THE PCCA BLOG

Building Stronger Veterinary Connections: Marketing Strategies for Compounding Pharmacies

Wed, 13 Aug 2025 15:06:00 GMT

by Mark Gonzalez, PharmD, PCCA Clinical Compounding Pharmacist

As compounding pharmacists, we’re used to juggling complex responsibilities — solving medication challenges with creativity, staying up to date with evolving science and technology, responding promptly to patients and prescribers, and carrying ourselves with professionalism in all situations. But there's one more responsibility that’s just as critical, yet often underutilized: marketing. Marketing is more than selling a product or service — it’s about building relationships. For compounding pharmacies looking to grow their veterinary services, effective marketing can make the difference between staying invisible or becoming indispensable.

Rethinking Marketing: Relationships Over Revenue

Some define marketing as advertising and sales. But for compounders, a more fitting definition might be this: “the pursuit, establishment and nurturing of relationships between a business and its customers.” Just like compounding itself, marketing is personal. The truth is, no matter how exceptional your service is, if veterinarians and pet owners don’t know you exist — or don’t understand what you offer — your efforts may go unnoticed. That’s why investing in relationship-driven marketing is essential to your success.

Veterinary Compounding: A Crowded and Competitive Space

The veterinary compounding niche is competitive, and many pharmacists find it challenging to break in. National players dominate with broad offerings and low prices, making it difficult for local compounders to stand out — unless they market themselves strategically. Thankfully, there are proven, real-world strategies you can adopt — not theoretical ideas, but battle-tested, cost-effective tactics that build long-term partnerships with veterinary clinics and pet owners. Let’s explore how innovation, education, responsiveness and professionalism — four values we already live by — can be harnessed for impactful marketing.

Innovative Marketing: Be Memorable

Great marketing, like great compounding, is all about creativity. Most veterinary offices are flooded with generic brochures and long lists of formulations. That’s why it pays to be different. One of the most successful veterinary marketing campaigns I’ve used involved something delightfully simple: a homemade brownie board. Here’s how it worked: I engraved my pharmacy’s contact information onto a 12x18 wooden cutting board, stacked it with homemade brownies and dropped it off at veterinary offices. Each board came with a standing invitation — call me for a brownie refill and get a quick update on the “Veterinary Concept of the Month.” It was a hit. The staff started calling me — not the other way around. It turned cold calls into warm conversations. And best of all, it cost very little. The takeaway? Good food and creative thinking can be a powerful gateway to meaningful relationships.

Educational Marketing: Empower Pet Owners

Your target audience isn’t just veterinarians — it’s also pet owners. They are, after all, the ones giving medications at home, and their experience can make or break treatment outcomes. Hosting an in-store or community seminar is a great way to connect. Use the opportunity to educate families on the basics of medicating pets: how species differ, what dosage forms are available and tips for handling picky patients. These events don’t have to be elaborate — just an hour of your time can deliver significant impact. An informed pet owner is more likely to return to your pharmacy and recommend your services. Education builds trust, and trust builds loyalty.

Responsive Marketing: Be the Local Lifeline

One area where local compounders have a natural advantage over national competitors is responsiveness. While large multistate veterinary compounders often offer attractive pricing, they may struggle with turnaround time and shipping costs. That’s where you step in. Market your pharmacy as a fast, responsive, locally rooted alternative. Emphasize your ability to provide same-day or next-day service, consult directly with the veterinarian and tailor compounds to the patients’ needs — without the wait. Even if you don’t get every order, you’ll become the go-to provider when time is critical or when a personal touch is needed.

Professional Marketing: Lead With Compassion

Marketing doesn’t always look like a pitch. Sometimes, it looks like a kind gesture. One of the most impactful forms of outreach I’ve seen is also one of the simplest: sending a handwritten sympathy card when a pet passes away. A custom memorial plaque with the pet’s name and photo can mean the world to a grieving family. These moments of compassion don’t go unnoticed. They show your pharmacy isn’t just a business — it’s part of the community. And that level of sincerity builds deeper emotional connections than any ad ever could.

Final Thoughts: Lead With Heart

Marketing doesn’t have to be complicated, expensive or pushy. When done with authenticity and purpose, it becomes a natural extension of the values that already define our profession. Whether you’re just starting to build your veterinary services or looking to deepen your existing relationships, think beyond flyers and discounts. Think about how you can show up — creatively, educationally, responsively and compassionately — for both veterinary professionals and pet owners. Because the best marketing isn’t about getting attention. It’s about earning trust.

