Compounding Pharmacy:
Valuable Resource
for an Aging Population


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Pharmacist Zoe Stefanadis

“Pharmacists have a special vantage point when it comes to observing and understanding the health issues associated with aging,” notes Pharmacist Zoe Stefanadis, owner of Chapel Hill Compounding. “We see not only the specific ailments that elderly people deal with, but the unique health challenges they so often face.

“Age doesn’t automatically result in arthritis or heart disease, of course,” she says. “But when our bodies have been around for a long time, there’s inevitable wear and tear, and problems result. You could say that we ‘start outliving our parts.’ And we often enter our senior years with a variety of health issues—many of them chronic. So, the real issue—which I see every day—is the combination of ailments and medications that contribute to difficult health problems for the elderly.”

Treating a single problem can be straightforward, notes Ms. Stefanadis, “but when someone is dealing with multiple issues—such as arthritis or other chronic pain condition, plus high blood pressure or a heart condition—additional problems often arise.

Graceful Aging with BHRT

“I would argue that any conversation about ‘healthy aging’ should include the issue of hormones—and hormone balance—which is a high priority at Chapel Hill Compounding,” says Ms. Stefanadis. “Hormones help control every organ system and bodily function—including growth, metabolism, reproduction, even mood. And hormone imbalances—at any age—can seriously impair our health. This is of special concern for the elderly,” she adds, “because as we age, we produce fewer hormones and the number of hormone receptors on cell surfaces decreases.”

The ideal way to address hormone imbalances, says Ms. Stefanadis, is bioidentical hormone replacement therapy—BHRT. “The only way to supplement what the body has stopped producing, or is producing in lesser quantity, is to put back exactly the same natural hormones, including estrogen, progesterone, DHEA and testosterone.

“It’s a simple solution to the many health problems people experience as a result of hormone imbalances,” she says. “But it’s not a simple process. The key to effective BHRT is to determine the precise levels of various hormones required. And sometimes it’s a matter of balance rather than absolute levels. With estrogen dominance, for example, there may be too little estrogen produced relative to progesterone and that can not only produce unpleasant symptoms but can also inhibit conversion of thyroid hormones to their active form, causing fatigue, hair loss, and other issues that might be associated with ‘aging.’ But aging itself is not the issue!”

The restoration process typically starts when an individual comes to Chapel Hill Compounding complaining of mood, sleep, or energy problems—or simply not “feeling well.” “The first step is testing to measure hormone activity at the cellular level,” says Ms. Stefanadis.

“And, testing is not only to establish a baseline, but needs to be repeated as we determine the right levels needed. We call our process ‘low and slow,’” she explains. “Because we want to make sure that we achieve not only the right levels, but the right balance of hormones for each individual.

“BHRT is not an overnight fix, and I usually find that 12 weeks is a target time to begin seeing positive results. That initial process can lead to on-going collaboration, sometimes spanning years. “And it’s important to understand that advanced age is not a barrier to BHRT,” notes Ms. Stefanadis. “Medical professionals are now understanding the benefits of balancing hormones even at age 70 or more. And there certainly   is no age ‘ceiling’ on wanting to have the energy and zest to enjoy your best life.”

Chief among these is what’s known as ‘polypharmacy’—when a person is taking many different medications at the same time, for many chronic diseases. The result can be additional side effects, dangerous drug interactions, or simply that one medication reduces the effectiveness of another. This is especially true with the elderly,” she explains, “because, as we age, we don’t metabolize the same way, meaning we don’t clear medications in the same fashion as when we’re younger—so you can get into an overdose situation very quickly.”

And it’s a trap a person can fall into gradually, she points out. “They may have a chronic condition requiring medication, then an acute situation occurs and new meds are added on. Unfortunately, since people often have multiple doctors, as time goes on things just keep being added on rather than removed. It’s not uncommon for us to see patients who are taking 10, 20, or more prescription medications! And when you consider that problem interactions can also occur with over-the-counter medications and supplements, it’s easy to understand the seriousness of this problem.”

Compounding Solutions to Complex Problems

Polypharmacy is just one of the health challenges that compounding pharmacists are uniquely positioned to meet, notes Ms. Stefanadis. “I think our role is to help the people who would otherwise fall through the cracks of the traditional health care system. We’re problem solvers.

“Take, for example, a patient who’s been battling a condition for years—without relief—even though their doctors have either increased doses or added more and more medications. It may be that the commercially available drug doesn’t come in the right dosage; it may be they need a lower dose. Or it may be that the patient’s genetic disposition affects how they metabolize medications. Compounding pharmacists can often solve such problems—by providing effective alternatives. The complex compounding we do is specifically tailored to an individual patient’s needs, and we are able to prepare medications that are simply not available commercially.”

There are many ways in which compounding can address medication problems, explains Ms. Stefanadis. “Dosages are an important one. We are able to prepare very precise dosages unavailable commercially. This is particularly useful when a patient is gradually adding or coming off a medication.

“The composition of medications is also potentially problematic,” she says. “In addition to active ingredients, they contain fillers, dyes, coatings, and preservatives—which some patients cannot tolerate. Alpha-gal—an allergy to meat-based products—offers a good example, because those with this allergy react to magnesium stearate, common in many medications, and to gelatin capsules. We regularly compound magnesium stearate-free medicines or use vegetable capsules to solve that problem.

“The mechanism for ‘delivering’ a medicine can also be a problem—particularly for patients (many of them elderly), who are dealing with chronic pain along with other health issues,” says Ms. Stefanadis. “And probably the most common and most effective thing that we do is to prepare transdermal pain medications. Because they’re not taken orally, these meds are not absorbed systemically—which can harm the GI tract—and they can be targeted directly to the source of pain. So for the athlete with a localized injury or the elderly person with diminished kidney function, we can offer an alternative: a transdermal anti-inflammatory.”

Alternatives & Counseling

“That’s the message we want to share,” says Ms. Stefanadis. “We want patients to know that there are alternatives to standardized medicines. Commercially available drugs do work for a majority of patients. But that’s the point: it’s a matter of percentages; they’re designed to work for most people but can’t possibly accommodate all the variables affecting individuals.

“I like to say that compounding pharmacists don’t make the drugs,” she says with a smile, “we just make them better sometimes. My approach is to be an advocate for patients—but always as a part of that critically important triad: the patient/physician/pharmacist relationship. That way you have a true team that is focused on the patient’s history, their current situation, and any future situations to be addressed.

“Which brings me back to the issue of polypharmacy. One of the valuable services we can offer our patients is to consult with them—in concert with their physicians—about their medications. Anyone taking multiple prescription medications and using over-the-counter medications and supplements should be reviewing their medication ‘load’ and exploring ways to prevent adverse reactions. We are happy to help with that.”