Getting custom dosages at compounding pharmacies (US, UK, and elsewhere)

[Altostrata]

If you wish to have a compounding pharmacy make liquid medications for you (or make capsules in custom dosages), you will need a prescription from a physician. Any MD can write this prescription, it doesn't have to be a psychiatrist.
 
Make your request for a compounded prescription calmly, politely, firmly, and, if necessary, repeatedly.
 

Instruction for doctors: How to write a prescription for a compounded drug

Write the prescription following this format:

 

Quote

Compounded Medication
Generic Name of Active Ingredient(s) / Strength or Dose (i.e., mg or %)
Dosage Form (i.e., Liquid, Capsules, Suppository, Transdermal Gel, Troche)
Quantity
Directions for Use

 

 

The doctors should be sure to write "Compounded Medication" at the top of the prescription form.

Typically, for a compounded liquid, the prescription may read something like "compounded liquid, 90mg Effexor in 90mL, concentration 1mg:1mL, take 3mg per day" (a 30 day supply).

 

With a 1mg to 1 mL concentration, for example, you can reduce from 10mg to 9mg by taking 9mL of the liquid.
 
Generally, for insurance coverage, the prescription should specify a daily dose that is not available in tablets or capsules, or your insurance will insist you use the tablets or capsules instead.
 
You may be able to find recipes for compounded liquids by using search at http://www.pharmacytimes.com
 
Cost of compounded drugs
Because of the additional labor by a pharmacist, compounded drugs are generally more expensive than ordinary prescriptions.
 
In the US, the retail cost of a compounded liquid drug can be around $70. But charges may vary widely; it may be productive to compare prices from various pharmacies.
 
Some health insurance plans cover compounded drugs and some do not. (US Medicare does cover compounding of drugs on the plan's formulary. Not all pharmacies will accept Medicare for compounded drugs, reimbursement is very low.)
 
You will need to contact the compounding pharmacy for an estimate and your health insurance plan to find out coverage of a compounded drug. Some plans may require "medical necessity" paperwork from the doctor before they will pay for a compounded drug.
 
Get an oral syringe to take a compounded liquid
With a liquid, you use an oral syringe to measure your dosage. Ex: If your liquid contains 1mg in 1mL and you want to take .5mg, you would take .5mL of the liquid. You can adjust the amount you take as you continue your taper.

 

Because the amounts of liquid drawn in tapering tend to be small, useful sizes of oral syringes are 2mL, 1mL, 0.5mL. A 5mL syringe generally does not have ticks at small enough intervals. See Using an oral syringe and other tapering techniques

Some compounding pharmacies in the UK
According to Dr. David Healy, these pharmacies in the UK can supply liquid formulations of many antidepressants and other drugs:

Rosemont Pharmaceuticals (Tel 0113 244 1999)
These prepare large batches (so may be cheaper) for:
Amitriptyline 10mg/5ml, 25mg/5ml, 50mg/5ml
Lofepramine 70mg/5ml
Mirtazapine 15mg/1ml
Venlafaxine 75mg/5ml
Sertraline 50mg/5ml
Dosulepin 25mg/5ml, 75mg/5ml
 
Contact to find out if they compound your drug.

Cardinal Health, Martindale (Tel 0800 137 627)
This manufacturer will usually prepare what you ask for, so if the antidepressant isn't in the above list [for Rosemont] opt for this.

Large chain pharmacies like Boots or Rowlands may have their own external supplier who they may prefer to use as they have a contract with them.
 
See below for more information about compounding pharmacies in your area.

Edited December 29, 2018 by Altostrata
updated

[Altostrata]

In the United States, these compounding pharmacies will fill prescriptions by mail:

• ValuScript Pharmacy Carmel, IN http://www.valuscript.net/
• B & B Pharmacy Bellflower, CA http://bbpharmacy.com/index.html
• Belmar Pharmacy Lakewood, CO http://www.belmarpharmacy.com
• Millers Pharmacy Wyckoff, NJ http://www.millerspharmacy.com/retailer/store_templates/am_custom_page.asp?pageID=2534&storeID=B546D7B798AF4E79B8FF3A135B6DE193
• Skip's Pharmacy Boca Raton, Florida http://www.skipspharmacy.com/wplog/services/

Edited September 17, 2015 by Altostrata
updated list

[alexjuice]

I've talked with the pharmacists at People's Pharmacy in Austin, TX who told me they can send compounded medications by mail generally. Occasionally, he said, a state may have regulations that restricted it. He also said controlled substances were not eligible.