What’s in Store at the LDN Virtual Conference

Fri, 15 Nov 2024 03:53:03 GMT

Individuals who suffer from symptoms of gastrointestinal, autoimmune, dermatological and pain conditions make up 80% of the patient population. But here’s the good news: multiple studies indicate that low-dose naltrexone (LDN) may potentially help many of these conditions. Take a sneak peek at topics our Clinical Services team will discuss during the Low-Dose Naltrexone One-Day Virtual Conference on Thursday, November 21, 2024.

The Immune System — Autoimmune Conditions and the Benefits of LDN

by Catherine Henderson, PharmD, PCCA Clinical Compounding Pharmacist

LDN has long been touted for its effects in autoimmune disorders. Understanding the mechanisms of LDN action involves diving deeper into immune system function and the irregularities that occur in autoimmune disorders. We’ll explore the data related to LDN’s various mechanisms for improving disease symptomatology and quality of life, as well as review real world published studies and cases of LDN use in various autoimmune disorders.

Dermatological Inflammatory Diseases and LDN

by Nat Jones, RPh, FAPC, PCCA Clinical Compounding Pharmacist

LDN is growing in popularity in the dermatology world. It has proven to be beneficial for pruritus and inflammation due to its ability to attenuate toll-like receptors found in the skin. We’ll discuss two cases: one of a tattoo allergic reaction and one of hidradenitis suppurativa (HS). Tattoo reactions to the coloring agents can be intense and difficult to treat. HS is a chronic inflammatory, potentially scarring, skin disease primarily affecting apocrine gland-rich areas of the body (axillary, groin, perianal, perineal regions and abdominal folds), often mediating pain and considerable morbidity, both physical and psychological.

The Use of LDN in Veterinary Patients

by Katy Hecker, PharmD, PCCA Clinical Compounding Pharmacist

As pet owners, we lovingly share many things with our pets including treats, affection and half of the bed. Research suggests we also share similarities in physiological function, disease state manifestation and treatment modalities utilized. Join in the discussion and learn more about the science behind LDN for veterinary clinical indications including behavioral disorders, atopic dermatitis, osteoarthritis, cancer, inflammatory bowel disease (IBD) and more!

Perimenopause and Menopause Are Inflammatory Conditions: The Use of LDN for Hormones and Weight Loss

by Sara Hover, RPh, FAARM, PCCA Director of Clinical Services

Understanding the inflammatory processes that characterize perimenopause and menopause will shed light on how the hormonal changes contribute to weight gain and obesity. Central to this discussion is the shift in estrogen profiles — from estradiol, which possesses anti-inflammatory properties, to estrone, a pro-inflammatory estrogen that becomes predominant during menopause. This hormonal transition fosters an inflammatory state that can disrupt metabolism and promote adiposity. Additionally, the presentation will explore various options aimed at reducing inflammation and managing weight effectively. Key strategies include optimizing sleep quality, utilizing probiotics to support gut health and implementing LDN as an innovative therapeutic approach. Attendees will gain a comprehensive understanding of the biological mechanisms linking menopause to inflammation and weight gain, along with practical interventions to enhance health and well-being during this pivotal life stage.

Using LDN for Chronic Pain Conditions

by Tricia Heitman, PharmD, PCCA Clinical Compounding Pharmacist

LDN is gaining attention for its anti-inflammatory properties and its ability to manage pain and opioid addiction. By acting on the opioid receptors at lower doses, LDN enhances endorphin production, which can help reduce inflammation and alleviate pain associated with various conditions such as arthritis, fibromyalgia and autoimmune disorders. Many patients report significant relief from chronic pain and inflammation while taking LDN. We will discuss the appropriate doses and review the literature associated with LDN and pain.

LDN for Gut Inflammatory Disorders

by Ranel A. Larsen, PharmD, PCCA Clinical Compounding Pharmacist

LDN is emerging as a promising therapeutic option for enhancing gut health, particularly in the context of IBD and irritable bowel syndrome (IBS). LDN helps to regulate immune responses, improve epithelial barrier function and reduce inflammation within the gut, all of which are critical for maintaining intestinal homeostasis. In IBD, LDN may lower disease activity and enhance quality of life, while in IBS, it can alleviate symptoms such as pain and bloating. Overall, LDN's role in improving gut health underscores its therapeutic potential to support management of complex gastrointestinal disorders.

