Many people are sensitive to dyes or preservatives and may need a lighter strength than usually prescribed. With a physician's consent, our pharmacists are able to change the strength of a medication, alter its form and make it easier for the patient to ingest.

Americanameds has pharmacists that specialize in compounding medications who are available to work with you and your physician to help determine the form of medication that best fits your individual needs. For humans it may be transdermal gel, topical cream, liquid and lozenges. For children it may be lollipops and gummy bears. For pets it may be chewable tablets.

Compounding is ideal for any patient requiring unique dosage forms and it can be done with nearly any kind of prescription medication.

The following compounding applications are currently available through Americanameds

• Bio-Identical Hormone Replacement Therapy
• Veterinary
• Hospice
• Pediatric
• Chronic Pain Management

• Capsules - Many medications may be formulated into capsule form.
• Lozenge - An advantage of this option is the direct absorption of a medication by your body.
• Creams - While primarily used for the treatment of skin problems, many other medications, especially natural hormones, can be compounded into a cream or gel and applied topically to give good therapeutic results.
• Flavoring - A wide variety of natural flavors are available to help conceal drug taste. This is especially useful in the treatment of children and in veterinary medications. Flavors can be directed to adults, kids and animals.

Call us at 1-800-469-0955 for more information or fill out the form below to tell us more about your compounding needs and how we can help you. We will have one of our specialized customer service representatives contact you as soon as possible to help meet your needs and determine pricing of the medication.

Bio-Identical vs. Non-Bio-Identical Hormones
Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The term "bio-identical" does not indicate the source of the hormone, but rather refers to the chemical structure. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. Bio-identical hormones are able to follow normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy.

There are significant differences between hormones that are natural to humans (bio-identical) and non-bio-identical (including horse) preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer. A patented drug can be profitable to mass produce, and therefore a drug company can afford to fund research as to the medication's use and effectiveness. However, bio-identical substances can not be patented, so scientific studies are less numerous on natural hormones, because medical research is usually funded by drug companies. Structural differences that exist between bio-identical human, and non-bio-identical synthetic and animal hormones may be responsible for side effects that are experienced when non-bio-identical hormones are used for replacement therapy.

Bio-identical hormones include estrone (E1), estradiol (E2), estriol (E3), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone. Our compounding specialists work together with patients and prescribers to provide customized bio-identical hormone replacement therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman's specific needs. Hormone replacement therapy should be initiated carefully after a woman's medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and medication adjustments are essential.

Confusing Research
The findings of numerous studies on hormone replacement therapy (HRT) conflict and, as a result, have raised serious questions regarding the appropriateness of HRT. Hormone replacement is an approved therapy for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Numerous studies have confirmed that estrogen replacement decreases the risk of colon cancer, estrogen and progesterone decrease fracture risk, and various hormones increase energy levels and enhance libido. Reputable sources offer conflicting reports regarding issues such as memory, Alzheimer's disease, and stroke.

With the exception of the Postmenopausal Estrogen/Progestin Intervention (PEPI) study, major studies have either failed to distinguish among types and dosages of HRT used in the study, or examined only the use of synthetic HRT preparations (as in the case of the Women's Health Initiative). The Women's Health Initiative (WHI) study was designed to identify the potential risks and benefits of HRT. The estrogen-progestin portion of the clinical trial was stopped in 2002 after results showed that a synthetic hormone combination containing conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) increased the women's risks of developing invasive breast cancer, heart disease, stroke, and pulmonary embolism. The data and safety monitoring board concluded that the risks outweighed the evidence of benefit for fractures and colon cancer. Utilizing data from the WHI, researchers later concluded that synthetic CEE plus MPA does not improve mental functioning and may increase the risk of dementia in women over age 65. They suggest these hormones increase the risk of stroke, which is known to increase the risk of dementia. With regard to the risk of dementia, typical HRT users are in their 50s and the WHI study focused on women aged 65 and over, who have a higher risk for dementia. The "estrogen-only" portion of the WHI study was halted in March 2004 after analysis of data suggested that synthetic CEE alone had no impact either way on heart disease (the main focus of the study), but may increase the risk of stroke.

