In 2006, a car accident left Ilyse Nielsen, 41, with debilitating back pain. It hurt to move, never mind walk. In the years that followed, she tried everything from narcotic patches to acupuncture to chiropractic adjustments—to no avail. Then, in 2013, her rehabilitative physician suggested Nielsen try something she hadn't even known was an option: a cream containing lidocaine, nonnarcotic pain medication, a muscle relaxant, and magnesium. Bingo. "Within 20 minutes of rubbing it in, I could feel my entire back relax," she says. When she'd taken some of those same medications in pill form, they hadn't done anything for her. "But when I could apply them directly to where I hurt, it was a whole new world." Nielsen's magic ointment was what's called a compounded drug: a prescription med custom-crafted in a pharmacy or a physician's office to meet a patient's unique needs when commercially available options aren't doing the trick. Compounded drugs aren't new, but there's been resurgent interest in them. Here, answers to the most common questions about this accessible form of personalized medicine.

Is this another wellness fad?

In a word, no. "Before medications were mass-produced, compounding was the primary way of creating prescription drugs," says James Ponto, a registered pharmacist and clinical professor at the University of Iowa College of Pharmacy. And of the more than four billion prescriptions filled at retail pharmacies in 2016, research suggests up to 276 million were compounded. At Heritage Pharmacy in Chicago, for example, director of pharmacy Adonis Ducre can concoct mango-flavored antibiotics (for kids), a dye-free antihistamine (for a patient allergic to dye), anesthetizing lollipops (for a needle-phobic dental patient), and even meds for pets (turning pills into a swipe-able balm). "Most people hear about us from their doctor," says Ducre. "They're often apprehensive at first, but when the prescription works, they come back."

Is compounding right for me?

Whether you realize it or not, it's likely that you've already been prescribed these drugs. Compounding is done at independent drugstores as well as big retail chains: CVS and Walgreens make allergy-free formulations and compound liquids and creams—creating liquid omeprazole for customers who have trouble swallowing antacids, say, or all-purpose nipple ointment for breastfeeding moms.

How safe are these drugs?

Although compounded medications are not FDA approved, they're created using FDA-approved drugs (plus other ingredients). But compounding's reputation suffered a serious blow in 2012, when contaminated injectable steroids produced by a Massachusetts-based pharmacy led to a fungal meningitis outbreak that sickened more than 700 people and killed more than 70. Multiple factors contributed to this tragedy, says Stacie Maass, senior vice president of pharmacy practice and government affairs for the American Pharmacists Association. The facility was using expired drugs and didn't maintain the sterile conditions required for injectables. It was also illegally producing large quantities and distributing to healthcare facilities without valid patient prescriptions. (Last summer the pharmacy's co-owner was sentenced to nine years in prison.) Yet, as Maass notes, "when done according to regulations, compounding is a traditional, safe practice that ensures patients have access to effective medications."

Is my pharmacist qualified?

While all licensed pharmacists learn to perform basic compounding, Maass recommends inquiring about extra training or certifications. You can also inquire about how much compounding pharmacists are doing; around 25 products per week is a good indication of experience. "Ask for recommendations and get to know your pharmacist," Maass suggests. "The better she knows you, the better she can compound with your needs in mind."


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