17 May Palliative Care Compounding
Palliative care compounding is used in cases where the goal is to manage patient symptoms and improve the quality of life for patients with terminal illnesses. Compounded medications are used to control symptoms and the medications are customized for each individual patient. Compounding is used in hospice and palliative care because some patients need customized treatments for their specific pain conditions and chronic illnesses, and there may not be an adequate commercial medication for these patients. A wide range of symptoms can be treated with palliative compounding, and the patient’s physician creates and prescribes the compounded medication based on need. The goal for hospice care is always to improve the quality of life for the patients as much as possible, and compounded medications accomplish this quite well.
Customized compounded medications can improve patient outcomes, treat symptoms such as nausea, reduce the side effects of other medications, and reduce discomfort and stress levels. Compounded medications may be used as a first line treatment or when commercial treatments fail. There may be several other circumstances where a compounded medication is used in hospice care, such as when a commercial medication has been discontinued but is still needed, when patients need to have a customized dosage or new route of administration, when the patients have allergies to an ingredient in commercial medications, and when patients require multiple medications to be combined into one medication for easier or simpler administration. In each of these circumstances compounded medications are useful, and so they serve a wide range of purposes in the hospice setting.
Medications used for palliative care
A wide range of medications are used in palliative care that are regularly compounded. Compounded treatments are used for wound management and care, nausea control, dry mouth therapy, upper airway infection management, pain management, and chemotherapy mucositis and radioation proctitis. Below is a brief detailed description of the types of compounded medications regularly used for each of these treatment areas:
- Dry mouth therapy – several different agents can be compounded for customized dry mouth treatments. Patients who are receiving chemotherapy may experience dry mouth, as well as other patients. Compounded medications can combat mouth infections, reduce pain and reduce the symptoms of mucositis that results from chemotherapy. A mouthwash with sodium bicarbonate, lidocaine, and diphelyhydramine may be used to treat chemotherapy related mucositis. Loss of saliva can be treated with pilocarpine or other medications.
- Anti-secretory drugs – upper airway secretions is a problem for 50% of terminally ill patients and drugs such as atropine and scopolamine are used to control excess saliva secretions. Other patients in a hospice setting may have drooling, particularly neurologically impaired patients, and although there are no specific drugs used to treat drooling, agents such as scopolamine can be used with some success.
- Wound care drugs – customized treatments can be useful for the treatment and management of wounds in a hospice setting. Patients experience wounds from chronic infections, diabetic ulcers, bedsores, and other wounds that may be susceptible to infections and difficult to treat. Compounded medications can combine several ingredients to create creams or other topical compounds to treat the symptoms of wounds. Compounded medications are particularly useful for wound treatments because the type of compound can be carefully selected, whether it is a gel, ointment, cream or other compound, and it can include several different ingredients as each patient needs. Wounds that need to be irrigated regularly may need to be treated with a gel, because gels are easier to rinse off for instance. Phenytoin can be used to increase the healing of ulcers of several types, traumatic wounds, burns, skin donor sites, and several other types of wounds. Ibuprofen or ketoprofen can be added into compounds to reduce pain and inflammation, and work better than oral anti-inflammatories. Also, topical anesthetics can be added into these compounds to control pain.
- Antiemetics – anti emetics are used to control nausea, and these medications are very important in a hospice setting because many patients experience nausea as a side effect of chemotherapy and other treatments. Persistent nausea can be controlled with oral medications, gels, lozenges and other medications based on the patient’s needs and ability to tolerate the method of administration. Promethazine is one common medication that is compounded in various different formats and it can be compounded into a gel to treat vomiting and nausea. Metoclopramide can reduce the number of instances of vomiting without major side effects. Other medications that may be used to treat nausea include haloperidol, metoclopramide, diphenhydramine, and several others.
Quality palliative care depends on compounded medications
Compounded medications serve the goals of palliative care very well because they are customized therapies that can treat a wide range of different illnesses and symptoms as mentioned above. Commercial medications often fall short in the hospice setting because they may only have one active ingredient when multiple ingredients can be much more effective. Also, many times patients can only receive medications a few times per day, and compounded medications improve the efficiency of medication administration by reducing the number of medications that each patient has to take. Compounded medications can treat many of the side effects of chemotherapy and other treatments that are regularly given to terminally ill patients, and they can substantially improve quality of life.
Physicians or other medical professionals who can prescribe medications who are interested in using a compounding pharmacy should be sure to work with a licensed pharmacy with the proper equipment to safely create compounded medications. At Absolute Pharmacy we offer a ISO class 6 cleanroom and ISO class 5 hoods per USP <797> and licensed pharmacists who can create a wide range of customized compounded medications for palliative care. We use state of the art equipment to carefully measure out your compounded medications, and we guarantee the purity and safety of all of our compounded medications. We can answer any questions that you may have about compounded treatments for palliative care, and if you are interested in signing up as a medical provider at our compounding pharmacy, get more information here.