 

Otherwise he said it presents no problem with proper Rx.

 

http://www.peoplesrx.com

 

Alex

[Altostrata]

Not every locality has a compounding pharmacy. Here are directories to find them:

 

International Academy of Compounding Pharmacists (IACP)

 

offers list of participating pharmacies

 

Write iacpinfo@iacprx.org or call the referral hotline at 1-800-927-4227

 

Pharmacy Compounding Accreditation Board (United States)

http://www.pcab.info/find-a-pharmacy.shtml

Edited March 24, 2014 by Altostrata
updated information

[Altostrata]

A Facebook correspondent recommends this compounding pharmacy in New Zealand http://www.pharmaceutical.co.nz/Home_Page.php

[Meimeiquest]

I am using a local (not mail order) compounding pharmacy in the greater Nashville area:

 

AllenHill Pharmacy

4096 Carothers Parkway #4

Franklin, TN 37067

615-790-3885

[Francis]

Ive had multiple doctors send prescriptions to Johnson Compounding in Waltham, MA and the compounded medication/vitamin/amino mix/B12 shots have been sent to me. They have been great at negotiating with my insurance company.

[bubble]

I went to the site International Academy of Compounding Pharmacists (IACP) which is really good

 

Unfortunately when it comes to Europe, according to their locator there are compound pharmacies only in Germany, Span, Turkey and UK (identified 1 per country...)

 

But since the EU has a common market, I guess it should be possible to order products within the EU from anywhere in the EU so I will explore those options...

[Altostrata]

Also see Association of Compounding Pharmacists of Canada http://www.acpcrx.org/

[Sweetcreature]

Well I am just off the phone to Cardinal Health, Martindale to see if they stock seroxat and was met with the most unhelpful response I have ever encountered.  I think I interruppted their xmas party.......  

 

Lady: 'We cant talk to individuals...' 'You need to go to a pharamcist' 'You need to go to your doctor...we cant advice you....we don't speak to the public....

 

Me:  (seeking advice/info and simply trying to do some homework on the subject) 'Okay well, when you get instructions from my pharmacist are you able to make the doseage up in the amounts he requests...(explained the whole saga about coming off and trying to reduce in minute amounts)

 

Her: 'We can try...but we cant talk to you...you'd have to go to a pharmacist'

 

Me; 'Any particular pharmacist??  I don't think my local village pharmacy is quite used to doing this and my doctor I'm not so sure either....any one that you recommend at all?

 

Her: ' We cant advice....you'd have to go to a.........

 

Me: 'Yes yes...I would have to go to a pharmacist...I heard you the first time - you've been extremely UNhelpful

 

Good ole British customer services!!!

 

Best this is one taken off the list as they were about as useful as a chocolate fireguard......

 

the people at Rosemont were lovely but unfortunately don't seroxat..........

 

 

[Altostrata]

Very sorry. You'll need a prescription for the liquid formulation. Perhaps they're asking for the prescription?

 

With a prescription, Seroxat liquid, supplied by GlaxoSmithKline UK, can be purchased in liquid form from the pharmacy http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Anxiety&medicine=seroxat&preparation=Seroxat%2020mg/10ml%20liquid

 

This is probably why the compounding pharmacies don't make it. It's already available.