How to Market LDN Studies

by Mark Gonzalez, PharmD, PCCA Clinical Compounding Pharmacist

Today’s compounding pharmacist wanting to effectively market LDN to practitioners and patients has access to tools that were not as available 20 years ago when LDN started to become popular. Clinical studies, therapeutic reviews and case series are now readily available to substantiate what were once only theories on the effectiveness of naltrexone in autoimmune disorders. These studies span a wide array of specialties and medical conditions. Research groups such as the LDN Research Trust, publications such as the series of three LDN books and many of the clinical presentations given on the subject of LDN all reference these studies. The pharmacist and marketer must leverage the power of this data as part of their communication to both the practitioner and the patient they are marketing to. With the additional aid of social media, positive patient stories can accompany the data from these clinical studies to make for attractive and effective marketing.

Register for the Low-Dose Naltrexone One-Day Virtual Conference today and get more details — plus more information — on the potentials of LDN. We look forward to additional discussions and answering your questions!

These 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.

$27/Day Delivers Comprehensive Support

Wed, 13 Mar 2024 15:38:09 GMT

PCCA’s Clinical Services team responded to well over 45,000 calls from our members in 2023, assisted in more than 300 formulation developments, presented at 30 Speaker Bureau educational sessions and 39 PCCA training events, plus much more. In January 2024, they responded to approximately 4,500 calls with a satisfaction rating of 100 percent and an average resolution time of under 35 minutes (the average resolution time depends on the amount of calls received and may not always remain under 35 minutes). Data, however, does not truly reflect the behind-the-scenes, comprehensive and multi-departmental collaboration our Clinical Services team delivers to compounding pharmacies and the patients they serve. Nor does the data reflect the sincere gratitude and appreciation expressed by PCCA members with clinical services access.

You have a true treasure on your Clinical Services team! Don is a wealth of information, which he shares readily. I have enjoyed speaking with him over many years. Thank you!
— PCCA Member, January 2024

Formulation Development: Content Evaluation to Collaboration

Content evaluation focuses on ensuring the accuracy of clinical information contained in all presentations provided by various speakers, long before a seminar or educational event occurs. More importantly, it also involves assessing opportunities for new formula development.

For example, during a recent presentation review, a PCCA clinical compounding pharmacist noticed a specific formula requested by a doctor was not included in the PCCA formulation database. Our pharmacist contacted the member pharmacy that was developing the preparation and learned help was needed to resolve some formula issues. Shortly thereafter, our pharmacist reached out to the PCCA Formulation Development team. Through discussions and testing, they recognized incompatibilities between the active pharmaceutical ingredients (APIs) contained in the original formulation. To rectify the issue, two separate formulas were created for simultaneous use, which eliminated incompatibility issues while addressing the physician’s original request. The collaborative nature between our Clinical Services and Formulation Development teams resolved a member-specific issue and created new formulations in the PCCA database, while ensuring seminar attendees had access to formulas and comprehensive information before the speaker walked onto the stage.

Deborah was very helpful! Our hospice doctor was very pleased with her suggestions and we are working on a formula for his patient.
— PCCA Member, January 2024

Collaboration Enables Comprehensive Support

By interacting with our compounding pharmacy members throughout various PCCA programs — including Concierge Compounding, Advisory Council and multiple PCCA Education events — our Clinical Services team often uncovers unmet patient needs that, in turn, help facilitate new product development at PCCA. In addition to sharing member insights with our R&D team, our Clinical Services team aids in product development by gathering additional information.

For example, during the development of SuspendIt^® Anhydrous, members of our Clinical Services team reached out to various healthcare specialists to understand how our new anhydrous suspension vehicle may help their patients. By sharing this information with other PCCA teams, our Science team knew to create case studies evaluating the use of SuspendIt Anhydrous in feeding tubes for hospice, geriatric and pediatric patients. Our Formulation Development team knew which formulations — including flavors — to develop and test. Our Clinical Services team members with expertise in animal care researched and shared the animal species that would best tolerate SuspendIt Anhydrous and those that are not good candidates.

In addition to the expert guidance PCCA Clinical Services team members provide daily for patients with specific conditions — from autism spectrum disorders to autoimmune diseases and beyond . PCCA members with clinical services access can also rely on this team for business and marketing support, as well as guidance on regulatory changes that impact community pharmacy.

Watch a short video, featuring PCCA Compounding Pharmacist Mark Gonzalez, PharmD, for a glimpse of A Day in the Life of a Clinical Services team member.

A Hard Pill to Swallow? A Permeation-Enhancing, Topical Base May Help!

Wed, 06 Mar 2024 16:53:59 GMT

by Beau Harger, PharmD, PCCA Clinical Compounding Pharmacist/Training Instructor

Popular compounds such as transdermal methimazole for hyperthyroidism and transdermal buprenorphine for pain in felines are common in the veterinary world. Not only has this delivery been a staple for pets like cats and dogs, in some instances, this method may be used for some exotic species as well. For example, delivery through the skin has been used under the wing in birds.

