Walk into a modern pharmacy to get a prescription and you will probably see the pharmacist fill it with a medication manufactured someplace else — either pills in defined sizes or liquids in measured containers.
But, unfortunately, those modern-day manufactured sizes aren’t always what a patient may need. So, two School of Pharmacy professors at Pacific University are exploring, with the help of a $10,000 grant, an option that can help define how one drug — a thyroid medication — may be used to fit patients’ individual needs in doses other than the standard manufactured form.
The grant was awarded by the International Academy of Compounding Pharmacists (IACP) Foundation to Deepa Rao and Jeff Fortner, both assistant professors of pharmacy, for research titled, “Solid-state stability of compounded levothroxie formulations.”
Levothyroxine is a thyroid hormone used to treat hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone. Without this hormone, the body cannot function properly, resulting in conditions such as poor growth, slow speech, lack of energy, weight gain, hair loss, dry, thick skin and increased sensitivity to cold, according to PubMed Health, a U.S. National Library of Medicine website.
The research relies on the practice of compounding medications, in which the pharmacist actually prepares the medication on site rather than using manufactured products, a practice many people aren’t aware was the standard in pharmacies many years ago, said the faculty members.
“It’s pharmacists making products that aren’t commercially available,” said Fortner, noting that some patients may need different dosages than the manufacturers provide, or may need a liquid because they can’t swallow a pill, or in a different strength than available commercially. When finding the right dose for a patient, some drugs — like hormones — can be “finicky,” he said.
A thyroid hormone, said Fortner, “is one of those drugs that has a lot of different dosages … some people require additional strengths beyond those that are commercially available.”
The medication levothyroxine to be researched is used in amounts that are “very, very small … we’re talking micrograms of the actual drug,” he said. “When you’re working with something that small, it’s really hard to measure accurately, because it’s just these little specks worth of powder.”
“Compounding pharmacists would try to get the drug mixed with something else so they weigh it out more easily,” Deepa said. “That something else doesn’t have an effect. It’s just there to kind of bulk it up, so that instead of taking something that looks like a speck, now you’re actually able to weigh out a certain quantity.”
The main goal of the research is to give pharmacists a sound scientific basis to know when this mixture of levothyroxine and bulk powder may expire rather than relying on estimates, said Rao. It will be important to know how long the mixed powder will be stable, since fillers can sometimes pull in water or chemically react with the hormone “so the drug might not work as you expected,” she said.
“You can think of it as a chocolate chip cookie, like the chocolate chips are the drug and the dough is the filler,” Fortner said. “If you ate the chocolate chips by itself, it might be a little too much. But you can mix it all together and then you can measure it out.”
In addition to the human population, animals seen often in veterinary practices are a “huge market” for compounding pharmacies, Fortner said. Sometimes, the veterinary medicine only comes as a tablet, “but try to convince your cat to swallow a tablet,” said Rao. “It doesn’t happen.”
“With everything becoming mass marketed, it almost seemed like compounding disappeared,” Rao said. However, she noted, many specialists such as dermatologists, have “realized that patients might need different strengths or different types or different combinations of medication.” As a result, compounding pharmacies are experiencing something of a comeback, she said.