Compounding, explained

Clomiphene citrate is a racemic mixture of two isomers, and enclomiphene is the trans-isomer on its own. Here is what that composition difference means, why enclomiphene is compounded, and how both compare to testosterone therapy.

Estriol is the weakest of the body's three estrogens and has no FDA-approved US product, while estradiol is the most potent and is sold in FDA-approved forms. Here is what each name means, how vaginal and skin creams differ, and where compounded Bi-Est fits.

Ondansetron blocks serotonin 5-HT3 receptors in the gut and the brain's vomiting center, and it is FDA-approved to help prevent nausea from chemotherapy, radiation, and surgery. Here is how it works, its main warnings, and the manufactured and compounded forms, including suppositories.

Cholestyramine ointment is a compounded preparation of a bile acid binder, ordered off-label for diaper-area, perianal, and peristomal skin irritation. Here is what it contains, the zinc oxide combinations, and how thin the evidence is.

Clobetasol propionate is a superpotent steroid described as standard treatment for genital lichen sclerosus. Here is what its label limits mean for vulvar use, and which ointment, gel, suppository, and mouth forms are compounded.

Numbing cream sold without a prescription is limited to 4% lidocaine, and the FDA has warned consumers about high-strength products marketed for tattooing and laser work. This post describes what compounded BLT numbing cream contains, how prescribers write directions for it, and why it is dispensed only on a prescription.

Methimazole is an antithyroid medication veterinarians prescribe for hyperthyroidism in cats, and an FDA-approved tablet already exists. This post explains what the compounded transdermal ear gel and flavored oral liquid are, how the gel is applied, and how to handle it safely at home.

The published seven-class topical corticosteroid potency chart, given twice: once by class and once sorted by molecule for lookup. Then what the vehicle changes, why a compounded strength has no class, and the triamcinolone and fluocinonide preparations Bayview compounds on a prescriber's order.

Bayview compounds Trimix, Bimix and Quadmix as intracavernosal preparations in 2.5 mL multi-dose vials, at the concentration a prescriber orders. This provider guide sets out the actives, the published concentration ranges, what a prescription or e-prescribe entry needs to contain, the cash prices, and the priapism language carried on the formulation pages.

Diltiazem for an anal fissure is compounded as a 2% rectal ointment or a 2% gel, the form often called diltigel, because there is no FDA-approved topical or rectal diltiazem product in the United States. This explainer covers what the preparation contains, how the two bases differ, what published guidelines report about topical calcium channel blockers, and what it costs.

A compounding pharmacy prepares a medication from individual ingredients on a prescriber's written order, in the strength, dose form and ingredient list that prescriber specified, rather than dispensing a finished manufactured product. This explainer covers what compounding is, why a prescriber writes for it, what a compounding pharmacy is not allowed to do, and how a compounded prescription is ordered and paid for.

A prescriber-facing guide to low dose naltrexone: available strengths and forms, the titration ranges reported in the literature, perioperative and monitoring considerations, and how to write the order. It reproduces what the published trials found, including the negative ones.

A troche is a compounded, prescription lozenge that dissolves slowly in the mouth rather than being swallowed whole. This guide covers what troches are made of, buccal versus sublingual placement, how to take one, storage, and what compounded troches cost.

Tacrolimus ointment carries a high price because it launched as a brand, generic competition arrived late and stayed thin, the active ingredient is costly, and insurers tier it behind prior authorization. Compounded tacrolimus is not a cheaper copy of the ointment: it is prepared on a prescriber's order in ear, rectal, gel, foam, and scalp forms no manufacturer makes.

Topical testosterone for women is described in the literature as applied to the inner thigh, lower abdomen, upper arm or shoulder, or buttocks, with sites rotated and covered to avoid transfer. This post covers application technique, what the 2019 Global Consensus Position Statement concluded, and the compounded cream, gel, troche, and tablet strengths Bayview prepares on a prescription.

Compounded creams are built from three parts a prescriber specifies: the active ingredients, the base that carries them, and the strength of each. This guide covers the common bases, the actives that go into pain cream formulas, what the published literature reports, and how strengths compare with over-the-counter and FDA-approved products.

Compounded medications for dogs and cats exist because doses land between commercial sizes, animals refuse tablets, and some drugs have no approved animal product at all. This page covers the forms Bayview prepares, how a veterinarian sends the order, what it costs, and what "near me" means for a pharmacy that ships.

Naltrexone blocks opioid receptors, so opioid pain medicines, opioid-containing cough and antidiarrheal products, and any procedure that may need opioid analgesia all require a conversation with your prescriber. This explainer covers reported side effects at low doses, what the literature says about stopping, and how the compounded strengths compare to the FDA-approved 50 mg tablet.

A plain answer to the questions patients ask about compounded trimix injection: what is in it, the injection steps a prescriber teaches, what "units" on an insulin syringe mean, how it is stored, and what it costs. Dose, maximum, and strength are prescriber decisions, and this post explains the terms rather than recommending numbers.

