Compounding pharmacists adust medications to serve patients

Whether it's helping women adjust hormone levels using natural hormone replacement therapy or finding a flavor of medicine that can help soothe a child's upset stomach, Steve Horst can mix up the proper medicine.

Horst, a registered pharmacist, is one of only a few compounding pharmacists in Southeast Missouri, or even the state. There are 7,123 licensed pharmacists in the state, but not all of them compound.

Compounding pharmacists can customize drugs to fit a patient's specific needs. In some cases it could mean flavoring a nicotine lollipop for someone who's trying to quit smoking or mixing a topical gel that can keep a cancer patient from feeling nausea after chemotherapy. Hormone replacement therapy is a growing part of the compounding pharmacy field as more and more women consider natural drugs over synthetic ones.

Though the majority of his business is in standard pharmacy practice, Horst has slowly been adding to his specialty. He began working at Horst Pharmacy in 1981 and started compounding in 1988, adding equipment and supplies.

And now, years later, much of his work is still educating the doctors and patients about compounding -- and making sure communication continues after the patient begins taking the customized medication.

Compounding is matching a prescription to a patient's needs instead of making a patient's symptoms fit the medication, Horst said.

Compounding isn't a large portion of his business, but it's certainly a rewarding part, he said. "It's not a lot of what we do, but if someone has a specific need, when they need it we're here to help."

Horst's compounding laboratory sits directly across the hall from his standard pharmacy area, where shelves are lined with bottles labeled by drug companies and most prescriptions are filled.

Across the hallway is a pristine, state-of-the-art laboratory where Horst also works. Here the shelves are lined with active ingredients used to make prescriptions. Sometimes Horst is working with eye drops or making capsules and gels.

Molds and beakers line the back of the counter where Horst works.

"We try to work with ingredients in pure form because there are less inactive ingredients to work around," he said.

Concentrated substances

Since most of the drugs are impure, concentrated forms, they can be potentially hazardous. He sometimes works after hours so that the fumes and odors of the drugs won't make customers and his workers ill. Safety is an important factor because of the potency, he said.

Horst's compounding work is filling a real need for people, said Shari McConnell, pharmacy educator. "You don't have too many people who do what he does."

Customizing drugs is really the birthright of pharmacy, said Patricia Paget of the International Academy of Compounding Pharmacists, based in Sugar Land, Texas.

"It is very consumer-, patient-oriented," she said. "We just ultimately want to get something to them that is tailored for them."

Estimates show that compounded drugs account for 1 percent of all prescriptions in the country. That means there were 30 million compounded prescriptions filled in 2001, Paget said.

There are 24,600 independent pharmacists in the United States and 82 percent offer some type of compounding service. There are only two compounding pharmacists locally -- Horst in Jackson and Ernie Moxey in Sikeston, though there are others farther into the Bootheel.

Though many people aren't sure about compounding, it was the normal practice for most pharmacies in the country until mass manufacturing of medicine became commonplace after the 1950s.

The Associated Press contributed to this report.

ljohnston@semissourian.com

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