by Dawn Ipsen, PharmD

More people than ever are taking medications. In 2018, pharmacies filled more than 5.8 billion prescriptions. Fifty-five percent of Americans now take at least one prescription medication and almost 12% take five or more prescription medications.

Medications can help improve the quality of life, reduce the risk for dangerous health complications and save lives. That could mean reducing the risk for a stroke by managing blood pressure, reducing blood clot risk with a blood thinning drug or treating nausea with an anti-nausea drug. 

But medications are rarely perfect, and problems are common. According to the FDA, Americans experience more than two million adverse drug events every year with an estimated healthcare cost of $136 billion. Side effects can be caused by the medication itself, but can also be created by other, non-active ingredients used to manufacture the medication. 

Knowing your options and who can help when a problem arises can make the difference between being able to take a medication or being faced with having to discontinue it or switch to a less effective medication. 

While your doctor will be the one to prescribe the medication, many people are surprised to learn that most of the time the doctor isn’t the best person to help solve a medication problem. Yes, you should always tell your doctor if a problem arises, but getting a pharmacist’s input is crucial for understanding your options and helping you solve a medication problem. For these reasons, if you haven’t made friends with your local pharmacist, make it a point to make your local pharmacist your BFF, or at the very least know them well enough that you’re on a first-name basis with them.

As the experts on medications, pharmacists are a critical member of your healthcare team and can help you find the best, most cost-effective medication for your condition. But, just like not all doctors are the same, neither are all pharmacists. Understanding the difference is important. Afterall, even though two professionals may be physicians, you wouldn’t go to a gynecologist for a knee injury.

Compounding Pharmacists are specialists who go through additional training. They specialize in providing custom made medications and solving even the most complex medication problems. Think of it like buying a cake. Many stores sell cakes, but if you want the extra-perfect, just-the-way-you-like-it-cake you’d probably consider going to a specialty bakery to serve your need. Compounding Pharmacists work with you and your physician to provide formulated medications to fit your exact needs.

Some of the more common medication problems patients encounter include supply or availability issues, medications that aren’t quite the right dose and medications that are difficult to take. Another common problem could involve the inactive ingredients, such as dyes and fillers that can actually make patients feel worse.  Luckily, there are often simple answers for each of these medication problems!

Medication That’s Unavailable or In Short Supply

Trying to get your prescription and being told that it’s out of stock can be stressful and scary. Unfortunately, supply shortages have become an increasing problem and more patients are experiencing this. There are several reasons for this, but typically it’s the result of a drug manufacturer not being able to keep up with demand, a medication being recalled due to a problem at the manufacturing plant or the manufacturer no longer having enough demand to continue to produce a medication. Pharmacists are able to provide many possible options for these issues. 

Sometimes the pharmacist can suggest a reasonable and equally effective alternative. The pharmacist could then help you communicate the requested change to your prescribing healthcare provider to ensure it’s a great fit for your needs. If no alternative exists, then a compounding pharmacist might be able to custom make the medication for you.

Medication That’s Too Weak or Too Strong

Medications come in standard doses. For most people that may work just fine, but many people have a hard time finding the dose that works just right for them. I call this “The Three Little Bears” phenomenon, which I see all the time. Just like in the children’s book, sometimes medications will seem ‘just not right.’  

And whether the medication is too strong or not strong enough, problems can arise. If a medication is too strong it can cause other medical problems and unwanted side effects. For example, a blood pressure medication that’s too strong might cause dizziness and, therefore, increase the risk of a fall. 

If a medication is too weak, you might not see any improvement in the condition it was designed to help. For example, a thyroid medication that’s too weak can leave a person feeling tired, cold and constipated.  When this occurs, a compounding pharmacist can create a dose that’s just right for you. That’s because compounding pharmacists make the medication fit the patient, not the patient fit the medication.

Medication That’s Hard to Take

If you’ve got the medication but can’t take it because the pills are too big, it tastes horrible or the dosing regimens are complicated and confusing, a compounding pharmacist can help you solve these problems. 

This common problem leads to phenomenon we call ‘pill fatigue,’ resulting in people stopping treatment without letting their doctor know. Pharmacists not only know all of the important prescribing details of medications, they also know what medications look, taste and smell like and how often they need to be taken.

Sometimes it can be as easy as asking the prescriber to change to a similar medication. Other times the compounding pharmacist can work with you and your prescriber to make the perfect medication, customized specifically for you! Compounding pharmacists can often change the size or flavor of the medication. Alternative forms may also be a solution, such as a transdermal cream, which delivers medication through your skin. Complicated medication schedules might be simplified by combining medications together into fewer pills.

Medication That Contains Unwanted Ingredients

Many people are unaware that medications contain unnecessary extra ingredients such as dyes, preservatives, and unwanted fillers. Some medications even contain gluten. Pharmacists can help with that medication problem too. Pharmacists have many resources at their fingertips that they can use to quickly identify inactive ingredients or fillers in your medication. 

If a traditional, mass-marketed prescription still doesn’t meet your needs, a compounding pharmacist can make your medication without the ingredients that might be making you feel worse.  To help avoid problems in the first place, be sure to always discuss your dietary and medication sensitivities with your pharmacist since they can help you screen for the best possible options.

Pharmacists can offer patients a lot of help and guidance when it comes to medications.  Pharmacists are highly trained and are the most accessible healthcare professionals. Your pharmacist should be your best friend in your health journey.  Please speak with your pharmacist or compounding pharmacist the next time you have a medication question, concern or problem. They are an important part of your healthcare team and there waiting to help you!

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About the Author

Dawn Ipsen, PharmD is owner and compounding pharmacist of Clark’s Compounding Pharmacy, Bellevue, WA (currently licensed in 9 states) and Kusler’s Compounding Pharmacy, Snohomish, WA.  Dawn graduated from the University of Washington with a Doctor of Pharmacy  degree where she received the Dean’s Outstanding Service Award.  She is a Clinical Instructor for the University of Washington School of Pharmacy and an Affiliate Faculty Member for Bastyr University.  She was named Professional Compounding Centers of America Pharmacist of the Month in 2016 and Washington State Distinguished Young Pharmacist of the Year in 2011.  Dawn provides consultative services on compounding opportunities for patients and prescribers via phone and in person.  She also has presented on the topic of pharmaceutical compounding to physician, patient, and peer groups.  She is dedicated to helping her community find solutions to medication problems through personalized medication therapies.