[MollyN]

Altostrata thank you thank you thank you!! I just went through the link here to the New Zealand compounding pharmacy. The people there are fabulous and happen to be just down the road, and for around $45 US they are making up 300mls liquid paroxetine for me, I am DELIGHTED xxxxx thank you so much again xxxxx

[dalsaan]

Here is a link to the professional association for compounding chemist in Australia. You can search for a compounding chemist vis their website:

 

http://www.pccarx.com.au/contact-us/find-a-compounder?param_zip=3000

[Altostrata]

Recommended by a correspondent on Facebook:

Randy's Compounding Pharmacy and Nutrition Center
1851 State Ave NE, Suite 105 Olympia, WA 98506
Brad Livingstone, R.Ph. Pharmacist/Owner. 360-491-0607
http://www.RandysCompoundingPharmacy.com
Brad at SoundCompounding%com

She said he's particularly knowledgeable about titrating benzodiazepines.

[Altostrata]

Nikki, read all of http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

We know many drugs are not very soluble. But people do successfully make homemade suspensions with them. (You cannot make a suspension from an extended-release drug such as Effexor XR, or Cymbalta or Pristiq.)

 

Yes, if you wish, you can get Serzone made into a liquid by a compounding pharmacy. You will have to ask your questions there.

 

Compounded drugs are often quite expensive.

 

Ordinary pharmacists are often poor sources of information about do-it-yourself titration methods, or of compounding information.

[Altostrata]

That sounds about right, Nikki.

 

For those in San Francisco, the best compounding pharmacy I've used is Parnassus Heights Pharmacy across the street from UCSF on Parnassus.

 

Koshland Pharmacy has a good reputation http://www.koshlandpharm.com/

[Altostrata]

I went to the site International Academy of Compounding Pharmacists (IACP) which is really good

 

Unfortunately when it comes to Europe, according to their locator there are compound pharmacies only in Germany, Span, Turkey and UK (identified 1 per country...)

 

But since the EU has a common market, I guess it should be possible to order products within the EU from anywhere in the EU so I will explore those options...

 

bubble, those few pharmacies might be the ones that are members of IACP. Most likely, there are many compounding pharmacies in Europe that are not members of that organization, which is based in the US (and seems to be for the purpose of lobbying the US government).

[chicken]

I'm adding Kare pharmacy in Danville VA to the list. They compound.

 

http://www.kare-rx.com/index.html

[Altostrata]

Koshland Pharmacy in San Francisco, California is a superior compounding pharmacy.

 

I happened to get a prescription here recently (for allergy) These people really know what they're doing and the pharmacists will answer questions, for example: How long a specific drug is stable in water. They run their own tests to determine this!

 

The pharmacist didn't blink at the idea I would titrate with a homemade suspension with water and was quite helpful with suggestions.

 

Their prices are about the same as any compounding pharmacy. They will mail a prescription for an extra $4 or so. I don't know if they will ship outside the U.S. http://www.koshlandpharm.com/

 

(They will also supply the superior Baxa oral syringes at no charge with an order.)

[Wildflower0214]

If I can afford to go to a compounding pharmacy, is there any reason I should lean towards doing it at home?

 

It's a question for the future. It would be with Ativan.

 

I was wondering what they use as a liquid at a pharmacy, and if there is a risk in having a reaction to it. Also, if what we make at home only lasts a few days at most, how does what they make last for a month??

[Altostrata]

It's a matter of preference and, as you note, cost.

 

Compounding pharmacies follow recipes and have information from tests demonstrating long a drug compounded according to formula will hold its strength.

 

The information we have about DIY liquids is incomplete.

 

We have a couple of people here who had bad reactions to compounded liquids. They can contain a lot of additives, such as flavorings. You would need to discuss making a hypoallergenic compound with your pharmacist.

[Altostrata]

Our member BethSimmons recommends Roy at http://www.customrx.com/ in Minnesota; he understands tapering at 2.5% if need be.

 

He will make up custom duloxetine (Cymbalta) capsules.

[MapleleafGirl]

Pharmasave In Vancouver, B.C. Canada..i used this all 4 years of my taper..compounding capsuls..

