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Pharmacy
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Compounding
Pharmacy compounding is preparing custom made medicines to meet the individual needs of patients.
Although pharmacists have been compounding since the origins of pharmacy, most medicines prescribed today are ready prepared, and therefore most pharmacies don't have the facilities to prepare compounded medicines.
At Main Street Pharmacy we have specially built compounding laboratories with the latest equipment and trained staff to ensure the patient is provided with a quality product. Main Street Pharmacy is a member of the Professional Compounding Chemists of Australia (PCCA).
There are many reasons why pharmacists may be asked to compound a medicine. The main reason is to increase patient compliance, that is, to make the medicine easy to take or give. Patients may be allergic to preservatives, dyes or additives, or may be unable to take the standard strength commercially available. The medicine may also be required in a form that does not come ready prepared.
A compounding pharmacist, in consultation with your doctor, can change the strength of a medicine, alter its form to make it easier to take by flavouring or by changing how it is to be given.
A compounding pharmacist can prepare medication using several unique delivery systems such as creams, transdermal gels, suspensions, capsules and troches or lozenges.
If you have a question or would like more information please call and speak to one of our friendly compounding pharmacists on 08 9344 2625 or use our Contact form.
Compounding Services
Working closely with a woman and her healthcare provider, a compounding pharmacsit can help a woman start and maintain a hormone replacement regimen that brings her hormones back into balance and closely mimics what her body has been doing naturally for years. With a healthcare provider's prescription, the pharmacist can prepare Bio-Identical hormones in a variety of strengths and dosage forms to suit the individual patient's needs and preferences.
Bio-Identical Hormones such as Progesterone, Estriol, Estradiol, Estrone, Pregnenolone, DHEA and Testosterone can be formulated into creams, troches, pessaries, suppositories and capsules. Various other medications can be utilised to help with symptoms related to hormonal imbalance such as:
- Amitriptyline, Gabapentin, Baclofen and Lidocaine used to manage/treat Vulvodynia (pain in the area around the opening of the vagina)
- Nifedipine, Silidenfail and Arginine for the treatment/management of female Sexual dysfunction.
- Hyaluronic Acid and Vitamin E to help with Vaginal dryness and Atrophic Vaginitis (inflammation of the vagina due to thinning and shrinking of the tissue, as well as decreased lubrication)
- Tinidazole, Paromomycin, Metronidazole and Nystatin for the treatment of bacterial vaginosis and trichomonas
- Boric Acid and Amphotericin to treat yeast infections
References -
- article 'The Vulvodynia Guideline' by Haefner, HK et al, J Low Genit Tract Dis, 2005 an;9 (1): 40-51
- PCCA - patient education material - https://members.pccarx.com
Bio-Identical Hormone Restoration Therapy
Hormones have a powerful effect on your body and affect many areas of your health including your mood, metabolism, sexual function and reproductive function. When unbalanced, hormones can make you feel like a stranger in your own skin.
Some common hormonal imbalance indicators include:
- Hot flashes
- Night sweats
- PMS
- Post-partum depression
- Weight gain
- Infertility
- Irregular menstrual cycle
- Fibrocystic breasts
- Decreased libido
- Painful intercourse
- Vaginal dryness
Eczema/Dermatitis
Eczema (and/or Dermatitis) is a disease pattern not a definite diagnosis. The type and cause of Eczema should be identified before starting treatment. Patient education on trigger factors and how to avoid them, ways to manage the condition and how to effectively and appropriately use their medications is crucial in improving quality of life.
Some treatment options include:
- Emollients - These help counteract skin dryness and maintain skin barrier integrity. Traditional ingredients eg, sulfur, salicylic acid, menthol, phenol and coal tar solution may be added to emollient creams and ointments for better symptom control and/or relief.
- Topical Steroids - Medications such as hydrocortisone, betamethasone and clobetasol can be used to treat (and stop) inflammation. These can either be used alone (as a single ingredient) or in combination with antibacterial or antifungal medications
- Antibacterial/Antifungal - normal healthy skin is colonized by a variety of micro-organisms. In cases where skin integrity is compromised (as in eczema) these micro-organisms tend to further aggravate the infammatory process. Products containing antifungals (Clotrimazole, miconazole, Econazole, terbinafine) are readily available; however combinations wtih antibacterials like mupirocin, fucidin and erythromycin as well as topical steroids could offer a more efficient and convenient treatment option.
