
include alendronate, etidronate, risedronate, and zoledronic acid.
Bisphosphonates are designed to slow or stop the bone loss that occurs during
the body’s natural process that involves removal and replacement of bone tissue.
In March 2010, at the annual meeting of the American Academy of Orthopaedic
Surgeons, reports suggested that if bisphosphonates are used for four or more
years, they may actually impair bone quality and increase the risk of certain
bone fractures. Two separate studies by researchers from the Hospital for
Special Surgery (HSS) and Columbia University Medical Center revealed data
suggesting that long-term suppression of bone remodeling with bisphosphonates
may alter the material properties of bone, potentially resulting in brittle bone
and contributing to the risk of atypical fractures.
http://www3.aaos.org/education/anmeet/anmt2010/podium/podium.cfm?Pevent=339
Accessed March 22, 2010
Bisphosphonates have also been associated with osteonecrosis of the jaw (ONJ),
an uncommon but potentially serious condition that can cause severe destruction
of the jaw. Initially, it was thought that the greatest risk was in patients
with cancer who received treatment with intravenous bisphosphonates. However, a
recent study at the University of Southern California found that ONJ caused by
oral aledronate was more common than previously suggested. The jaw problem was
found in 9 of 208 patients receiving oral alendronate, or approximately 4% of
the population. The findings from this study indicated that even short-term oral
use of alendronate led to ONJ in a subset of patients after certain dental
procedures were performed.
J Am Dent Assoc. 2009
Jan; 140(1):61-6.
Concerns about bisphosphonates have prompted many people to search for other
forms of therapy to improve bone density and prevent osteoporosis.
Declining estrogen levels after menopause
result in bone loss and increased fracture risk. Estrogen levels can be
increased with transdermal estradiol, which is well tolerated and similarly
effective to raloxifene (a drug approved for the prevention and treatment of
postmenopausal osteoporosis) in preventing bone loss.
Menopause. 2009 May-Jun; 16(3):559-65.
In addition, we recommend that both men and women utilize a broad-spectrum bone
support program beyond the basic calcium/magnesium/vitamin D in order to
optimize bone density and quality and to reduce the risk of osteoporosis.
Your questions
are welcome.
Copyright
2010, Storey Marketing.
All rights reserved.
Questions regarding this article should be directed to the compounding
professionals at
rx@ricedrugs.com.
Clearing Up Fungal Nail
The
first sign of a fungal nail infection is discoloration - yellow or white opacity
- of the nail, most commonly on the big (great) toe. If left untreated, toenails
can become thick, causing pressure and irritation, and thus act as a trigger for
more severe complications. This can be particularly problematic in elderly
patients and patients with diabetes, because fungal nail (clinically known as
onychomycosis) is among the most significant predictors of foot ulcer, which can
ultimately lead to severe infection and even amputation. As the severity of
onychomycosis may be associated with the length of time the individual has had
the infection, early intervention is advisable.
Conventional therapy involves taking oral antifungal drugs for
several months. When these medications are taken orally, the patient must have
baseline and regular lab work to monitor liver function, as these medications
can be harmful to the liver. The reason that topical antifungals typically are
not used to treat fungal nail is that most commercially available topical creams
are unable to penetrate the nail to reach the site of infection. Our
compounding pharmacy can solve this problem by preparing customized
formulations containing a penetration enhancer to increase the extent of
absorption through the nail. When selecting the best form of treatment, the
practitioner needs to consider the cause of the infection, other medications
that the patient is taking in order to avoid drug interactions, and the
potential for adverse events associated with antifungal therapy. Topical
treatment of onychomycosis offers a distinct advantage to oral therapy. Because
topical preparations can be applied directly to the affected area and therefore
result in lower drug levels in the blood, the potential for serious problems
associated with oral antifungal therapy, such as drug interactions and liver
problems, is decreased. Ask our compounding pharmacist for more information on
customized therapies for fungal nail.
Am J Clin
Dermatol.
2009;10(4):211-20. J
Dermatolog Treat. 2005 Feb;16(1):52-5
J Cutan Med
Surg. 2004
Jan-Feb;8(1):25-30. J Cutan
Med Surg. 2004 Jan-Feb;8(1):25-30.
Prescrire Int.
2009 Feb;18(99):26-30. Copyright
2010, Storey Marketing.
All rights reserved.
Questions regarding this article should be directed to the compounding
professionals at
rx@ricedrugs.com.
Pure Sesame Oil for Treatment
of Dry Nasal Mucosa
Many
people experience problems with dryness of the tissue lining the inside of the
nose, which is worse during the winter, in warm and dry inland climates or
deserts, and after nasal irradiation. Complaints of nasal dryness may occur in
situations involving low humidity including long journeys by airplane and
air-conditioned environments. Normal saline (Isotonic sodium chloride solution;
ISCS) has long been the most commonly used therapy for nasal dryness. But, it
has been shown that normal saline produces little change and
pure pharmaceutical grade sesame oil has been shown
to be significantly more effective than normal saline for treatment of nasal
dryness.
