← Health Advice COMPOUNDING
Compounded Medicines Explained: When Off the Shelf Is Not Enough
Most medicines come in fixed strengths, fixed flavours and fixed forms. For a lot of patients that works fine. For the rest, there is compounding.
Written by the pharmacy team at Paradise Compounding Pharmacy, Surfers Paradise · Reviewed by a registered pharmacist · About 7 minutes to read
The short version
- Compounding means preparing a medicine from individual ingredients for one patient, to a prescriber’s formula
- It is used when strength, flavour, base or dosage form of the commercial product does not suit the patient
- Every compounded medicine needs a current prescription from a doctor, specialist, dentist or vet
- Price depends on ingredients and quantity, so always ask for a quote before you commit
- Compounded preparations carry a shorter expiry than manufactured products
If you have ever been handed a tablet and told to cut it into quarters, watched a toddler spit out a medicine for the fourth night running, or been told the cream that worked for years has been discontinued, you have run into the limits of mass production.
Pharmaceutical manufacturing is built for scale. A medicine gets made in two or three strengths, one or two forms, and whatever base the manufacturer chose. That covers the majority of patients. It does not cover all of them, and the people it misses are usually the ones who need the medicine most.
Compounding is the part of pharmacy that fills the gap. At Paradise Compounding Pharmacy we prepare medicines from individual ingredients, in our own compounding room on Surfers Paradise Boulevarde, to a formula written by the patient’s prescriber.
What a compounded medicine actually is
A compounded medicine is made from scratch for one named patient. A pharmacist takes the active ingredient your prescriber specified, combines it with the carriers, bases and flavours that suit you, and prepares it in the form and strength written on the prescription.
The active ingredient is the same one your prescriber chose. What changes is everything around it. That distinction matters, because compounding is not an alternative to conventional medicine. It is conventional medicine, assembled differently.
Compounded versus manufactured, side by side
| Manufactured | Compounded | |
|---|---|---|
| Made for | Everyone | One patient |
| Strengths | Fixed by the manufacturer | Whatever the prescriber writes |
| Form | Usually tablet or capsule | Liquid, cream, troche, capsule and more |
| Expiry | Long | Shorter, assigned conservatively |
| Availability | Subject to supply shortages | Made when needed |
Five reasons a prescriber reaches for compounding
1. The strength does not exist
Doses are worked out for an average adult. A small child, an older patient losing weight, or someone being carefully titrated up or down often needs a strength that is not manufactured. Splitting tablets is a rough tool, and some tablets cannot be split accurately at all.
A compounding chemist can prepare the exact strength on the prescription, which matters most when the gap between too little and too much is narrow.
2. The patient cannot swallow it
Children, older patients, people recovering from surgery and anyone with a swallowing difficulty struggle with tablets and capsules. So do most animals. The medicine is right, the delivery is wrong.
Compounding turns it into a flavoured liquid, a troche that dissolves in the mouth, a cream absorbed through the skin, or a lozenge. Paediatric and veterinary compounding are two of the most common requests we take.
3. Something in the product causes a reaction
A tablet is mostly not the drug. It is binders, fillers, dyes, preservatives and coatings. Patients react to lactose, to gluten, to particular dyes and to specific preservatives, and when they do, the commercial product is off the table even though the active ingredient is fine.
Compounding lets us leave the offending ingredient out and prepare the medicine in a base the patient tolerates.
4. The product has been discontinued or is out of stock
Manufacturers withdraw products when they stop being commercially worthwhile, and supply shortages hit Australian pharmacies regularly. Neither has anything to do with whether the medicine still works for you.
If your prescriber confirms the same active ingredient is appropriate, it can often be compounded. Bring the old packaging or the product name to the pharmacy and we will tell you whether it is possible.
5. Two medicines would be better as one
Applying three separate creams twice a day is a regimen most people abandon within a fortnight. Where a prescriber considers it appropriate, a single compounded preparation can replace several, which is usually the difference between a treatment being followed and being forgotten.
Worth saying plainly: compounding always starts with a prescriber. We cannot compound a medicine because a patient would like us to, and we cannot recommend one. What we can do is tell you and your doctor what is achievable, so the conversation is an informed one.
What to expect if you are sent to a compounding pharmacy
Price
Compounded medicines are usually more expensive than a manufactured equivalent, and usually private rather than PBS subsidised. The ingredients are bought in small quantities and a pharmacist spends real time preparing and checking each one.
Ask for a price before anything is made. We quote on the details of the prescription, and nothing is prepared until you say go ahead.
Timing
Some preparations are ready the same day. Others take longer, either because an ingredient has to be ordered in or because the preparation itself takes time. Phone the pharmacy with the details rather than assuming, particularly if you are on your last few doses.
Expiry and storage
A compounded preparation carries a shorter expiry than a manufactured product, because it is made fresh without the stabilisers and sealed packaging that give commercial medicines a long shelf life. Some need refrigeration and some do not. The label tells you which, and it is worth reading properly.
How to start the conversation with your doctor
Patients often assume compounding is something you ask a pharmacy for directly. It is not. It starts with your prescriber deciding it is clinically appropriate, and that decision is easier for them to make if they know what is possible.
- Tell your prescriber specifically what is not working: the swallowing, the flavour, the reaction, the strength
- Ask whether the same active ingredient could be prepared in a different form or strength
- Ask them to call us before writing it if they want to check what is achievable
- Bring the prescription to the pharmacy and ask for a price and a timeframe before committing
Prescribers are welcome to call us on 07 5527 9428 or fax 07 5604 1432 to talk through a formula. We would far rather have that conversation before a script is written than after.
The short answer
Compounding exists because patients are not identical and manufacturing assumes they are. If the medicine your prescriber wants you on does not come in a form you can take, a strength that suits you, or without an ingredient you react to, compounding is usually the way through.
If that sounds like your situation, talk to your doctor first, then bring the prescription to us. You can also send it through online or read more about what we compound. You may also find consumer medicines information and how compounding works useful.
General information only. This article is general in nature and is not personal medical advice. It does not take your circumstances, other medicines or medical history into account. Always speak to your doctor or pharmacist before starting, stopping or changing any medicine. Compounded medicines require a prescription. In an emergency, call 000.
Talk to a Compounding Pharmacist
Have a prescription that needs compounding, or a question about one you already take? Call us, or walk in seven days a week on Surfers Paradise Boulevarde.