How To Order Custom Compounded Suspensions

[scalper]

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I am a new doctor, so bear with me.

Most of us are trained to write standard meds, however, I recently was asked to prescribe a taper program for an SSRI that was very slow with very small decrements.

What is the proper way to write a script for custom compounding? Sure, we can write it out in paragraph form, but I figured you PharmDs would have a more 'elegant' method that eliminates any ambiguity it what we are wanting.

Also, do we need to specify the vehicle to use for delivery? Or can we just say the amount of drug per measurement we want and let you all figure out the solubility, vehicle, suspension/tincture, etc.

It seems like compounding is becoming a lost art, but could offer patients a real advantage as we move into the future of more custom therapies and medications. I know it is happening in bioidentical hormone replacement, but sure could offer advantages elsewhere too.

 

[Praziquantel86]

If you write out what you want, a pharmacist will be able to come up with the best way of doing it (especially if you refer the patient to a specialty compounding pharmacy). Specifying the vehicle, or at least calling ahead of time to discuss options, is probably a good idea. You won't need to write out the specific compounding directions, but you will still need specific directions for the patient.

Ex:

Sertraline 20mg/mL in cherry syrup
Sig: 1 tsp QAM x5day, then 2 tsp QAM, then 2 tsp QAM and 1 tsp QPM, then 2 tsp QAM and 2 tsp QPM

Obviously the sig is probably nowhere near what you want (if it's even tapering the right way), but you get the idea.

Just a few general pointers: when you specify a concentration, make it so that a reasonable dose is an easily measurable amount (5 mL vs 3.26 mL). Also, double-check (either in a reference book or by calling a pharmacy) that there isn't something close to what you want commercially available. Finally, calling a pharmacy ahead of time to see if they're able to make an oddball compound is always nice - the majority of pharmacists will know how, but time and resources can be an issue.

 

[scalper]

Thanks for the info. Sounds straightforward.

Any idea what kind of additional charges a patient might run into for such compounding?

 

[All4MyDaughter]

Some insurance plans don't pay for compounded drugs, or require prior authorization. Many speciality compounding pharmacies are cash only and the patient is responsible for submitting the claim to their insurance for reimbursement.

The patient will need to check with their plan for specifics as there is wide variability.

 

[genesis09]

Try and build a relationship with a local compounding pharmacy. They will help you with this process. There are many standardized compounding recipes.