"A lot of pharmacies have given up on this practice because it requires a high level of expertise, plus an investment in labor and equipment," observes Peter Koshland, the senior compounding pharmacist at Berkeley-based Elephant Pharm.

Elephant Pharm Revives Custom Compounding

Time-Honored Tradition Allows "One-of-a-Kind" Prescription

Issued October 29, 2007

Medicine that tastes like candy? Gummy bears for a sore tummy? The world of cus to m compounding is giving new meaning to �just a spoonful of sugar makes the medicine go down� (unless you�re a diabetic and you need medication with no sugar�compounding enables that as well).

Compounding is the process of creating �custom� prescriptions--enabling doctors to write special, one-of-a-kind prescriptions for medicines not available in standard off-the-shelf formulations. Patients can then fill these at participating pharmacies.

Custom compounding also allows pharmacists to do many things, like improve the taste of children�s medications�including making medicated gummy bears; creating unique dermatology formulations; as well as other applications, including bio-identical hormone replacement therapy, dental medications, pain management (i.e. in a cream rather than a pill) and even veterinary prescriptions (like liver flavored treats for dogs).

 �A lot of pharmacies have given up on this practice because it requires a high level of expertise, plus an investment in labor and equipment,� observes Peter Koshland, the senior compounding pharmacist at Berkeley-based Elephant Pharm. �You need an area of the pharmacy that�s totally dedicated to doing it, with special equipment, and experienced, well-trained and dedicated compounding pharmacists.�

Many doctors are not aware that custom compounding is now so readily available in the region.  Koshland says one of his goals is to do more physician outreach to increase their awareness of the service, how the process works, and its varied applications.  

In a specialty largely abandoned long ago by chain drug stores, Elephant Pharm � with stores in San Rafael , Los Altos , Walnut Creek and Berkeley � has emerged as the leading regional formulator of custom compounded medicines. As active members of the Professional Compounding Centers of America (PCCA), Elephant employs specific, well-researched guidelines for pure, strength-standardized formulations. All its compounding pharmacists go through dozens of hours of extra continuing education as well.

Depending on the medication and a customer�s preferences, the medicines can be formulated into topical creams and gels, orally dissolving sublingual (under the tongue) troches and drops, oral sustained-release capsules, suppositories, as well as many other forms.

Bio-identical hormone replacement therapy (BHRT) is an increasingly interesting alternative to off-the-shelf, one-size-fits-all, synthetic hormone replacement medicines. 

It can be especially beneficial for treating common symptoms in pre-, peri- and postmenopausal woman. One important natural hormone that�s used � progesterone � can help patients avoid some of the serious risks and long-term side effects observed in treatments using synthetic progestins.