- Topical Immunomodulators - these can only be initiated bt a specialist physician (GP) and only after careful consultation with the patient. Tacrolimus has been used as a short-term treatment option in the form of an ointment or cream.
Acne
This is a chronic inflammatory condition associated with teh sebaceous glands and involving the hair follicles. It can begin in the early teenage years and persist into later adult life. Acne treatments aim to reduce the intensity and duration of inflammation as well as prevent acne scar formation.
Mild Acne - Typical treament may involve the use of benzoyl peroxide, retinoids and/or antibacterials. Benzoyl peroxide has antimicrobial and mild keratolytic properties, and both comedones and inflammation generally respond well. Azelaic acid is a good alternative that may cause less local irritation, but may be less effective. Topical retinoids are effective in both comedonal and inflammatory acne. Topical antibacterials - Tetracycline, clindamycin and erythromycin are generally used for inflammatory acne, with the addition of a topical retinoid or benzyl peroxide to increase efficacy and reduce the risk of developing resistance. Nicotinamide has also been used topically in mild to moderate inflammatory acne.
Ingredients such as Salicylic Acid, Glycolic Acid, TCA (Trichloroacetic Acid), Resorcinol and Lactic Acid can be as chemical peels which help reverse the signs of skin aging and to treat skin lesions and acne scars.
Moderate Acne - Best treatment option is with oral rather than topcial antibacterials - tetracyclines (drugs of choice i.e Tetracycline, doxycycline, lymecycline, oxytetracycline, and minocycline). Alternatives to the tetracyclines include erythromycin, co-trimoxasole, and trimethoprim. A topical retinoid may also be used for additional comedolytic activity.
Severe Acne - Various treatments include oral isotrentinoin, high doses or oral antibacterials with a topical retinoid and benzoyl peroxide and the use of anti-androgenic cyproterone with ethinylestradiol (considered in females only).
Psoriasis - Unlike Eczema, psoriasis is a chronic immune mediated inflammatory skin disease, characterised by clearly defined thickened/raised skin patches (scaly plaques). Treatment depends on severity of the disease, location of the plaques and the type of psoriasis. Some topical treatment options include Emollient creams and ointments; Coal Tar preparations; Dithranol; Salicylic Acid; Tacrolimus; Calcipotriol and Potent topical steroids like betamethasone and Mometasone. Other treatment options include Phototherapy and systemic therapy (using medications such as methotrexate and cyclosporine).
Viral Warts - As the name suggests, warts are caused by the Human papilloma virus and are more often than not self-limiting (will resolve without the need for treatment). The focus of treatment is to destroy the warts (locally) or to stimulate an inflammatory reaction. A good guage for starting treatment is the severity of patient's physical and/or psychological discomfort and whether the warts interfere with work or daily life. Although there is no specific treatment regimen, application of wart paints containing podophyllin, salicylic acid, formaldehyde, diphencyprone, and cyrotherapy.
References
1. Dermatology Research and Practice volume 2010 – Acne Scars : Pathogenesis, Classification and Treatment.
2. DermNet New Zealand - http://www.dermnetnz.org
3. British Journal Of Dermatology 2001 – Guidelines for the management of cutaneous warts.
4. Martindale The Complete Drug Reference 32nd Edition
Dermatoloy - Skin Disorders
Dermatology is the diagnosis, treatment and prevention of diseases of mainly the skin; but may also involve hair, nails, oral cavity, genitals and cosmetic care and enhancement.
The skin is the largest organ on/in the body and protects all the other organs from harmful micro-organisms, physical injury, temperature fluctuations and environmental changes. It is also susceptible to a wide variety of disorders and adverse conditions including - infection, infestation, inflammation, irritation/allergic reactions, dryness, scarring, sun-burn, sun-damage, hyperpigmentation.
Topical medication forms such as lotions, solutions, gels, creams, ointments, washes, shampoos, sprays and powders would be the conventional treatment options for skin disorders.
Young children often find difficulty in swallowing capsules and tablets. In some cases the medications prescribed are not available in the strengths required thus leaving parents and carers the complicated task of cutting, breaking or crushing the tablets, or opening the capsules in order to dose the child. Some common examples include Nitrofurantoin (Macrodantin); Omeprazole (Losec); Lansoprazole (Zoton) and Melatonin (Circadin). At the compounding pharmacy, these medications can be re-formulated into syrups, suspensions, creams, powders and smaller capsules at the correct strengths for easier dosing.