[Altostrata]

Another good compounding pharmacy in the U.S. that will fill prescriptions by mail order: Clark's Pharmacy
Address: 15615 Bel-Red Rd, Bellevue, WA 98008
Phone: (425) 881-0222
 
Others in Washington state:

The Falls Pharmacy
Brock Nyberg, R.Ph.
8112 Railroad Ave SE
Snoqualmie, WA 98065
(425) 888-6858

 

Arlington Pharmacy
Brian Henley, Pharm.D.
540 West Avenue
Arlington, WA 98223
www.arlingtonpharmacy.com
(360) 435-5771

 

Bellegrove Pharmacy 
Mark Holzemer, R.Ph. 
1535 116 Ave. NE - Suite. 103
Bellevue, WA 98004 
(425) 455-2123

 

Key Pharmacy 
Jonathon D. West, R.Ph.
23422 Pacific Highway South
Kent, WA 98032
www.keynutritionrx.com
(206) 878-3900

 

Juanita Bay Pharmacy Inc. 
Donald W. Hanson, R.Ph.
13520 100th Avenue NE
Kirkland, WA 98034 
(425) 821-4009

 

Fairwood Pharmacy 
Elwin Blair, R.Ph.
17254 140th Ave. SE
Renton, WA 98058
(425) 226-7000

 

Kelley-Ross, Inc. 
John Oftebro, 
616 Olive Way
Seattle, WA 98101
(206) 622-3565

 

Rxtra Care Pharmacy
Holly Whitcomb Henry, R.Ph.
11003 35th Avenue NE
Seattle, WA 98125
(206) 417-8066

 

Univ. of Washington Medical Center
Virginia Leland, R.Ph.
1959 Pacific Street
Seattle, WA 98195
(206) 598-6060

 

Kusler's Pharmacy 
Janet Kusler, R.Ph.
Dawn Ipsen, Pharm.D.
700 Avenue D
Snohomish, WA 98290

www.kuslerspharmacy.com
(360) 568-7787

 

Mike's Eastside Drugs 
Mike Graeff, R.Ph. 
8506 E. Mill Plain Blvd.
Vancouver, WA 98664 
(360) 694-3353

 

Union Avenue Pharmacy 
Bruce Ruckenbrod, R.Ph. 
2302 S. Union Ave - Suite C25
Tacoma, WA 98405
(253) 752-1705

 

Medical Center Pharmacy
450 NW Gilman BLVD
Suite 107
Issaquah, WA 98027-2483
(425) 392-8650 phone 
(425) 391-8624 fax

[Altostrata]

Compounding pharmacy in Sydney, Australia http://www.freshtherapeutics.com.au/

 

Importing from outside Australia https://www.tga.gov.au/personal-importation-scheme

[ActivistScientist]

Compounding pharmacy in South Orange County, CA .... https://stores.healthmart.com/thedruggistpharmacy/stores.aspx
 
The Druggist Pharmacy, 24022 Aliso Creek Road, Laguna Niguel, CA 92677PHONE(949) 643-0740

[greenwell3977]

Hi all,

 

I am tapering off Nefazadone (which is generic Serzone).  I was using a pill cutter with a digital scale.  On the scale, it showed 32.  Given that the uncut 50mg pill showed 100, I calculated by 32 pill to be 16mg.

 

Since cutting up a pill is a pain and not precise, I decided to give a compound pharmacy a try.  They made me 16mg capsules of nefazadone.  Today is the first day I am trying the capsule and I am unable to sleep. 

 

My questions: Is there an adjustment period going from a tablet to the compound capsule?  Should 16mg from the cut up tablet be the same as the 16mg compound capsule?   Or is there a difference (perhaps because of a difference in the active/inactive ingredient ratio between the two)?

 

Thank you.

[Altostrata]

greenwell, it looks to me like your math was correct. However, it could be the compounding pharmacy used a different brand of nefazodone than your tablet, and there is variation in strength between them. (Often, they grind up tablets.)

 

For example, what you thought was 16mg nefazodone in your tablet was actually 14mg, and the generic nefazodone tablet used by the compounding pharmacy contained more nefazodone than yours.

 

Or, the compounding pharmacy might have used pure generic nefazodone powder and their capsule is stronger than your tablet fragment.