Our compounding pharmacy can place pure
pharmaceutical grade sesame oil in a nasal spray. The recommended dose
is 1 to 3 sprays in each nostril 3 times daily.
In studies, a few patients reported allergies
to sesame seed. However, when they received oral 1-ml doses of pharmaceutical
quality pure sesame oil, no allergic reactions were observed. Pharmaceutical
grade pure sesame oil does not contain the proteins that typically cause
allergic reactions.
Sesame oil contains a high concentration of
tocopherols (vitamin E) that might neutralize oxidants and prevent tissue damage
and inflammation that would otherwise occur.
Rhinology 2000
Dec;38(4):200-3
Arch
Otolaryngol Head Neck Surg 2001 Nov;127:1353-1356 Copyright 2010, Storey
Marketing.
All rights reserved.
Questions regarding this article should be directed to the compounding
professionals at
mailto:rx@ricedrugs.com.
Medication
Changes Needed after Gastric Bypass
Bariatric surgery is
done to help patients lose weight, control diabetes, and improve cardiovascular
risk. Roux-en-Y gastric bypass reduces the stomach size and bypasses part of the
small intestine to limit absorption, and therefore medication form and doses may
need to be adjusted after surgery. For example, patients should use liquid or
non-oral meds (such as a transdermal gel) for weeks to months after bypass
surgery to allow healing. It is important to avoid medications that contain
sugar, sucrose, corn syrup, maltose, fructose, lactose, honey, mannitol, and
sorbitol to reduce symptoms of dumping syndrome (nausea, pain, diarrhea,
sweating, rapid heart rate, or fainting). We can
compound medications that are free of these problem-causing additives.
After bypass surgery,
absorption is unpredictable due to the shortened intestine, and medications
should be switched to “immediate release” versus extended-release or
enteric-coated forms. Our compounding pharmacist will work together with
patients and their physicians to customize medication doses to meet each
patient’s specific needs.
When people lose weight,
medications for problems such as diabetes and hypertension may no longer be
necessary. Birth control may need to be changed.
Due to decreased absorption of
nutrients, patients who have had a Roux-en-Y procedure may need to increase
their consumption of calcium, fat-soluble vitamins (especially vitamin D), folic
acid, iron, thiamine, and vitamin B12. Ask our professional staff to
recommend quality supplements.
Copyright 2010, Storey Marketing.
All rights reserved. Questions
regarding this article should be directed to the compounding professionals at
mailto:rx@ricedrugs.com.
Copyright 2011, Storey Marketing. All rights reserv3:54 PM 12/12/2011ed. Questions regarding
this article should be directed to the compounding professionals at
Rice's Pharmacy.
Satisfactory pain control is possible but barriers exist…
with health care professionals:
with patients:
with the health care system:
Fears and misunderstandings about addiction, tolerance and physical dependence greatly hinder use of opioid therapy. On their website, www.painfoundation.org, the American Pain Foundation seeks to clarify these issues:
Addiction may occur when people use legal or illegal substances repeatedly in a way that causes them to feel high or euphoric, or, sometimes, to escape psychological pain. This use may trigger a brain change that may cause the person to crave the substance, lose control over its use and continue to use the drug despite physical or psychological harm.
Copyright 2011, Storey Marketing. All rights reserved. Questions regarding
this article should be directed to the compounding professionals at
Rice's Pharmacy.
Hypogonadism is the clinical term for low levels of serum testosterone in association with specific signs and symptoms including:
Testosterone levels can be measured by saliva or blood tests. Hormone therapy is recommended for men with symptoms of hypogonadism and low total testosterone levels or high estrogen levels.
Copyright 2011, Storey Marketing. All rights reserved. Questions regarding
this article should be directed to the compounding professionals at
Rice's Pharmacy.
(Note: Drugs are also withdrawn from the market due to health risks, and we do not compound medications that were discontinued due to safety concerns.)
Our professional pharmacists can help during a medication shortage or when a
medication is discontinued by obtaining the Active Pharmaceutical Ingredient (API)
and compounding the needed drug in the most appropriate dose, dosage form, and
flavor for each patient. We can also compound medications that are free of problem-causing
additives such as sugar, alcohol, preservatives, dyes, and gluten. We utilize the
finest FDA approved chemicals, follow current USP guidelines, and are licensed and
regulated by our State Board of Pharmacy.
Current Shortages (as of March 1, 2011):
Examples of Discontinued Medications:
In addition to the above, there are countless products and “remedies”
that are no longer commercially available, but that physicians and patients
report are very useful in treating a specific problem. Ask our compounding
pharmacist about therapeutic options.
Copyright 2011, Storey Marketing. All rights reserved. Questions regarding
this article should be directed to the compounding professionals at
Rice's Pharmacy.