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CHAPEL HILL COMPOUNDING

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CHAPEL HILL COMPOUNDING

Zoe Stefanadis, RPh

109 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

www.chapelhillcompounding.com

Designing Medications for Children:
Special Care to Match Age and Need

Ministering to the health needs of children has occupied the expertise of Zoe Stefanadis for many years. She is a registered pharmacist, a certified compounding specialist, the mother of three, and owner and overseer of Chapel Hill Compounding. In a conversation with Health&Healing, she explained the important role that compounding pharmacies play in supporting children’s medical care.

Pharmacist Zoe Stefanadis and
her colleague Kevin Gott confer
about a medication being
compounded for a young patien

Health&Healing: Are com-pounding methods dramatically different for children than for adults?

Ms. Stefanadis: Absolutely. It’s important to remember that children are not pint-sized adults; treating their medical needs is not just a matter of reducing the dosage. So, com-pounding pharmacists take a completely different approach to a child’s health care. Infants need special attention, with dosage being a critical issue. It must be exact, because they’re tiny, sensitive bundles of humanity and need all of our special formulations to be based on their kilogram weight.

Adolescents present a different set of challenges. They’re inquisitive, ever-developing humans and the goal is to empower them as they learn how to take care of their own health. My approach is to provide as much quiet support and guidance as possible.

And last, but not least, we want to gain the parents’ confidence that we are providing a preparation that is spot on. We also endeavor to build good relationships with pediatricians, so that we’re in sync as a health team.

Being a mother of three grown children, I remember how hard it was to dose a child three times a day, so I’m conscious of helping parents administer meds. I’ve had doctors who prescribe two tablespoon doses, which is a full ounce. That’s a lot. We try to minimize the amount that has to be dispensed, sometimes by lowering the volume. We make sure to place meds in devices that have dosage marks, adding little inserts so liquids don’t spill.  We always consider flavoring for palatability. Taste is important—a child of any age is going to take medications only if they taste good. Spitting out medication is often a big problem for children and we always make sure that there’s enough to complete the therapy in the allotted time.

I love having children come into the pharmacy. We attempt to satisfy their curiosity about medicine by engaging them and helping them feel like they are part of the process. If they feel empowered, they are more likely to be compliant.

H&H: What are the typical kinds of medications that you provide, and to what ages?

Ms. Stefanadis: I’m not sure I’d use the word “typical,” because compounding medications for children is all about solving a particular medical problem for each individual child. We have to pay attention to dosage, to taste, to when and how children need to get their medications.

Dosage is particularly important. Children have to have very specific dosages. Just because a medication is commercially available in generic form, doesn’t mean that you can simply crush a tablet and put it in pudding.  The FDA has a 10 percent margin of error for such medications. But if the child’s prescribed dose is somewhere in between, the crushed pill in pudding isn’t going to deliver the required dose. And when you’re talking about children, you’re dosing based on kilogram of weight versus just a therapeutic range. We really want to dial-in to that dose.

Some special issues require steroids or anti-depressants. Most often, we dispense these in liquid form. Children who have swallowing issues, as with autism, are very sensitive to flavors. Cerebral palsy introduces the need for muscular control issues. We have to take all these factors into consideration.

We also work with schools where children are frequently on medications and need to be dosed during the day. Parents need assistance because schools have very specific rules and conditions related to medications for children. We may have to make an additional bottle, or sometimes we preload oral syringes for school use. This also applies to child care givers as well.

H&H: Do you deal with a lot of allergy issues?

Ms. Stefanadis: Sensitivities are on the rise. It is alarming to me that we’re seeing young children with allergies and sensitivities that we simply didn’t see 30 years ago. Our world is becoming more toxic from different artificial chemicals, plastics, and other exposures. Some children may not be able to tolerate manufactured medication fillers or artificial colors. In our pharmacy, we do not use any artificial flavors or colors, instead, we use a little bit of B vitamin because it’s a nice bright orange. Colorings are used more often in powders. It helps us to make sure that we’re getting an equal distribution of the active and pharmaceutical ingredients throughout the trituration process.

Because of the prevalence of allergies and sensitivities, we do a lot of allergy preparations. And we’re currently involved in a really interesting project with a local allergist. The project goal is to find a way to desensitize people to peanut and tree nut allergies. Our role is to make a titration of doses of peanut protein and other nuts which children take to gradually desensitize them. These medications are dispensed in the allergist’s office—to ensure that they don’t have an anaphylactic reaction. The early results are very encouraging: they’ve have actually gotten kids to where they can eat a Snickers bar, which is very exciting.

H&H: What can you do for kids entering puberty and their hormones start kicking in and fluctuating?

Ms. Stefanadis:  This is a big unknown. Adolescents are almost like peri-menopausal women—lots of hormone fluctuations. It’s difficult for me to see really young girls—as early as 13 or 14—put on birth control pills to regulate their hormones. Birth control pills create an artificial control of hormone release, shutting down the natural hormones that the body is producing. No one knows exactly what this is going to do to these young women 20 years down the road, especially with long-term use. Birth control pills are for contraception, not for hormone balance.

I had a personal situation, with my own daughter, who was diagnosed with polycystic ovaries. Her doctor wanted to go the traditional route of putting her on birth control pills. We refused that option and instead, decided to go the dietary route—with some liver cleansing to help rid the body of the excessive metabolites of estrogen and a low dose of palpable progesterone. Within six months, she no longer had polycystic ovaries and was back to having a regular cycle. I believe that the less you disrupt hormones in a developing adolescent, the better. Especially if there’s no truly organic reason that’s upset their hormone balance.