Compounding Information Resources
Linda F. McElhiney, PharmD, RPh, FIACP, FASHP
With the increasing number of manufacturer backorders and unique patient populations, pharmacists often need to research information on compounding dosage forms in order to provide good quality care to meet the needs of their patients. Twenty years ago, there were very little compounding references available. Old editions of Remington's and the United States Pharmacopeia (USP) contained compounding information and some old formulations but were not too comprehensive or useful. The American Society of Hospital Pharmacists, now known as the American Society of Health-System Pharmacists (ASHP), published a small compounding reference titled Extemporaneous Formulations and Lois Reynolds authored a publication titled Extemporaneous Ophthalmic Preparations, which, in the 1980s and the early 1990s, were the newest references available. Now there are dozens of reliable compounding resources available to help all pharmacists prepare compounded formulations to meet the needs of their patients.
Many community compounding pharmacists pay to become members of a compounding organization that provides them with compounding technical support, supplies, and chemicals. However, this membership is generally not available to most health-system pharmacists. Most U.S. chemical wholesalers have compounding technical support staff that can assist pharmacists with questions concerning compounding. The technical support staff usually consists of pharmacists and technicians, whose responses are obtained within 24 hours or less by the inquirers. Pharmacists can also obtain copies of stability studies for compounded formulations and published compounding articles. Most of these technical support services are provided free of charge, although some companies charge a nominal fee. A list of these resources is provided below:
Peer-reviewed journals often publish stability studies for compounded formulations. ASHP's American Journal of Health-System Pharmacists (AJHP) contains these studies, and the journal is provided as part of the pharmacist's membership in the organization. The American Pharmacists Association (APhA) also provides the Journal of the American Pharmacists Association (JAPhA) as part of the pharmacist's membership. The JAPhA sometimes contains stability studies for compounded medications. The U.S. Pharmacist can be obtained by hospital pharmacists free-of-charge, and it contains a monthly feature, Contemporary Compounding, which highlights a compound. The article provides the formula with mixing instructions and explains properties of each ingredient in the compound.
The most comprehensive journal with compounding information is the International Journal of Pharmaceutical Compounding (IJPC). It contains information articles on compounded treatments and case reports, formulations, peer-reviewed stability studies, and basic compounding information to improve and enhance pharmacists' and technicians' compounding skills and knowledge. Subscribers can choose to obtain a monthly hard copy of IJPC, as well as an electronic version. Subscribers can also join a compounders' list serve which allows them to share information with other compounders from all over the world. It can be a valuable resource when trying to find compounding information.
Several published text references are available that provide reliable compounding information. Some of them are published and sold through professional pharmacy organizations, while others are sold through independent publishers. Health-system pharmacists should purchase the texts that would aid them in their practice settings and build a good compounding resource library. All pharmacies should have a current hard copy or electronic subscription to the USP because it is a very comprehensive compounding resource that is constantly updated, and all of the chapters under 1000 are legally enforceable. It provides information on good compounding practices, quality assurance, and assigning beyond-use dating. The United States Pharmacopeia (USP) Expert Committee is also increasing the number of compounded drug monographs available so that patients will receive consistent compounded medications throughout the country.
The Handbook of Pharmaceutical Manufacturing Formulations by Niazi is a set of books that contain actual formulas of manufactured products. Each book focuses on different dosage forms. With the increasing manufacturer backorders, the textbooks on sterile products and liquid products can be an invaluable resource for health-system pharmacists that need to compound these medications in order to continue their patients' care. Pharmacists need to use this resource in conjunction with following the compounding standards published in the USP.
Other good text references that are recommended for a compounding library include the following:
- Trissel's™ Stability of Compounded Formulations (Trissel LA)
- Extemporaneous Formulations for Pediatric, Geriatric, and Special Needs Patients (Jew RK, Soo-Hoo W, Erush SC)
- Pediatric Drug Formulations (Nahata MC, Pai VB)
- Suppositories (Allen LV, Jr.)
- The Art, Science, and Technology of Pharmaceutical Compounding (Allen LV, Jr.)
- Handbook of Pharmaceutical Excipients (APhA)
Most health-system pharmacists have access to medical libraries onsite and/or online. This is a great resource within which to find clinical evidence to support an unlabeled use for medications, compounded formulations, and compounding stability information from other medical journals. Medical libraries provide good, reliable search engines, such as Medline and OVID. If an article is not available in the library, the librarian staff can often "borrow" or obtain the article from another medical library upon request.
Databases, such as Lexi-Comp Online or MicroMedex Online, are often provided by health-system employers. Lexi-Comp contains extemporaneous preparation information, usually under the pediatric section, that is based on a published stability article. MicroMedex provides information on unlabeled uses for medications based on published studies. This information can be used to obtain articles from the medical library.
The best comprehensive compounding resource available online through a subscription is CompoundingToday.com. It contains numerous databases, tools, formulas, standard operating procedures, Trissel's 2 Clinical Pharmaceutics Database (sterile and nonsterile), and up-to-date compounding information. It saves a lot of labor time in researching compounding information because it is literally "one-stop shopping" for compounding information. Pharmacists can use this online resource to help them develop compounded formulas for their patients, even when there may not be any other published information available because the physicochemical characteristics of drugs can be obtained.
It is not difficult to find compounding information. Pharmacists just need to learn where to look for it. Health-system employers should select a few pharmacists and technicians in their organization to develop their compounding skills and knowledge through compounding classes and seminars offered by chemical wholesalers, professional organizations, and the USP. Having compounding experts in health systems can improve patient care because they can quickly find the compounding information needed to prepare good, quality compounded medications in order to meet the specific needs of their patients.