Are pharmacies capable of mixing variations on medicines?

Medievalist

I'm curious as to whether or not a pharmacist could alter a prescription medicine if a patient couldn't tolerate an inactive ingredient contained within it. For example, the cyclosporine in Restasis eye drops could be effective in treating severe dry eye, but what if a patient can't tolerate the castor oil within the medicine? Is it possible for a pharmacist to create a similar eye drop but use a different carrier liquid (at a doctor's request), or is this against brand/ patent laws?


Does this applay to all medicines? Do pharmacists have the ability to 'create' medicines in order to avoid intolerances? It's piqued my curiousity now.

upforit101

Medievalist wrote: »

I'm curious as to whether or not a pharmacist could alter a prescription medicine if a patient couldn't tolerate an inactive ingredient contained within it. For example, the cyclosporine in Restasis eye drops could be effective in treating severe dry eye, but what if a patient can't tolerate the castor oil within the medicine? Is it possible for a pharmacist to create a similar eye drop but use a different carrier liquid (at a doctor's request), or is this against brand/ patent laws?


Does this applay to all medicines? Do pharmacists have the ability to 'create' medicines in order to avoid intolerances? It's piqued my curiousity now.

Technicaly they could as all Pharmacists have undergone undergraduate training in compounding or the making of medicines.
However this compounding training is pretty basic in the context of modern sophisticated medicines.
The main concern here is that the facilities available to a community Pharmacist are very basic.
e.g. for the eye drops you have mentioned this would neccessitate a sterile manufacturing environment (where the microbe content is guaranteed free of microbes) Community Pharmacists simply don't have immediate, ready at the hand access to these kinds of sterile product facilities.
Some Hospitals (many in the Uk esp) do have sterile product facilities and make Chemo and paediatric products on site.
To get the product you wish made would usually necessitate the Pharmacist contacting a specials maufacturer and enquiring if it could be made.
It may be that the restasis dops cannot be made to a certain standard or according to good manufacturing practice (GMP) without the castor oil.
In any case you can be almost assured it will be expensive for a specials manufacturer to produce such a medicine.

Medievalist

Thanks Upforit, that's really interesting. I hadn't thought of the practical aspects of the technology and physical space required for compounding medicines.

Hopefully I might find somewhere that has the facilities and know-how to do it.

Big_G

That is interesting, I too was wondering if there were any compounding pharmacies in Ireland as I'm a dentist and I'd like to order a particular formulation of topical anaesthetic that is made by some compounding pharmacies in the States but for all intents and purposes is impossible to get here in Ireland. So are there any in the UK or Ireland apart from those previously mentioned?

locum-motion

Just curious: why'd you chose the example of Restasis?
It's not available in Ireland, nor as far as I can tell, in Europe. It's an American product. I reckon a patient would find it hard to find a doctor in Ireland who'd prescribe it for them.
And, tbh, they'd find it hard to get a pharmacy equipped to do what you ask either. Theoretically, any pharmacist could do it, given the equipment and access to all of the ingredients. (Usually it's just creams and ointments that we have to do in practice) But I'd say about 99.9% don't have the equipment.
There is one pharmacy I know of, quite close to the Eye and Ear Hospital, that has the sterilisation etc equipment necessary, coz they often get prescriptions for odd eye drops from the hospital.
That being said, getting the ingredients would be a problem, even for that pharmacy.

Medievalist

It just came up in conversation with my opthamologist and it got me thinking. I know of a few Europeans who are getting it compounded in their own countries, and I realised I have very little knowledge of the pharmacy industry here.

While Restasis is a US brand/ product, if I understand correctly cyclosporine etc isn't limited in the same way. It would therefore be a cyclosporine based compound and not Restasis itself that would be prescribed here.

locum-motion

Medievalist wrote: »

While Restasis is a US brand/ product, if I understand correctly cyclosporine etc isn't limited in the same way. It would therefore be a cyclosporine based compound and not Restasis itself that would be prescribed here.

Indeed, you're right, any such prescription wouldn't be for the Restasis product, but for Cyclosporin to be made up extemporaneously. However, Cyclosporin isn't licenced for ophthalmic use in Ireland, so that's why I reckon it'd be tricky to find a doctor to prescribe it. And getting hold of the cyclosporin as a raw ingredient would be nigh on impossible.