Key Considerations

The site of transdermal application is important. The ideal site has a thin stratum corneum with minimal hair follicles, adequate blood perfusion and is difficult for the patient to access (i.e., the pinna in felines and canines).¹ Another key consideration is the selection of the base vehicle. PCCA Lipoderm^® had been the industry-leading base used in permeation-enhancing compounded preparations for many years. While Lipoderm had met the need for an alternative dosing form, the industry was seeking anhydrous options for stability and extended-beyond use dates (BUDs) without compromising the skin-permeation performance.

Innovation Meets Demand

PCCA introduced PermE8^® Anhydrous Gel, an anhydrous, permeation-enhancing base, in 2018. PermE8 is classified as an anhydrous base due to water activity below 0.6 (Aw < 0.6).² Comparison testing between Lipoderm and PermE8 Anhydrous Gel was conducted in vitro using a human skin model that measured the skin percutaneous absorption of ketoprofen. Test results indicated that PermE8 performed comparably to Lipoderm and significantly outperformed Anhydrous Lipoderm^®.^2,3 Traditionally, anhydrous bases didn’t have a smooth feel; however, PermE8 offers a soothing, silky texture that makes application more enjoyable for patients. It was also formulated without preservatives and may be an option for those pets with sensitive skin.

Important Considerations

It’s important for pharmacists and veterinarians alike to understand that not all drugs are good candidates for transdermal delivery.

Important considerations include:

Molecular weight of the drug
Intended use of the preparation
Dosing delivery
If the drug has a narrow therapeutic index (i.e., warfarin, digoxin)
Irritation potential of the drug on the patient’s skin
Risk of drug transference to the caregiver/owner⁴

Drugs with large molecular weights may not pass through the skin and antibiotics could produce low serum levels, resulting in antibiotic resistance. If the veterinarian recommends proceeding with transdermal administration, it is important that monitoring parameters are established to assess the effectiveness of the preparation.

Compounding Tips

When compounding with PermE8, we recommend not exceeding a 20% powder load. This could include the pure API alone or with commercially available drug tablets or capsules containing excipients. Appropriate wetting agents are propylene glycol, diethylene glycol monoethyl ether or ethyl alcohol at a 5-10% concentration. We also recommend using an electronic mortar and pestle (EMP) on a high setting before and after milling to ensure full incorporation of wetting agent and API.

Permeation-enhancing formulations offer options for veterinary patients who otherwise may not receive treatment. Compounding pharmacies that provide these therapies should consider and have access to the newest technology — for people as well as pets — to optimize their influence in their community and in the compounding industry.

PCCA members with clinical services access may contact our Clinical Services team for answers to questions about permeation-enhancing topical preparations, as well as other compounding concerns.

References

Forsythe L. E. (2017). Feline Transdermal Formulation Considerations. International journal of pharmaceutical compounding, 21(6), 446–452.
PCCA PermE8® Anhydrous Gel. PCCA Document #99608.
PCCA (2018) Evaluation of the in vitro Human Skin Percutaneous Absorption of Ketoprofen in PCCA PermE8™ Anhydrous Gel vs. PCCA Lipoderm® PCCA Document #99732.
Eichstadt, L. R., & Davidson, G. S. (2014). To compound or not to compound: a veterinary transdermal discussion. International journal of pharmaceutical compounding, 18(5), 366–369.

Cats with No Pants: Feline Atopic Skin Syndrome

Wed, 13 Sep 2023 13:45:51 GMT

by Deborah H. Clark, RPh, PCCA Clinical Compounding Pharmacist

Canine atopic dermatitis, or allergic skin disease, is one of the main reasons dog owners visit their veterinary (vet) clinic.¹ Much less is known about allergic skin disease in feline patients.

Compared to human patients with eczema or canine patients with atopic dermatitis, cats typically present varying clinical signs. Testing cats for serum allergen-specific immunoglobulin E (IgE) does not always indicate IgE prominence; skin barrier function in cats is not well known and even clinical signs can vary from cat to cat and from year to year.

Feline FASS

Feline atopic skin syndrome (FASS) is a subclassification of a broader condition: feline atopic syndrome (FAS). FAS contains a spectrum of hypersensitivity disorders with various presentations that may affect the skin, gastrointestinal and respiratory tracts.² FAS affects 12% of cats, usually within the first three years of life; 22% of these cats may exhibit onset of signs after age seven.³

FASS involves inflammatory reactions that are like those seen in canine patients. T cells are involved as well. The most commonly affected areas in FASS cats are the head and the ventral area (the belly or chest). In 70%, allergen specific IgE was detected, suggesting involvement of an allergic component; 50% of FASS cases have no secondary bacterial infection.

