By Rachel Singletary

Do your doctors freeze when you say, "Why don't you have it compounded?"

Why does this happen when mentioning compounding medications? How about when you should send a prescription to a compounding pharmacy in the first place? Are you finding yourself questioning what you should consider when choosing a compounding pharmacy?

With these four tips below, I can debunk some myths and get you on the road to compounding bliss. After all, compounding pharmacies are there to make our lives a little easier.

Why are some doctors hesitant on using compounded medications?

I believe the main reason is the unknown with compounded medications. Doctors are so used to manufactured products, which are not patient specific, and generally come in capsules, tablets, or suspension.

When using compounded medications, you can do pretty much any size/strength. You can also choose what formulation the client will actually be able to dose, such as capsules, transdermal, quad tabs, and chewable tabs, to name a few examples. Most veterinarians are not familiar with compounds, so they tend to avoid them all together.

Another possible reason is their unfamiliarity with the regulations that come with compounding. A lot of times it feels safer and easier to use a manufactured product on the shelf. Some doctors are hesitant due to needing the prescription as soon as possible, compounded prescriptions take three to seven business days to arrive to the clients so in some cases it is not an ideal option.

What are some reasons you would need to compound?

Gone are the days of asking your team to cut tablets into one-eighth crumbling slivers! When cutting scored tablets into eighths, you cannot guarantee the medication is consistently spread throughout. The general rule of thumb, as you may know, is do not split a tablet if is not scored or quartered.

What would you do if you are unable to achieve the desired dose with a product like trazodone, for example, because it is only available in capsules or tablets and the dose is too high?

Are you questioning if a compounded medication is right for this patient? You can use compounding pharmacies to prescribe a topical transdermal or a suspension formula instead that is the exact dose you need for that patient.

The compounded medication must be clinically different from the original version, and the veterinarian should also be able to explain why. For example, say you need a 10-mg trazodone dose and the only size available in clinic is 25 mg, for that case, compounding would be an acceptable option.

Another good example on when to use a compounded medication would be prescribing a transdermal methimazole pen for a cat that does not like to be pilled. An instance when you should not compound is if there is an FDA-approved drug available and you decide it would be more cost effective for the owner to get it from a compounding pharmacy instead. Keep in mind, you can also purchase compounded medications for in-house use in some states; just make sure to check your state's regulations prior to keeping it on your shelves.

For example, Florida regulations in regards to controlled substances allow doctors to prescribe 30 days' worth of a compounded controlled drug upon a verbal call in and allow more than 30 days with a written prescription request. Again, always check your state's regulations first. 

What should you consider when prescribing a compounded medication?

Some things to consider would be the best use by date (BUD), any possible adverse reactions, if the medication you are prescribing works with the formula you are requesting, proper strength, and instructions.

Most often, compounding pharmacists may not be familiar with the requirements for animal drugs unless you use a veterinary-specific compounding pharmacy. It is okay to consult them for strength and quantity suggestions, but always be sure of what you are prescribing! Have you had a pet that had a horrible reaction to penicillin in the past, but you want to prescribe an oral antibiotic for your pet?

You should always mention any possible allergies or previous adverse reactions prior to prescribing so the pharmacist can tell you if the requested drug has anything similar in it. Depending on the pharmacy, you can usually get a prescription delivered to the client in three to seven business days.

Having the many formula options, such as transdermal, oral suspension, quad tabs, flavored tabs, chew tabs, and so much more makes it easier on the veterinary industry to take good quality care of our clients.

What should you consider when choosing the right compounding pharmacy?

Prior to choosing a compounding pharmacy, investigate them and ask for recommendations from trusted peers.

Some things to ask an unfamiliar pharmacy include:

• What type of sources do they use for the required medication?
• Are they using USP (U.S. Pharmacopoeial convention) quality-control and quality assurance checks on all of their products?
• Can the they ship to your state, and how do they determine their BUD date?

The pharmacy should be able to answer any of these questions so do not be afraid to ask!

Utilizing an outside compounding pharmacy can seem overwhelming at times, but if used in the right way, it could improve the client bond. Easier dosing means happy clients and pets! Not only are there websites that list the verified compounding pharmacies, but any pharmacy chosen can answer all questions you may have. By arming yourself with the knowledge and tools available the choice should seem much easier. After all, using a compounding pharmacy should provide some relief to you and your patients and not added stress.

Rachel Singletary is a practice manager in Lakeland, Fla., working with Family Vet Group. She started from the bottom and moved her way up and has managed many areas of animal hospitals. Her top passions are inventory, staff development, and budgeting. Client satisfaction, growth, and inventory are major factors in her daily life because she strives to provide a positive experience for both her clients and staff.