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Thursday, 06 November 2014 18:32

Customized compound medications and disease management can increase positive outcomes in patients experiencing resistance to traditional therapeutic interventions

1st Annual PCCA Poster Competition, Compounding Innovation at the International Seminar, Houston, USA (3 – 6 October 2014), Poster Presentation Finalist

By Roderick G. Peters, BScPharm, RPh; Terri L. Peters, BScPharm, RPh; Linval Matthews, PharmD Candidate; and Ayube Ally, PharmD Candidate, of Quality of Life Pharmacy 8900 Edgeworth Drive Capitol Heights, Maryland


The practice of Compounding Pharmacy coupled with Medication Therapy Management (MTM) tools, such as Medication Therapy Reviews, Pharmacotherapy consults and Disease management coaching support offers the opportunity to assess, personalize patient care, and improve patient outcomes.


A 57-year-old white female was referred to the pharmacy for a consult from her primary care physician. The patient was treated for extreme fatigue, osteoarthritis, Irritable Bowel Syndrome (IBS), chronic constipation, migraines, fibromyalgia, and a foggy mind. MTM consultation showed that the patient was taking 10 medications including: Tramadol, Levothyroxine, Lidocaine patches, Elavil, Lyrica, Protonix, Zofran and Levsin. She was also taking traditional hormone replacement therapy (HRT) subsequent to a hysterectomy. The patient had been taking these medications for six years with only minimal therapeutic improvement and also experienced a wealth of side effects from the HRT, so it was discontinued. The Physician restarted the patients HRT therapy with Bio-Identical hormones (BHRT) Biest and Progesterone. The patient was given a saliva test kit to quantify her symptoms and to assess lab values to improve our ability to assess her hormonal and therapeutic needs. The following results were observed: depleted estrogen, progesterone, and cortisol reserves; food sensitivities to soy, egg, dairy, and gluten. A care plan was implemented to address the test results and involved: new BHRT dosing, DHEA to address cortisol depletion, and dietary changes to address food sensitivities. The care plan was forwarded to the physician for review and prescriptions were written accordingly.


The patient followed the care plan and is now pain free, no IBS, constipation, fatigue, or migraines. Current medications now include Elavil and BHRT to support menopausal symptoms.


The results indicate how patients can benefit from patient specific compounding and MTM consultations in an area that is normally outside the scope of a regular physician or pharmacist’s practice.