Secondary bacterial infections in these cats may be challenging for a vet to diagnose because they present very differently from dogs and humans. In many cases, the presenting signs are so close to those of other allergic types that a secondary bacterial infection may get overlooked. Adding to the complexities, fungal dysbiosis with Malassezia can also be present.

Clinical Signs

Regardless of the cause of the allergy — be it fleas, other parasites, food or environment — FASS cats may present a variety of reaction patterns. For example, FASS can present allergic rhinitis, asthma or conjunctivitis; in some cases, all three. Cutaneous signs can include head and neck pruritus, self-induced hair loss or “fur-mowing.” Fur-mowing can involve the entire ventrum down through the inside of the legs, giving the appearance of “cats with no pants.”

Other cutaneous signs include eosinophilic granuloma complexes and miliary dermatitis (eosinophilic papulocrustous dermatitis). Some FASS cats exhibit indolent ulcers around the mouth, while others may show granulomas inside the mouth or within the throat. As stated earlier, these signs can occur alone or in combination, can change from season to season or simply appear as signs worsen.²

Once other conditions are ruled out and diet or environmental modifications tried and failed, medical therapy is normally instituted to gain control of the condition. After clinical signs are controlled, the vet may offer the option to conduct allergy testing and institute allergen-specific immunotherapy. Some cat owners, however, are not willing to commit to this.

Medical Therapy

Cyclosporin is the only FDA-approved medication for the treatment of FASS. Cyclosporin is dosed at 7 mg/kg PO every 24 hours for 4-6 weeks or until resolution of clinical signs. Once achieved, medication is typically tapered to the lowest effective dosage due to the increased risk of developing diabetes mellitus (DM) and gingival hyperplasia.⁴

A manufactured product, Atopica®, is available for cats and, per the FDA’s Guidance for Industry (GFI) #256, must be considered first by a vet. The vet may choose a compounded formula if they have a valid reason that Atopica cannot be used in the individual feline patient. Fixed oil suspensions with this API are not recommended.

Antihistamines may be given as a treatment adjunct due to their steroid sparing effect but have limited efficacy.² Corticosteroids, such as prednisolone, may also be administered.

When cats cannot be pilled, prednisolone oral solution or suspension is an option. Several manufactured human oral solutions and suspensions exist and, per GFI #256, must be considered before compounded preparations. However, some of these products contain alcohol — which is toxic to cats — while others contain flavoring that a cat may reject.

Another potential issue is the high-volume dosing required with commercial medications, which many cat owners find impractical and/or impossible to administer.

Remember to also look at excipients for species toxicities when considering manufactured drug products as a therapeutic option.

PCCA members with clinical services access may contact our Clinical Services team for help with compounding for FASS patients and other compounding concerns.

A version of this article originally appeared entirely in PCCA’s members-only magazine, the Apothagram.

References

Apostolopoulos, N. Miller, C. (Published online April 14, 2023; Issue May/June 2023) The Canine Skin and Ear Bacterial Microbiota. Today’s Veterinary Practice. Accessed May 2023 at https://todaysveterinarypractice.com/dermatology/the-canine-skin-and-ear-bacterial-microbiota/
Griffin, J. (2023) Pruritic and Purring: How Feline Allergy Differs From The Dog. Fetch DVM360 Conference
Bajwa J. (2018). Atopic dermatitis in cats. Can Veterinary J. 59(3), 311–313. Accessed April 2023 at https://pubmed.ncbi.nlm.nih.gov/29599562/
Plumb’s Veterinary Drugs Online. Accessed May 2023 at https://plumbs.com/

Choosing the Appropriate Oral Base Vehicle

Wed, 07 Dec 2022 12:00:00 GMT

by Stacey Lemus, BS, and Courtaney Davis, BBA, PCCA Senior Formulation Specialists

PCCA offers many oral base vehicle options for use in compounding. We break down the characteristics of several of these oral vehicles below to help guide you on choosing the most appropriate base for your compound.

Use caution when using certain vehicles in patients with special dietary restrictions such as diabetes or autism. When compounding for veterinary use, the pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species. It is also important to check the pH of your compounded preparation to ensure adequate preservation in the chosen base.

PCCA SUSPENDIT® (PCCA #30-4825)

An all-in-one oral suspension base developed with superior anti-sedimentation technology.
Natural suspending agent with a patented synergistic polymer complex that offers a unique thixotropic flow— it thins as it’s shaken and thickens upon standing— which allows rapid redispersion of APIs with agitation and minimizes sedimentation.
All-natural sweetener derived from monk fruit.
Formulated without sugar, parabens, gluten, casein and dyes.
When wetting an active pharmaceutical ingredient (API) to make formulations using SuspendIt, most are wet with the vehicle base itself rather than using glycerin or propylene glycol.
Preserved with a combination of potassium sorbate and sodium benzoate, which is suitable for preparations with a pH below 6. In certain formulations where the pH may be higher, it would be suggested to refrigerate or additional testing may be required to validate the preservation.

Veterinary Use

SuspendIt contains sodium benzoate, a potential toxin to felines when chronically ingested, so limit use to two weeks. The pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species.

PCCA-PLUS™ ORAL SUSPENDING VEHICLE (PCCA #30-3227)

Contains a suspending agent but no sweeteners.
Oral suspension base often used 1:1 with PCCA Sweet-SF™ Sugar Free Syrup Vehicle (PCCA #30-3228) or PCCA Syrup Vehicle™ (PCCA #30-3521).
Use glycerin or propylene glycol to wet APIs.
Preserved with potassium sorbate, methylparaben and propylparaben; effective over a wider pH range.

Veterinary Use

Appropriate for vet use, although the pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species.

PCCA SWEET-SF SUGAR FREE SYRUP VEHICLE

Oral base vehicle used alone or 1:1 in combination with PCCA-Plus Oral Suspending Vehicle.
Contains no suspending agent. API must be soluble or mix 1:1 PCCA Sweet-SF with PCCA-Plus to suspend insoluble API.
Use sorbitol as sweetener and cherry as flavor.
Use glycerin or propylene glycol to wet API.
Preserved with potassium sorbate, methylparaben and propylparaben; effective over a wider pH range.

Veterinary Use

Appropriate for vet use, although the pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species.

PCCA SYRUP VEHICLE

Contains approximately 56% sucrose, which is less than other syrup vehicles but still maintains a pleasant, sweet taste.
A good choice for medications that have a bitter and salty taste.
Use caution when using this vehicle in patients with special dietary restrictions such as diabetes or autism.
When wetting API to make formulations using Syrup Vehicle, most are wet with the vehicle base itself rather than using glycerin or propylene glycol.
Preserved with sodium benzoate, which when used alone requires a more acidic pH for preservative effectiveness (4.6 or below) unless combined with PCCA-Plus.

Veterinary Use

Appropriate for vet use, although the pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species.

PCCA FIXED OIL SUSPENSION VEHICLE™ (PCCA #30-4316)

Anhydrous vehicle for APIs that are known to be unstable in water or if the aqueous stability is unknown.
Anhydrous, contains no water, which allows for extended beyond-use dating of the formulation depending on the API used.
When appropriate, oil bases can help coat a drug particle in suspension, thus making a bad-tasting drug more palatable.
Contains suspending agent but no sweeteners, giving you the flexibility to add your own sweetener for customization.
When wetting API to make formulations using Fixed Oil Suspension Vehicle, most are wet with the vehicle base itself rather than using glycerin or propylene glycol.
pH not applicable since anhydrous.

Veterinary Use

Certain species, such as avian (birds), are prone to aspiration when using oil vehicles. Make sure to consult with the pet owner and ensure a proper handling relationship with the animal to avoid issues. This vehicle is not appropriate for use in equine (horses) and certain species of rodents and reptiles. The pharmacist should assess each vehicle to ensure it is appropriate for the animal’s species.

PCCA BITTER DRUG POWDER™ USE 26 MG/ML (PCCA #30-3447)

Contains a suspending agent and a blend of sweeteners.
Helps mask the undesirable taste of medications as well as suspend the actives that may not be soluble in the preparation.
For use in aqueous formulations only and when no other suspending agent is used.
The recommended use is 26 mg/mL.
See PCCA Formula #5795, Bitter Drug Powder Oral Suspension.
Contains sodium benzoate.

Veterinary Use

Not suggested for vet use. May use Dry Powersweet (PCCA # 30-4948) 0.1-1%, acesulfame potassium 0.1-0.5% or steviol glycosides 95% 0.1-0.5% instead.

PH AND PRESERVATIVES

It is important to check the pH of your compounded preparation to ensure adequate preservation. Since some formulas have a higher pH, refrigeration may be required (per USP guidelines for preservative-free preparations) due to potential lack of preservative action of the base in a higher pH environment. Parabens may be added to the preparation to ensure preservative action.

FLAVORING

Every API has a specific taste characteristic such as bitter, sour, sweet or salty, so it is important to have a variety of flavors in stock to enhance the taste of compounded oral formulations.

ADDITIONAL INFORMATION

See our PCCA Blog post, How to Start Building Your Flavoring Inventory , for general information on flavoring, emulsifiers and sweeteners for oral bases.
For detailed information on flavoring, refer to our PCCA Flavor Guide on the Members-Only Website > Formulas > Flavor Guide or at Members-Only Website > Resources > Formula Tools > Flavor Guide
Access FormulaPlus™ extended beyond-use date studies using PCCA oral bases in the FormulaPlus Master Formula List (PCCA Document #98004).
For additional information on PCCA Bases, refer to Exclusive PCCA Bases (PCCA Document #99650).

PCCA members with Clinical Services access who have questions about compounding our formulas may contact our Clinical Services team at 800.331.2498.

A version of this article originally appeared in PCCA’s members-only magazine, the Apothagram.

Key Factors and Common Issues in Equine Compounding

Wed, 16 Sep 2020 12:42:26 GMT

By Deborah Clark, BSPharm, RPh, PCCA Clinical Compounding Pharmacist

Many of the calls that I receive from PCCA member pharmacies deal with veterinary compounding and therapeutics. I like to get to know the people I regularly talk to, and if time allows, I will normally ask the pharmacist about their veterinary compounding business. I get responses that vary from, “It seems like every other call is from a veterinarian,” to “Well, it is not as busy as I want it to be — do you have any suggestions?”

Most veterinary compounders get customized medication prescriptions for smaller species, such as dogs, cats, ferrets, pocket pets, birds or reptiles. Depending on the area where your pharmacy is located, there may be the occasional call for a horse. Equine compounding seems to be an area that some compounders avoid due to lack of education. I have to admit, when you are not familiar with horses, they do seem quite intimidating to compound for. Think about it: A horse is a large animal. They usually weigh anywhere from 800 to 1,000 pounds, and sometimes more. How do I get a medication into a horse? What do I have to consider when compounding for horses? These are important questions, and in this article, I would like to address them and many other common challenges for compounding custom horse medication.

Key Factors in Compounding for Horses

What does the horse do?

Horses can have a variety of activities they are involved in, and many have an actual job. A lot of horses are competitive athletes. Many people know this from watching equine events during the Olympics. Horses are involved in what is known as Equestrian Sports. There are a variety of competitions that include, but are not limited to, show jumping, dressage, endurance riding and racing (barrel, flat, harness, steeplechase).

Horses can also have multiple jobs on a farm or ranch as well as in the city. Stock horses are trained to work with livestock and are characterized by their agility, power and speed. A few jobs they are used for on the ranch include herding cattle, roping calves and team penning. They are also members of the police force in many cities. Mounted police can handle situations where officers on foot or in a car would not be able to go. Horses are also used to pull sight-seeing carriages in cities to entertain tourists.

When choosing a medication therapy for an individual horse, the animal’s activities or job is an important consideration. If the horse is a competitor, you need to look at the guidelines that are set forth by the governing body of the sport in which they compete. The Association of Racing Commissioners International (RCI) and United States Equestrian Federation (USEF) have strict rules about which drugs or substances can be used as well as withdrawal times for certain ones that are allowed. Doping to enhance performance of a horse is a concern in these sports very similarly to human sports. Stimulants, pain relievers and relaxing agents are commonly employed to enhance performance or calm the horse to present better in a show. Sometimes veterinarians ask compounding pharmacists to provide these medications in a dosage form for a horse, so it is important to know the regulations. If you live outside of the United States, it would be good to familiarize yourself with the International Horse Sports Confederation (IHSC), which is the new joint governing body of equine sport (a cooperation between the Fédération Équestre Internationale (FEI) and the International Federation of Horseracing Authorities (IFHA)). Additionally, if you are dealing with a working horse, you do not want to use anything that may impair their ability to do their job.

What is the best dosage form for the horse?

Another important thing to consider is the best route of administration for the disease you are treating. Horses are fragile animals and can have myriad issues, especially with environmental changes or with improper care. You also do not want to choose a route of administration that may cause extra stress to the animal. This is where communication between the compounding pharmacist and owner is key. It is good practice when taking on a new veterinary patient in general to ask what dosage forms and flavors have been tried in the past that did not work. (To help with this, PCCA members can use our veterinary client intake form .) This will help avoid repeating the previously unsuccessful therapy. Also, keep in mind when choosing formulas that these medications are typically going to be stored and administered in a barn or stable. There is usually no refrigeration available, so formulas that have this storage requirement may not be the best option.

