A vast majority of the population have sensitivites to many things that we all encounter in life, whether food, environment, or chemicals. One of the challenges that patients with senstivities have is finding medications that are free of ingredients that they are sensitive to. Some of the most common of these ingredients are gluten, lactose, sweeteners (natrual and artificial) and dyes.

At Pharmacy Innovations, we can create medications for your patients that require special fillers, sweeteners and flavoring that they are able to tolerate.

Patients that are on specific diets can often find it difficult to obtain commercially available medications that meet the requirements of their diet. A child on a ketogenic diet is a classic example of a patient who cannot take commercially available drug products. This diet is a treatment option for young children who have catastrophic, intractable epilepsy or inborn metabolic defects involving glucose metabolism. Children who are placed on this diet are fed a high-fat, low-carbohydrate, and low-protein diet designed to increase the body's dependence on fatty acids for energy rather than glucose. The calculations of daily allowances of protein, fat, and carbohydrates must be exact.  Our compounding pharmacists assist the caregivers or patients and their dieticians by preparing medications whose carbohydrate content is calculated exactly. Because most of these children are unable to swallow pills, they require an oral liquid. Unfortunately, most of these contain sugar and are loaded with carbohydrates, especially antibiotic suspensions. At Pharmacy Innovations, we can prepare suspensions for these patients using USP-grade powders, stevia or artificial sweeteners, and methylcellulose as a suspending agent. A fixed oil suspension is another vehicle for patients on a ketogenic diet. The oil itself can be counted in the patient's daily fat intake and it can be sweetened with stevia or other artificial sweeteners that add no carbohydrates.

The use of transdermal creams and gels, nasal sprays and sublingual drops are also dosage forms that can be used in treating patients on a ketogenic diet.

Patients suffering from celiac disease are another group of patients with special medication needs. In prescription and over-the-counter medicines, fillers (inactive ingredients or excipients) are added to the active drug to provide shape and bulk for tablets and capsules and aid in water absorption (helping the tablet disintegrate). These fillers can be derived from any starch source, including corn, potatoes, tapioca and wheat. Celiac patients cannot take medications containing these filler, as they can aggravate symptoms that may already be present from the disease. Other active ingredients that might come from wheat or barley include dextrates, dextrins, dextrimaltose, and maltodextrin. Cross-contamination during the manufacturing process is another potential problem. Because gluten sensitvity is strongly linked to autoimmune disease, it is especially important that these types of patients have access to gluten-free medications. Pharmacy Innovations can prepare gluten-free medications when there is not one commercially available. 

 * International Journal of Pharmaceutical Compounding Vol 11 No 2.