Babies suffering from persistent Reflux may benefit from PPIs such as Omeprazole or Lansoprazole prescribed by their doctors to alleviate regurgitation, pain and discomfort whil their gastrointestinal tract matures. School-aged children on stimulant medications may require sleep aids like Melatonin to prevent insomnia and fatigue due to lack of sleep. Various combinations of essential Amino Acids, Minerals and Vitamins can be made up depending on the individual child's needs to promote and maintain healthy growth and development.
Children's Medicines - Paediatrics
Children can be fussy when it comes to taking their medications. The medicine may taste awful or may not be available in an 'easy to measure' dose. Our compounding pharmacists in consultation with your doctor can help.
Compounding provides the option to add flavour to or change the flavour or an already existing medication theremore making it more palatable for the child and improve compliance. Flavours used are sugar-free.
A change in Dosage Form can help alleviate some of the unwanted side effects. Instead of a capsule or tablet, pain medications can be compounded in topical gel, cream or spray forms that can be applied directly to the site of the pain and absorbed through the skin. They can also be made up in the form of troches that dissolve under the tongue, nasal sprays or suppositories. These dosage forms bypass the gastrointestinal tract, helping patients with stomach irritation as well as those who have difficulty swallowing pills. In some cases, these delivery methods may allow for a smaller/lower dose of the drug to be taken therefore reducing other side effects like dizziness and drowsiness.
Some chronic pain sufferers are placed on a variety of medications and doses, which means taking multiple drugs varying doses. Compounding may provide the option for Combination Therapy - making it possible for these patients to get all their medications in a single preparation hence encouraging compliance. Patients can also have individualised doses - Strength/Dose Variations that will suit their particular body size, symptoms and pain tolerance.
Commonly used topical pain management medications include:
- Diclofenac
- Ibuprofen
- Gabapentin
- Amitriptyline
- Baclofen
- Ketoprofen
- Guasfenesin
- Lidocaine
- Tetracaine
- Benzocaine
- PEA - Palmitoylethanolaminde
- Magnesium
Many of these medications are commerically available through your doctor, healthcare practitioner or pharmacist; but for those having trouble with these, there is an alternative approach to acute and/or chronic pain management.
Oral Medications
PEA - Palmitoylethanolamide
What is Palmitoylethanolamide?
PEA is a natural, protective fatty substance produced by the human body, animals and plants. PEA can be found such as meat, eggs, soy beans and peanuts and has been shown to be very effective and safe to use as a supplement for pain and inflammation.
What does PEA do in our body?
PEA is involved in many cellular functions in chronic pain and inflammation. Often people with chronic disorders don't produce enough PEA.
PEA - has been found to be useful used in many conditions including:
- Osteoarthritis and Rheumatoid Arthritis - to reduce pain and inflammation
- Nerve Compression Syndrome - Carpal Tunnel
- Migraine
- Fibromyalgia
- Pelvic pain in Males and Females
- Vulvodynia
- Complex Regional Pain Syndrome
- Peripheral Neuropathies - Diabetic and Chemotherapy-Induced Neuropathy
- Postherpetic Neuralgia
- Sciatic Pain
- Low-back Pain
Pain Management
Everyone experiences some sort of pain, ranging from a headache or muscle strain to pain as a result of work or accident related injury. Pain can also be associated with other diseases or medical conditions and is the most common symptom for which people seek medical help.
Acute pain can easily turn into chronic pain, which can be difficult to treat. There are many commercially available pain relief medications that help with the chronic pain of conditions such as arthritis, fibromyalgia, migraine headaches and other nerve and muscle pain. Some of these medications may also have unwanted side effects like drowsiness, dizziness or stomach irritation.
Veterinary Medicines
Anyone who has ever had a sick pet knows it's not easy getting them to take medicine.
When an animal is sick and refusing to take the medicine that will make them better it is stressful for the whole family.
In consultation with your vet the team at Main Street Pharmcy can make a yukky medicine taste like tuna, beef, chicken, pina colada or any other favourite your pet may have. Some medicines can even be made into a gel and applied to your pet's ear, making medicine time a happy time for both you and your pet.
Animals comes in many breeds and sizes, so sometimes you only need to give a tiny dose. Our team can assist your vet by formulating the medicine into an easy to measure dose in suspension, gel or capsule, taking the guess work out of caring for your pet.
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