Brandon Knott, PharmD

Of Cascade Specialty Pharmacy in Poulsbo, Washington
 

Years in Compounding: 16
 

Path to Compounding: Interestingly, I had a negative perception of pharmacy until I was in college. It began to shift when I became acquainted with a few faculty members at the college of pharmacy. After I got to know them, my viewpoint of pharmacy began to broaden. Specifically, I began to see outside of the traditional roles pharmacists fill in the health care system—that, in fact, there were also entrepreneurs and business owners who have an opportunity to drive health care, whether it be in pharmaceuticals, nutritional supplements, health care administration, etc. It was then I realized my desire to pursue a career in the field of pharmacy.
 

I first learned about compounding during multiple internships when I was in college. I worked at an independent pharmacy making penile injections and then at a respiratory pharmacy where we were producing compounded respiratory medications. I chuckle now as I reflect back on these valuable experiences.
 

I also attended a PCCA student training program that ironically intimidated me because I didn’t feel like I had the creativity to be a compounding pharmacist. As I reflect back, I realize that it’s not the knowledge and creativity that makes a great compounding pharmacist. It’s the desire to serve people and work with them and others to come up with a solution.
 

When I finished school, my first job was in Critical Care and Pediatrics at the University of Florida. This experience gave me an introduction to sterile and non-sterile compounding as well as the confidence I needed to expand into my future career.
 

What I enjoy about compounding is the connection I have between the products that I make and the patients who receive them. It’s very personal.
 

Favorite Formulas:

PCCA Formula #9279 (PCCA members can access this formula here.)

Using stock solutions has helped us with our compounding efficiency by reducing the time it takes to weigh powders, decreasing milling time, and reducing equipment to clean.
 

PCCA Formula #9382 – Topical in PCCA Lipoderm^® (PCCA members can access this formula here.)

Back before the pain-cream craze, a favorite formula of mine was a combination of ketoprofen and ketamine. I used this combination for a patient who had had a knee replacement and couldn’t get through rehab. Oral meds gave her too many side effects and impaired her ability to function. This combination got her through.
 

Success Stories: A long-term hormone patient whom I had known for several years had come down with multiple sclerosis. She was declining very fast, to the point where she needed to use a wheelchair and her countenance had completely diminished. I made the time to talk to her one day, and she shared what was going on and all that she had tried for the MS.
 

During our conversation, I recommended that she consider low-dose naltrexone (LDN). She had exhausted most of the traditional drugs her doctor had encouraged her to use, so the timing was right. We worked with her doctor, who reviewed literature on the subject and then wrote her a prescription for a compounded LDN medication. I’ll make a long story short. After using LDN for six months, she had dramatic improvement, which included ditching the wheelchair. It warms my heart each time I see her, and she gives me a hug. I remind her that I didn’t do much other than suggest she give something new a try.

We have also been treating chronic regional sinusitis with polyps using steroid rinses for many years. I recall a patient calling some years ago thanking me for the miracle drug we had made for him. I was quite taken aback by his excitement because I was thinking that he felt better simply because he could breathe better.

What he went on to tell me, though, was that he had forgotten what food tasted like. His sense of smell had been suppressed for many years by the disease process, and he had unknowingly lost most of his sense of taste as well. After using the steroid rinses for a few months, his sense of smell had returned. He had rediscovered his sense of taste, and for that, he is forever grateful.
 

Advice for New Compounders: Be passionate about helping people, and teach your team to do the same. 

Don’t talk about what your competition is doing because you really don’t know what they are doing. Focus on what you do—your quality controls, your research, your formulations, your customer-centered values, etc. A PCCA consultant taught me that early on in my career, and it has stuck with me.

The views and therapies expressed in the above article are those of the interviewee and may not be endorsed by PCCA. The statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment. Every patient is unique, and formulas should be adjusted to meet their individual needs.

Cascade Specialty Pharmacy is owned by Brandon Knott, PharmD.