Animal Health Solutions

10 Covetrus | ph: 855.724.3461 | fx: 888.329.3861 | northamerica.covetrus.com Compounding benefits for the veterinary practitioner Compounding offers additional therapeutic control, including ingredients, strengths, dose forms, combination medications, and maintaining availability during commercial backorders. Control what is in the drug Pharmaceutics (ie, drug design science) is an integral part of compounding and involves the prescriber knowing and managing exactly what is in a drug formulation—from its active pharmaceutical ingredient (API) to excipients. Excipients are inactive vehicles included in a preparation to serve a mechanical, chemical, or pharmacologic function. Common excipients include flavors, coloring agents, sweeteners, and preservatives. 3 Studies have been conducted to assess species-specific preferences to improve palatability and compliance. 3 Solubility, volume, stability, and flavor-masking factors are important to maintain the end product's integrity and effectiveness. 4 Modulating drug formulations allows veterinarians to add species-specific flavoring for improved compliance; reformulate a gabapentin suspension without xylitol; and change to a different transdermal base to achieve penetrated, soothed skin instead of messy, matted fur. 5 Control the dose Vital to the practice of veterinary medicine, accurate weight-based dosing can be best achieved through compounding. Very large, very small, and exotic animals often depend on the flexibility of compounding to receive treatment. Many commercial veterinary products offer a range of dosing options but cannot cover all potential therapeutic scenarios. Compounding pharmacies can fill the gaps while maintaining potency. For example, a veterinarian can get a 50 mg/mL metronidazole suspension for a 5-lb puppy with Giardia spp infection, or a zoology specialist can get a properly dosed antifungal nasal spray developed for 10-inch walrus nostrils. 6 Change how the drug is given Compounding can be particularly beneficial in situations in which a unique administration solution is desired. Dosage forms include powders, capsules, tablets, chewables, lozenges, creams, lotions, ointments, troches, pastes, liquids, gels, and suppositories. These various forms can have several helpful uses in veterinary medicine, including: • Reformulating hard-packed tablets into soft, flavored chewables; • Switching to a methimazole transdermal gel to be applied on the ear pinna 7 ; and • Changing a prednisolone tablet into an oral suspension. Combine multiple drugs into one product Complicated drug regimens can sometimes be compounded into combined formulations to decrease pill burden, liquid burden, and/or the amount to be applied. Combining multiple medications into one capsule while still retaining pharmacokinetic efficacy is possible. Multiple liquids can be combined to decrease the volume given and increase ease of administration. Find elusive medications Compounding pharmacies can help source and dispense difficult-to-find medications or excipients. For example, if a veterinarian is looking for a backordered medication, a compounding pharmacy may be able to compound them during times of inaccessibility or help a provider find a reputable source. What cannot be compounded Compounding offers near-endless creativity to find patient- specific options and continues to hold a crucial role in veterinary care. However, it is not meant to create a direct mimic of a commercial product with dose, formulation, or route. Precisely what can and cannot be compounded in veterinary medicine is currently controversial and unclear; this will be discussed in a future article in this series focusing on compounding rules and regulations. Clinicians should carefully research potential compounding pharmacies to ensure their staff is trained to serve veterinary patients.

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