Photo by Geri McShane

For well over 90 percent of Curtis Clarambeau’s customers, the drugs prescribed by their doctors and dispensed from his pharmacy work just fine.

Saturday, September 15, 2001

For well over 90 percent of Curtis Clarambeau’s customers, the drugs prescribed by their doctors and dispensed from his pharmacy work just fine.

But what if you couldn’t swallow? What if no commercial medication exists to meet your needs? What if your child is an asthmatic, and the taste of life-saving prednisone, a steroid used to treat severe symptoms, is so distasteful that not breathing seems a better option?

That’s where a practice as old as pharmacy itself, known as compounding, comes in. Compounding is the art and science of preparing customized medications for patients.

Compounding’s presence throughout the pharmacy profession has changed over the years. In the 1930s and ’40s, approximately 60 percent of all medications were compounded. With the advent of drug manufacturing in the 1950s and ’60s, compounding declined. The pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms.

Within the last two decades, though, compounding has seen a resurgence as modern technology, innovative techniques and research have allowed more pharmacists to meet specific patient needs.

Clarambeau, owner of New Richland Drug and a member of the International Academy of Compounding Pharmacists, started compounding in May of this year. He had training when he obtained his pharmacy degree from South Dakota State University in Brookings. This year, he opted to further his training by attending a special school in Houston, Texas, staffed with chemists, pharmacists and doctors. He then added compounding to his current pharmacy practice.

&uot;It’s interesting,&uot; Clarambeau said of compounding. &uot;I like counseling patients on their regular prescriptions, but with compounding, I feel like I’m really participating in their treatment.&uot;

For the young and old, whether temporarily or permanently disabled by chronic or terminal illness, drug delivery systems can be a big problem. Compounding allows physicians more flexibility in selecting dosage strength as well as route of administration. The doctor writes the prescription that compounding pharmacists formulate. The various state boards of pharmacy regulate standards throughout the country.

Clarambeau said he does a lot of work with hospice patients, who need to relieve as much pain as possible without sedation and adverse side effects. In many instances, patients may no longer be able to swallow, so a transdermal gel which carry medication through the skin may be needed. Others may need a flavored troche which is placed between the gum and teeth. It melts slowly, releasing the drug inside the mouth where it is absorbed through the many blood vessels under the tongue. Concentration can be changed and flavoring can mask an unpleasant aftertaste. Medications also may be prepared as suppositories, oral suspensions, lollipops, capsules, urethral inserts, cream, jells or liquids depending on patients’ needs.

&uot;We can make sugar-free preparations as well,&uot; Clarambeau said.

He said he likes to think of himself as a problem-solver. &uot;I have a special interest in pain management and diabetic neuropathies,&uot; he added.

Clarambeau compounded a cream that had three different medications in it for a woman with neuropathic problems. &uot;She could take the medication orally, but she had to take such large doses to feel the effects,&uot; he said.

He’s compounded another cream for a patient with arthritis who was no longer able to take oral pain medications because they caused stomach problems. &uot;Enhancers are used in the medication to push the chemicals through the skin. It’s good for patients who suffer from liver or stomach problems,&uot; he said.

Other common compounds Clarambeau has done is Natural Hormone Replacement Therapy, or &uot;HRT.&uot; Women who don’t want or can’t use synthetic hormones may be prescribed a natural mixture by there physician. It has the same chemical makeup as the human body.

&uot;This is not for everybody,&uot; Clarambeau said of compounding. &uot;It is for people who have had problems and traditional therapy is not doing well. It’s tailoring, just for one person.

&uot;We can do the same for veterinary medications and needs,&uot; he added.

All bulk pharmaceuticals, equipment and packaging materials Clarambeau uses come from the Professional Compounding Centers of America, a Food and Drug Administration-registered supplier.

The newest technology makes what was once a laborious process easier for the pharmacist. At Clarambeau’s pharmacy, there are encapsulation machines, cream dispensers, lozenge templates, lip balm tubes, suppository molds, mixers, balance, hot plate and stirrer.

&uot;When we made capsules in the past, it would take forever,&uot; he said. &uot;Now we can do 100 capsules in no time.&uot;

Clarambeau said pharmacies that have gone to compounding are somewhat rare, and to find one in a town the size of New Richland even more so. Regionally, they can be found in Mason City, Mankato, Rochester and Northfield.

&uot;I think we’re going to hear a lot more about compounding,&uot; added his wife, Deb.

For more information, contact Clarambeau at New Richland Drug and Professional Compounding in New Richland, 1-888-465-4030 or ask your doctor if compounding is right for you.