pdf of this article


For more information, contact:



Zoe Stefanadis, RPh

109 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

Medications That Work in a Toxic World

One rarely considers the possibility of ingesting toxins with a daily prescription, but it is not an unlikely hazard, notes Zoe Stefanadis, a registered pharmacist and owner of Chapel Hill Compounding Pharmacy.

Pharmacist Zoe Stefanadis (right) and her colleague Stephanie Bowers, PharmD, discuss the option of hemp-derived CBD oil.

“Medicines—both over-the-counter and prescription medicines—can be toxic. Because we all respond uniquely to the things we’re exposed to and the things we ingest.”

With that awareness, Ms. Stefanadis and her colleagues use their time, talent, and training to ensure that each of their clients has the safest and most effective medication possible in hand. She notes that each compounded prescription is formulated for a specific client with their physician’s guidance, reflecting their individual health needs taken into consideration.

“Some people have toxic reactions to the fillers in their prescribed medications, decreasing their ability to absorb the product,” explains Ms. Stefanadis. “For example, magnesium stearate may be one of many common fillers used in commercial medications. It is an animal-derived substance, and has the potential to cause anaphylactic shock in those allergic to it. Compounding pharmacists are able to make medications without this potentially toxic filler.

“When compounding medications,” she explains, “we endeavor to offset the effects of toxins by using natural supplements, trying not to subject our patients to anything that they may be sensitive to. We have an option, for example, of using cellulose capsules—which are vegetable capsules—rather than gelatin.


In 2014, North Carolina passed a law allowing for over-the-counter sale of cannabidiol oil (CBD oil), notes Ms. Stefanadis, “which is an ancient supplement that has been used for a number of symptoms. In fact, we have hundreds of receptor sites for CBD in our bodies.

“It is important to understand that CBD oil—which is extracted from the hemp plant and then diluted with a carrier oil—is not medical marijuana,” Ms. Stefana-dis explains. “Cannabidiol is one of 104 chemical compounds found in cannabis; the psychoactive ingredient, tetrahydrocannabinol (or THC), which is the compound in cannabis that makes one high, is not part of CBD. (By law, the THC has to be below 0.3 percent by dry weight.) So CBD oil has no psychotropic effect.

“I personally like the idea of selling this product in my pharmacy,” she says. “It doesn’t require a prescription, but it does require guidance and education, so the source is really important and pharmacies are thus a prime selling location.  The CBD oil we carry is a very high grade and has a certificate of analysis that not only tells us how much CBD is in it, but also makes sure that the THC level is well below the limits of North Carolina law. Because it’s a plant product, we also get a toxicology report, making sure that there are no contaminant pesticides or heavy metals.”

She notes that scientists are now exploring CBD oil’s effects on a number of health issues, including pain, anxiety and depression, cancer, acne, and heart health.

“At our compounding pharmacy,” she notes, “we have pretty much gotten away from lactose fillers completely. Dextrose is a different type of sugar that a lot of people can tolerate better than magnesium stearate or lactose fillers. Instead of dyes, we use vitamin B, because it has color, which we need in compounding. During the distribution process of active ingredients, we can see by the color that we’re getting a nice uniform mixture along with our other mechanical means of blending.”

The Value of
Genetic Testing

“We’re learning a lot through genomics—whether patients are fast or slow metabolizers, and whether or not they can actually metabolize the medication to the actual active form. Some medications don’t even work, or it may be that the doses, especially for people who are either fast or slow metabolizers, may have to have different strengths to get a true effect. We can compound the specific strength your body needs to be able to assimilate the medication. Occasionally, the difference in a dose can change what that drug treats and its pharmacological effect in the body.”

A perfect example of this, notes Ms. Stefanadis, “is naltrexone, which was developed years ago to block opioids. A 100 mg dose will rescue people who have overdosed on any opioid, connecting to that receptor site and blocking the opioid’s effect. Now we’re finding that low-dose naltrexone is helping people who have autoimmune disorders, like Hashimoto’s, or even pain, such as fibromyalgia. I can compound anywhere from 0.002 mg up to 16 mg and have some really good outcomes. Somehow this lower dosage signals the brain to act differently than the original 100 mg naltrexone did. We’re still not sure exactly the mechanism of action, or how the drug works.  When I was in pharmacy school, I would say that the mechanism of action for 80 percent of the drugs was unknown.”

Autoimmune Disorders

“I’ve seen more autoimmune disorders now than in my 30 plus years of being a pharmacist” she says. “There are two factors involved: first, exposure to more toxins, whether environmental or internal stress, and second, we now have the tools and the science to be able to recognize toxins at work in the body.

“Some doctors now recommend detox and we carry detox kits that are nutritionally-based and are liver and GI tract cleansers. I’m a big fan of empowering patients to take charge of their own health care and with good guidance they get good outcomes.