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Zoe Stefanadis, RPh

109 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

Many Approaches to Medication

Years ago, before the advent of mass scale drug manufacturing, compounding medications was the backbone of a pharmaceutical practice, integrating art and science into the preparation of medications.

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

“Compounding can be viewed as a manifold approach to medication, taking care of patients who would otherwise fall between the cracks of traditional medicine,” notes Pharmacist Zoe Stefanadis, owner of Chapel Hill Compounding.

The goal in com-pounding, she explains, “is always to address the unique needs of a patient—to make their medication effective. That could mean creating a more palatable medicine, one that avoids side effects, or one that delivers the drug more efficiently. So, we change flavors, textures, and dosages. And we look for options for transmitting the drug that are most effective.

“We can compound almost anything,” she says, “for patients from birth to old age, as well as pets. Examples include bio-identical hormone replacement therapy, veterinary medications, hospice medications, pediatric formulations, dental, dermatologic, chronic pain medications, medications for infertility, wound therapy, sports medicine, podiatry—and more.”

Compounding for Children

“I once was called upon to support a two-year old child who’d had a liver transplant,” Ms. Stefanadis recalls. “Following surgery there was a good deal of pain and anxiety for both child and parents. We needed highly specialized medications to help this child—and his parents—through the trauma of this event: exactly the right medications in exactly the right strengths, delivered in exactly the right way. And this was only available through compounding.

“Often prescriptions are not available in the dosages that a child needs. Children are generally dosed on a ‘milligram-per-kilogram’ basis until the age of about 12 or a weight of 40kg or more; and dosages can change every three months due to weight gain. It’s all about volume, flavor, and texture for children, and all children do not like the same thing. It’s very individualized and the beauty of compounding is that we can treat that one individual.

 Helping Memory, Avoiding Side Effects, Treating Pets

“Frequently we’re asked to make a compound for people who have trouble remembering to take their meds. We include additives to slow the release of active ingredients to where their effect may linger. A perfect example is T3, a thyroid medication, which has a very short half-life. Some people say this drug makes them crash; they take their morning dose at 8:00 and by 3:00 they’re ready to lie down. So we’ll add a slow release to extend the effect of the T3 so patients can make it to the nightly news. It may also reduce unwanted side effects. For example, a patient may need to be on a higher dose of T3, but that causes heart palpitations. By adding the slow release, it helps them tolerate the required dose, avoiding the unwanted side effects.”

Another example of problematic side effects is that 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. “For the patient with congestive heart failure,” she explains, “NSAIDs can have an impact on kidney function. But we can avoid that problem with a transdermal application—where the therapeutic affect is localized and we avoid systemic absorption by absorption through the skin. This makes the patient pain-free by reducing inflammation.”

Timing can also alleviate side effects, she notes. “Occasionally we need to accelerate the effect of a drug, by going straight to the affected site. That’s where transdermal meds help a lot, especially with pain. If you take something orally, it has to travel through the body, be absorbed, or go through the blood-brain barrier before it starts acting. An example might be baclofen or cyclobenzaprine for muscle spasms, which make people very drowsy. When you apply it to the skin, you bypass that systemic effect and also the brain, so the patient isn’t drowsy.”

Perhaps one of the most common needs for compounding is medicine for pets. “There’s a steadily increasing demand for compounded medications coming from veterinarians in the area,” Ms. Stefanadis notes. “And any cat owner who has tried to put a pill down a cat’s throat can understand it. We can compound a fish-flavored fixed oil suspension or a transdermal medication that is rubbed into the inside of the cat’s ear. Most cats like having their ears rubbed anyway and it’s a very effective and very peaceful type of application.”

‘Is It Possible?’

“I get inquiries from physicians and patients almost daily asking, ‘Is this possible?’ And usually it is. We recently received a request from a local allergist to encapsulate peanut flour—an unusual request and something I’d never done before. This allergist is desensitizing children from peanut and nut tree allergies by starting the children on really low doses and building up their doses to the point that they’re desensitized.

“But we do have limitations in what we’re able to do. A physician who heard about transdermal medication for treating pain recently asked me if we could include about 15 different drugs in one transdermal medication. I explained to him, ‘I’m sorry, but that’s just not possible. You’ve asked me to take 150 people and put them in a Volkswagen and drive them over a bridge.’  It’s important to understand the amount of ‘vehicle’ that’s needed to transport chemicals through the skin. Some drugs may have very big molecules and may not be able to be absorbed through the skin very well.”