Compounding pharmacies can alter the medications prescribed to you for more convenient use. They can add flavouring, change colouring, and create a different delivery method for your drugs. Of the pill, liquid, inhaler and other medicinal delivery methods, one of the most versatile is the capsule. It consists of two gel half-pieces of a whole pill that are filled with the drug and then merged. Encapsulation by your compounding pharmacist can have its advantages. There are, however, disadvantages that could harm your health.
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Altering Capsules to Help
Encapsulation enables a pharmacist to very easily alter the quantity of the drug contained in a capsule of medicine so that it meets the dosage and delivery specifications of the prescription. The pharmacist can lower a dose or increase it by simply opening the capsule and adding or removing some of the drug. By altering the size of the capsule used, the pharmacist can also dictate how much of the medicine is delivered over a certain period of time. For patients who cannot handle the size of a capsule or those who need the effects altered during certain times of day, the ability to alter quantities is an advantage of encapsulation in pharmacies.
Errors in Alterations
Altering drugs from their manufactured form during encapsulation opens the patient receiving the drug to a dose that is too high or too low. This can and does occur despite the pharmacist's knowledge, because of an incorrect measurement, uncalibrated tools or another human error. The U.S. Food and Drug Administration's 2006 Limited Survey of Compounded Drug Products estimated that the potency of the encapsulated drug can vary from 67 per cent to 268 per cent from the intended dosage. This can be a dangerous variance for the drug's user.
Advantage of Fillers
Drug potency dictates how much of the drug goes into the capsule. Each capsule must be filled to an appropriate weight. For this, compounding physicians and drug manufacturers use fillers. These placebo substances are made of lactose, acidophilous bacteria, cellulose and calcium carbonate. These fillers do not affect how the medication works and are used by the body. The calcium carbonate filler, for example, helps your bones and teeth. Patients can actually help their nutritional intake while taking their medicine.
Fillers have their disadvantages. Lactose-intolerant patients can experience digestive discomfort from taking a capsule containing lactose filler. The calcium carbonate filler can also cause medical issues for patients with kidney stones, cancer and other illnesses. The calcium can even cause digestive discomfort in otherwise healthy patients. Fillers can alter the active ingredients in the capsule if it is incorrectly filled.
The Overcapsulation Argument
Altering the capsule during encapsulation can lead to issues in absorbing the medication. Called "over-encapsulation," the use of a capsule that is too large or small can cause too much or too little medication to release at one time. Some compounding pharmacists have figured out how to use encapsulation to advantage to strengthen a capsule that is otherwise too weak to accurately deliver a potent drug.
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- "U.S. Food and Drug Administration"; 2006 Limited FDA Survey of Compounded Drug Products
- "The Compounding Pharmacy"; Robert P.Goldman
- "Drug Development and Delivery"; Influence of Fillers, Compression Force, Film Coatings & Storage Conditions on Performance of Hypromellose Matrices
- "Pharm Tech"; The Effect of Overencapsulation on Disintegration and Dissolution