Many patients and medical professionals are unaware of the availability of bio-identical alternatives. In reality, women's experiences and clinical outcomes of HRT differ vastly depending on the dose, dosage form, and route of administration, and most importantly, whether the hormones are synthetic or bio-identical. As a result of concerns and doubts generated by studies that use synthetic hormones, many women who could substantially benefit from bio-identical hormone replacement may never have the opportunity.

Published research delineating the differences between natural bio-identical and synthetic HRT is now more abundant, but studies of bio-identical HRT will probably never be as plentiful as those dealing with patented synthetic hormones. Our pharmacy welcomes your questions.

Estrogens
Estrogens actually refers to a group of related hormones, each with a unique profile of activity. Under normal circumstances, a woman's circulating estrogen levels fluctuate based on her menstrual cycle. For Hormone Replacement Therapy, these hormones are often prescribed in combination to re-establish a normal physiologic balance. The three main estrogens produced in female humans are:

• Estrone -E1- (10-20% of circulating estrogens) is the primary estrogen produced after menopause.
• Estradiol -E2- (10-30% of circulating estrogens) is the most potent and major secretory product of the ovary, and the predominant estrogen produced before menopause.
• Estriol -E3- (60-80% of circulating estrogens) causes little or no buildup of the endometrium, and is very effective in alleviating vaginal and urinary symptoms in postmenopausal women. Estriol is produced in very large amounts during pregnancy. High levels of estriol are found in vegetarians and Asian women, who have a much lower incidence of breast cancer.

Progesterone
Progesterone is a term that is incorrectly used interchangeably to describe both natural bio-identical progesterone and synthetic non- bio-identical derivatives. Synthetic progestins (also called progestogens or progestational agents) are analogues of bio-identical progesterone, and have been developed because they are patentable, more potent, and have a longer duration. Medroxyprogesterone acetate, the most commonly used synthetic progestin, was shown in a large study to cause significant lowering of HDL "good" cholesterol, thereby decreasing the cardioprotective benefit of estrogen therapy. Bio-identical progesterone has not been reported to produce any serious side effects when administered in physiologic doses. However, progestins can have significant and serious side effects at typical doses, including migraine headache, weight gain, mood swings, depression, irritability, acne, menstrual irregularities, and fluid retention. These side effects are a frequent cause for discontinuation of HRT. Only about 20% of women who start synthetic HRT remain on it two years later.

Progesterone:

• is commonly prescribed for perimenopausal women to counteract "estrogen dominance" which occurs when a woman produces smaller amounts of progesterone than normal relative to estrogen levels.
• alone, or combined with estrogen, may improve Bone Mineral Density.
• minimizes the risk of endometrial cancer in women who are receiving estrogen.
• is preferred by women who had previously taken synthetic progestins.
• may enhance the beneficial effect of estrogen on lipid and cholesterol profiles and exercise-induced myocardial ischemia in postmenopausal women (in contrast to medroxyprogesterone acetate).

The benefits of progesterone are not limited to prevention of endometrial cancer in women who are receiving estrogen replacement. Progesterone therapy is not only needed by women who have an "intact uterus", but is also valuable for women who have had a hysterectomy. Vasomotor flushing is the most bothersome complaint of menopause, and is the most common reason women seek HRT and remain compliant. For over 40 years, estrogens have been the mainstay of treatment of hot flashes, but transdermal progesterone cream may be effective as well. Women who have had postpartum depression once have about a 68% chance of having it again after another pregnancy, but trials using prophylactic progesterone have shown that it is possible to reduce the recurrence rate to 7%. Other benefits include improved bone density and enhanced glucose utilization.

