Extemporaneous preparation of oral suspensions, creams, and ointments by pharmacists is of great importance for the pediatric population. Why? The “one size fits all” model doesn’t work for kids. Dosing for kids is mostly weight-based and is calculated milligram(drug)/kilogram (child’s weight) or dosed based on the child’s body surface area. Most compounded preparations for pediatric patients are considered to be “simple compounds” in that there are only 2 to 3 ingredients in the compound; the drug (crushed tablets or bulk powder) and a suspending agent (simple syrup, ora-blend, cherry syrup).
Parents needing compounding services for their children run into road blocks because not every pharmacy compounds. My suggestion for parents is that they discuss with their pediatrician where compounding pharmacies are located in their area before leaving the doctor’s office or hospital. Parents, if you’re uncertain if a drug needs to be compounded, please ask the pediatrician when he or she writes the prescription.
Typically the pediatrician will be aware of community pharmacies in the area that provide compounding as a service. Some pharmacies in your area may even solely focus on pediatric patients.
When the parent finds a pharmacy they want to use by physician referral, web search, or even word of mouth please give that pharmacy a phone call to ensure that the pharmacy accepts your child’s insurance.
If you have questions or concerns about the compounded medication your child will receive never hesitate to ask to speak to the pharmacist on duty or the pharmacy supervisor. Consultation should always be offered, but never hesitate to speak up on your child’s behalf. The pharmacist should be able to provide information about the drug, how the compound is prepared, how it should be stored, and be able to discuss side effects and concerns that parents typically have with the associated compounded medication.
Lastly, parents please give the pharmacy sufficient time to compound the medication. Compounding is a process that shouldn’t be rushed. Pharmacists must work with their staff to ensure the proper protocol for compounding is followed to ensure patient safety. Typical turn around for compounded medications can sometimes be 24 to 48 hours depending on the pharmacies volume and workflow.
For information about compounded medications please check out the FDA’s website regarding the topic: https://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/pharmacycompounding/ucm339764.htm