The dermatology literature describes hydroquinone courses of several weeks to a few months, with the AAD noting melasma improvement usually takes three to twelve months, and cycles of about 8 to 12 weeks followed by a break. This post explains tyrosinase inhibition, the 2020 removal of OTC hydroquinone, the Kligman-type combination with tretinoin, and how compounded blends are made to a prescriber's percentages.

503A compounding pharmacies prepare medications for individual patients on a prescription and answer to state boards of pharmacy; 503B outsourcing facilities register with the FDA and batch preparations for clinics without patient names. This explainer covers which one fills your prescription, how to verify a pharmacy's license, and what "not FDA-approved" means for each.

Most compounded prescriptions are paid out of pocket because a preparation made for one patient carries no national drug code for a plan to price against. What that means in practice, what drives the price, what real preparations start at, and how HSA and FSA cards fit in.

Searching for a compounding pharmacy near you turns up whoever is closest, which is not the same as whoever can make what you were prescribed. What to check before you choose one, what 503A and the USP chapters mean, and when a licensed mail-order compounder is the better answer.

Naltrexone is manufactured only as a 50 mg tablet, so the 1-9 mg doses prescribed as LDN are prepared by a compounding pharmacy against a prescription. Here are the strengths and forms Bayview compounds, what they cost, how to get a prescription sent, and where we can ship.

Learn about the basics of nutrition and how you can implement it in your diet.

Topical minoxidil 2% and 5% are already sold as FDA-approved over-the-counter products, so compounding is reserved for strengths, vehicles and combinations no manufacturer sells. What a compounded minoxidil preparation is, and why dose and suitability are the prescriber's decisions.

What benzocaine, lidocaine and tetracaine each contribute, why BLT requires a prescription, and the FDA guidance on applying high-strength numbing products.

What the three ingredients in all-purpose nipple ointment do, why it is compounded and prescription-only, and why persistent nipple pain is worth having evaluated.

What ketamine is, how compounded nasal spray differs from the FDA-approved esketamine product, and the risks the FDA identified in its 2022 alert.

What low-dose naltrexone is, the proposed mechanisms behind it, and what the small trials, open-label studies and case series do and do not show. Every use at these doses is off-label, and it is compounded against an individual prescription.

How nail fungus is diagnosed, what oral and topical antifungals achieve in trials, where compounded preparations fit, and realistic timelines.

Most TMJ disorders settle with conservative care first. What that care involves, where compounded topical preparations fit alongside it, and the red flags that mean the jaw is not the problem.

The five reasons a dermatologist orders a compounded preparation, what compounding cannot do, how vehicles change a drug's behavior, and the safety points that matter.

What low-dose atropine is used for in childhood myopia, what the trials have and have not settled, and why this is entirely an eye doctor's decision.

Topical creams, troches and low-dose naltrexone: what each preparation contains, and what compounding can and cannot do. None of it is a decision a pharmacy makes rather than a prescriber.

Read about hormone replacement therapy, and the treatment options available.

Clomiphene citrate is FDA-approved for ovulation induction in women, so a prescription written for a man with low serum testosterone is off-label. How it acts on the pituitary signal, and what a prescriber weighs before writing one.

What testosterone therapy in women is supported by evidence, what it is not, and how it is dosed, monitored, and regulated.

A rectal rocket is a compounded multi-ingredient suppository molded with a flared end, so part of it sits inside the anal canal and part rests against the perianal skin. No FDA-approved product uses this design, so every ingredient and strength is set by the prescriber who writes the order.

Federal law limits when a compounding pharmacy may prepare a drug that is commercially available, and those limits turn on FDA's shortage list rather than on empty shelves. This page walks through where those lines fall, using the 2022 pediatric ibuprofen and acetaminophen scarcity as a worked example.

What the evidence does and does not support for vitamin C, vitamin D, zinc, echinacea, elderberry and probiotics. Where the literature is thin, and where a supplement can interact with a prescription.

What alveolar osteitis is, why it follows some extractions and not others, what goes into a medicated socket dressing, and what the evidence behind those components does and does not show.

What TRT is, the forms it comes in, the risks and monitoring involved, and why a diagnosis based on repeat morning testosterone testing comes first.

Oxytocin is FDA-approved only as an injectable used in hospital obstetric care, so compounded troches and nasal sprays are off-label preparations. This page covers what the preparation is, what the published literature reports, and what remains unsettled.

What epimedium is, how it differs in law and in evidence from sildenafil, and the FDA's documented problem with adulterated sexual enhancement supplements.

How sildenafil works, its history, dosing, the interactions that matter (nitrates above all), and where compounding does and does not fit.

Palliative care is specialized medical care for people living with a serious illness, directed at controlling symptoms rather than curing the disease. Where compounding enters, and the kinds of preparations a palliative or hospice prescriber may order.

Learn about five easy ways to get started with exercise.

A sublingual dose dissolves under the tongue and crosses the lining of the mouth into the bloodstream without passing through the stomach and liver first. What that route changes, and which compounded forms are prepared for it.

In this post, we'll discuss the difference between a compounding pharmacy and a retail pharmacy.