Androgens
Androgens are hormones that are important to the integrity of skin, muscle, and bone in both males and females, and have an important role in maintaining libido. Declines in serum testosterone are associated with hysterectomy, menopause, and age-related gender-independent decreases in DHEA and DHEA-sulfate. DHEA (dehydroepiandrosterone) is an androgen precursor from which the body can derive testosterone. After menopause, a woman's ovaries continue to produce androgens; however, the majority of the androgens produced in the female body, even before menopause, come from peripheral conversion of DHEA. As the body ages, production of DHEA declines so that by the time a woman goes through menopause, the production of DHEA is often inadequate. Additionally, ERT may cause relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement. Recently, attention has turned to the addition of the androgens to a woman's HRT regimen in order to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes.

Androgens, such as testosterone and DHEA: (WE CANNOT SHIP)

• enhance libido.
• enhance bone building (increase calcium retention).
• provide cardiovascular protection (lower cholesterol).
• improve energy level and mental alertness.

PEDIATRICS

We work together with prescribers, children, and their families to customize medications and meet specific needs.

Children pose many challenges when it comes to medication: they may resist having to take a medication, dislike the taste or texture, have difficulty swallowing solid dosage forms, and are fearful of injections.

The limited pediatric market for most drugs may be the leading reason for the lack of investment in drug development for this population by the pharmaceutical industry. Most medications are not labeled for pediatric populations, and when a medication is not approved for use in infants and children, it usually is not available in a suitable pediatric dosage form. Fortunately, our compounding pharmacy is able to help. We can compound oral medications into pleasantly flavored suspensions, solutions, concentrates, freezerpops, "gummy bears" or lozenges, in colors that entice the child to take the medication. A palatable formulation is more likely to improve compliance and minimize spillage or waste during administration. Lollipops are an ideal alternative to "swish and swallow" medications that need to be retained in the mouth for a prolonged period of time. Most drugs can be compounded into transdermal gels that can easily be applied to an appropriate site, such as the child's wrist, for absorption through the skin.

Professional compounding is not just diluting existing medications, or mixing powders with bases. We must consider physical and chemical properties of each active and inactive ingredient in order to prepare an effective and safe customized medication with the desired taste, color, fragrance, viscosity, uniformity, texture, and stability. The efficacy of any compounded medication is influenced by the technique and equipment used in preparing the formulation, the purity and quality of the ingredients, choice of vehicle (base), and proper use of additives such as penetration enhancers

VET

Pharmacists Helping Vets and Pets

Our "specialty service should not be viewed as competition with local veterinarians; rather, compounding allows veterinarians to broaden their prescribing abilities and to offer [dosage] forms that are patient-specific in strength and formulation. Therefore, the goal of compounding for the veterinary patient is to enhance the veterinarian's ability to treat patients in a more effective and efficient manner...

"Compounding can make medicating animals easier if the pharmacist prepares flavored chews that animals accept readily. For example, tranquilizing a feral cat with a liver-flavored chew eliminates the possibility of over- or underdosing. If a chew contains 10mg acepromazine and the dose fails to gain a response, a second flavored chew can be given to the animal. Furthermore, the amount of medication incorporated into the chews, capsules, [topical or transdermal], or liquid preparations can be formulated to the specific request of the veterinarian, thereby eliminating the need to cut-up tablets and divide the contents of commercially prepared capsules... As manufacturers decide that certain products are no longer economically rewarding to market, the list of commercially prepared veterinary medication becomes smaller. At present, the armamentarium of medications available for animals is less than perfect. Cherry-flavored amoxicillin or orange-flavored cephalexin may not be [appealing to a cat or monkey]..."

Veterinary Forum October 2002, (pp. 62-65)

Our compounding pharmacy can prepare:
Flavored medication
Medicine in ideal size, strength, and dosage form
Unavailable medications
Combinations to improve compliance
Novel Devices and Delivery Systems

Compounding is actually a means to an end. We work together with veterinarians and their clients and patients to solve medication problems by compounding specialized medications that meet the unique needs of each animal - pets, exotics, horses, or zoo animals. Let us know how we can help you and the animals in your care.