 

If you phone them, they will be able to tell you what they did. If they used the pure powder, it's likely your capsules are stronger compared to the tablets you had.

 

If they ground up a tablet, there's no way to tell if what you got in the compounded capsule is stronger or weaker than your nefazodone tablet (unless you had a chemical analysis done of each).

 

If they used a different brand, you might simply be sensitive to the change in brand. How many times have you taken a capsule?

[greenwell3977]

Hi Altostrata,

 

Thank you for your response.  I have only taken the capsule once.  How long do you suggest I wait until I make a change (perhaps back to the tablet or a different brand)?

 

I am concerned that i put all this effort and time into lowering my tablet nefazadone to 16mg only to start taking a stronger version of it.  In other words, I will be at a higher level of strength and have additional tapering to do.

 

Thank you for your feedback.

[Altostrata]

If you still have tablets, you might want to take a tablet fragment (as you were doing before) until you can talk to the pharmacy and get a better idea of what's in the capsules.

 

If it's simply a brand change, it's possible your nervous system will settle down in 4 days or so of taking the capsule. Or, if you're convinced it's too strong, you may wish to take a little powder out of the capsule. Use your scale so you can keep the amount you take consistent.

[Altostrata]

Mark Drugs in Illinois will ship throughout the continental US http://markdrugs.com/shipping2.html

[indigo]

I had tapered my dose of prozac to 3.4 gms and had decided to stay at that level for several months to totally stabalize.

To avoid the fiddle of measuring the liquid prozac with a one mL syringe every day, I decided to have a compounding pharmacy (Lauden Compounding Pharmacy, Santa Cruz, CA)

make up capsules of 3.4 of prozac. After a week on the new capsules I was a mess, high anxiety and dark thought withdrawal. At first

I thought it was just the bump from changing from liquid to capsules. However I decided to weigh the each capsules with my accurate gram scale.

I was shocked at the discrepency between each capsule. Lowest was 264 mg the highest was 289 mg. Of course these weights include the filler powder

and weight of capsule, but clearly the dose of actual prozac in each capsule was way variant.

I'm in the last stages of tapering and am super sensitive to even the slightest variation in dose.  Had been at 3.4 for four months and had stabalized great.

Now I'm all screwed up again.

Is it common for compounding pharmacies to be this careless in their measurement of medication in capsules?

[Altostrata]

Not usually. I would phone the pharmacy and get an explanation of the discrepancies.

[peggy]

i spoke at length to a compounding pharmacy about compounding effexor for me.  the pharmacist told me they have quality control guidelines but they are by law able to be out by 3% on each capsule.  I decided that was too much discrepancy for me - it might be okay for people who are not highly sensitive.

 

For effexor, the process she told me went like this.. they get a prescription for a specific number of whole capsules (usually one box which would be 28 capsules)  They open ALL of them at once and put into a machine. So, if they are working with 75mg capsules and they are compounding into 25mg capsules they would then have 2100mg of effexor in the machine. That will make 84 x 25mg capsules.  They add the filler so they will make whole capsules mix well and then make 84 capsules.  I asked her how can they be sure that the effexor is evenly distributed between the capsules and she said the machine mixes well. 

 

We can't get immediate release effexor here-if we could then i could have a liquid made up which i would think would give you a more accurate dose.

 

I still haven't worked out how i can proceed with my taper - i might just have to continue counting beads out - but tiny, tiny drops each month - it's just so tiresome and i get crosseyed.

[Castor]

I am getting compounded capsules of Seroquel from Johnson Pharmacy in Waltham, MA. They can create sustained-release capsules. They also appear to ship nationwide.

[Fresh]

Anyone having capsules compounded should get a few quotes - the price range is astonishing!

 

I got quotes recently for 200 and 300 x 1mg capsules of pristiq (with slow-release additive).

Pharmacy 1:  $100 per hundred , so 300 caps.costs $300:00

Pharmacy 2:  $ 55 for 200 caps. , 300 caps. costs $80:00

 

About the "slow-release additive"  (necessary for pristiq and some other meds.):

""We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 

 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "