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Sterile compounding is the preparation of custom medications for patients in a sterile environment to prevent contamination and maintain patient safety. Pharmacies that offer this service are known as compounding pharmacies. There are be a number of reasons to order a compound medication, ranging from concerns about patient allergies to a custom chemotherapy formulation. In a compounding pharmacy, personnel follow very specific guidelines to keep the environment clean and safe.
The process of sterile compounding starts with a physician consultation. The doctor talks with a pharmacist about the medication and the patient's case to allow the pharmacist to develop an appropriate formula. In addition to the biologically active ingredients, the pharmacist also needs to think about what to use as a carrier and buffer; in an ointment, for example, a cream is needed to carry the drug, while an oral medication might need a buffer coating to protect the stomach.
A compounding pharmacy may use pharmacists or technicians to prepare medications. In both cases, they work in a sterile environment. Protective gear is available to prevent contamination, and it is common to work under a vented hood. The sterile compounding can result in oral or injectable medications, and the pharmacist can also make suppositories, medications for hanging in intravenous bags, and medications that go into pumps located below the skin in patients who need a continuous supply of drugs.
Pharmacists who perform sterile compounding need a detailed knowledge of the medication so they can select the most appropriate components. They also need to consider the patient's needs. An asthma patient with allergies, for example, might need an inhaled medication that does not contain any wheat or dairy products. The pharmacist must select appropriate ingredients for compounding to avoid triggering an allergy attack in the patient.
Many compounding pharmacies prepare human and veterinary medications by request. They may serve a large area and can deliver custom medications to pharmacies that cannot afford to perform sterile compounding on their premises. This work requires sterile equipment and state-of-the-art facilities, along with the ability to pass regulatory inspections. A small pharmacy with a limited customer base might not be able to invest the necessary funds to start sterile compounding.
Large hospitals usually have a sterile compounding facility, especially if they have a cancer treatment center. Chemotherapy medications often need a custom formulation, as the drugs and dosage are tailored to the needs of the patient. In this case, the pharmacy may also need radiological certifications, as some chemotherapy is radioactive.