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Zoe Stefanadis, RPh

105 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

Combatting Medications’ Side Effects

“When I think about the connection between physical and mental health,” observes pharmacist Zoe Stefanadis, founder and owner of Chapel Hill Compounding, “I naturally think first of the role that medications play. And it’s a connection I see every day.

Pharmacist Zoe Stefanadis, owner of Chapel Hill Compounding, is often involved in every step in compounding drugs for a variety of purposes.

“As a pharmacist—and especially as a compounding pharmacist—a paramount concern at all times is the problem of medication side effects. Medications are not benign; everything we take in our body has to be metabolized. So, even when carefully targeted, medications can produce many unintended—and sometimes harmful effects.”

And this, she notes, “is where we often observe the powerful mind-body connection. For example, medications taken to treat arthritis or high blood pressure may produce memory loss or depression; mental health medicines such as anti-depressants, for example, can cause physical side effects such as nausea, constipation, dizziness, or insomnia. The simple truth is that our minds and bodies are really just parts of a whole-body system, and medications affect the entire system.

“It’s also important to understand,” says Ms. Stefanadis, “that prescription medications are designed and produced for a broad audience—they’re meant to work for most patients with a specific health condition. But they’re not designed for individuals. As a consequence, two people with the same symptoms may respond very differently to the same drug. We’re all different—each of us metabolizes food and medications differently, and that process is affected by all the things that make us unique—our genes, our health history, and our lifestyle, including stress.”

Medications for a Single Patient

“As compounding pharmacists,” explains Ms. Stefanadis, “we focus on individuals—people who would otherwise fall through the cracks, because of their unique physiology. The beauty of compounding is that we can treat that one single person—providing the medication they need, in the dosage that works best, while minimizing any side effects. And we can compound almost anything, for patients from birth to old age.”

To do that, she explains, “it is important to understand metabolic pathways for medications. For example, some people with congestive heart failure and high blood pressure may not be able to take NSAIDs (non-steroidal anti-inflammatory drugs), which tend to increase blood pressure and can impact kidney function. We can alleviate those problems with a transdermal application, where the therapeutic affect is localized and we avoid systemic problems—bypassing the kidneys, for example—by absorption through the skin.”

Compounding options are especially valuable in treating children, she notes. “Often prescriptions are not available in the dosages a child needs, and the typical dosages on a ‘milligrams-per-kilogram’ basis can require frequent adjustment based on the child’s weight. It’s all about volume, flavor, and texture for children; and all children do not like the same thing.”

Medications and Polypharmacy

“The problem of medication side effects,” says Ms. Stefanadis, “has increased considerably in recent years, due to a phenomenon known as ‘polypharmacy’—or complications arising from taking multiple medications. It sounds incredible, but it’s common now for people to be taking ten or more prescription drugs—something that was previously unheard of.

“It often comes about,” she explains, “because people will get additional prescriptions to treat the side effects from an initially prescribed medication; and it can snowball. The result can be really problematic—as some drugs cancel or reduce the effectiveness of others, and new drugs product new side effects. . . and on and on.

“By tailoring medications to the specific needs of a patient,” she says, “we can often prevent side effects and thus avoid the need for additional medications.”

The Power of Belief in a Public Health Crisis

“The public health crisis we’re dealing with right now,” observes Ms. Stefanadis, “is another example of how what we think can affect our health. Unfortunately, what we’re seeing right now is the negative power of our beliefs.

“I say that from the perspective of a public health provider; my early training was in public health, and, in fact, I come from a family of public health providers. As a compounding pharmacist, my focus is on each individual patient. But when considering a public health issue—and the pandemic is very much a public health problem—my focus is very different. And I understand that we can only solve it if we’re willing to come together to see COVID as a shared problem.

“Unfortunately,” she says, “it seems that too many people see the COVID crisis not as a shared health problem, but as an individual one. And too many people lack the complete information they need to make good choices about their own health in this moment. And one thing I’ve learned in my career is that information is power and our beliefs shape the choices we make and profoundly affect our physical health.

“There is, for example, so much misunderstanding about the COVID vaccines; and much misunderstanding about viruses—how they function, how they mutate. The knowledge is out there. We know, for example, that vaccines not only protect individuals from the disease, but they interfere with the virus’s ability to grow and mutate. And the simple truth is that if you have a population that’s not vaccinated, they become a wonderful laboratory for the virus to mutate.

“And this is something that I struggle with as a compounding pharmacist, as well as a public health person. Because people don’t understand that we’re fighting a war against this virus—all of us. And we have to win. It’s not just about me protecting myself—we have to win for allof us.”

But, she says, “I’m optimistic. We have the knowledge to beat this virus—and to respond to the next one, because, sadly, there will be another pandemic. The scientists are saying, ‘We can kick this beast in weeks if we all just do what we need to do.’ So, my hope is that understanding will prevail; and that beliefs will change to embrace the idea of seeking a collective, shared solution to this public health crisis.

“I also hope that people will understand that we’re on a road of discovery. We’ve learned much already about this virus and about how to combat it; we’ll learn more. We need to respect that knowledge as we move forward.”