Also on The PCCA Blog: “ How to Get Started in Veterinary Compounding ”

Common Treatment Issues for Horses

Those Beautiful Eyes

Horses have large eyes that protrude from their head and are prone to injury because of their placement. They also produce copious amounts of tears that can wash out traditional ophthalmic medications. Many times, ophthalmic drops need to be compounded to a thicker consistency to prevent this.

Oral Medication for Horses

Horses are herbivores, and as such, their gastrointestinal system maintains a delicate balance of flora to keep their “fermentation tank” in optimal shape. When administering oral preparations to the horse, it is very important to keep this in mind. Anything that upsets this delicate balance should be avoided. Equine oral medications can be formulated as several options: pastes, powders to add to feed, oral suspensions and treats. (PCCA members with Clinical Services access can see examples of equine oral medication formulas in our database.)

Oils are not a normal part of a horse’s diet, and it is advisable to not use them as an oral vehicle in these patients. If a horse does not like a suspension, they cannot spit it out. If it is thin enough, though, they can easily expel it from their mouth by simply lowering their head and allowing it to run out of their mouth. If the suspension is thicker or sticky, they are going to ingest it. It is a good idea to make suspensions thicker because of this.

Volume is another thing to keep in mind if making an oral suspension for a horse; 24 mL is a good maximum limit. If the owner indicates no preference of flavor, then fenugreek, peppermint and cherry are a few common favorites of horses, so you can consider those. If you use a cherry flavor, make sure that it is artificial and not natural (such as our artificial cherry flavor ). Certain components of cherry can be toxic to horses. If horses ingest something that is toxic to them, they cannot vomit.

Skin Issues

Horses can also have dermatological issues. These issues can be precipitated by the season, environment or stress. Atopic dermatitis can occur in equine patients. Parasitic, bacterial and fungal infection of the skin can also affect horses. The size of the horse can make it difficult to administer topical medications to larger areas, but compounded sprays with the appropriate active pharmaceutical ingredients can help address this issue.

Wound Care

Wounds are very common for horses. Scrapes and abrasions can occur during everyday activities. Horses overdo everything, and healing is no exception. When recovering from wounds, horses form what is known as “proud flesh,” which is overgrown scar tissue that can protrude from the area. These can be very unattractive and is something most owners want to avoid. Compounders can use bases such as PCCA’s ZoSil ^® or PracaSil^®-Plus and add active pharmaceutical ingredients that may help address this issue. (PCCA members with Clinical Services access can find some examples of topical spray and gel formulas for horses in our database.)

Hooves

You may see a three-legged dog, but you will never see a three-legged horse. Horses’ legs and hooves are very important to their overall health. Horses can be prone to hoof issues, and this is a great area where the compounder can be a huge asset to the equine veterinarian. The farrier, or blacksmith, is also a great person to get to know regarding this. The compounder can make custom poultices or soaking solutions for the equine veterinarian to use to treat these problems.

Compounding for horses can be challenging; however, when compounders educate themselves and take the time to build relationships with equine professionals, the outcomes can be quite rewarding for the horses, their owners and compounding pharmacies.

Deborah Clark, BSPharm, RPh, is a Clinical Compounding Pharmacist at PCCA. She previously worked in two independent hybrid pharmacies in Charlotte, North Carolina, managing compounding operations. While there, she worked with a local veterinary specialty and emergency hospital providing compounded medications for challenging veterinary patients. She also worked with the Carolina Raptor Center and several smaller veterinary clinics in the Charlotte Metro area. Deborah’s compounding experience also includes hospice, hormone replacement therapy (HRT), pain management, wound care, sterile products and pediatrics. She is certified in medication therapy management, and she is an associate member of the Society of Veterinary Hospital Pharmacists.

Photo by Lola Delabays on Unsplash.

5 Crucial Insights I Discovered from Compounding for Zoos

Wed, 08 Jul 2020 14:51:12 GMT

By Mark Gonzalez, PharmD, PCCA Clinical Compounding Pharmacist

Recently, I read that the United States Department of Agriculture has licensed approximately 2,400 zoos or “animal exhibitors.” These can include general zoos, aquariums, safari theme parks, nature centers and aviaries. Most of the larger and more well-known facilities are members of the AZA (Association of Zoos and Aquariums) which has licensed 240 facilities around the world (217 in the U.S. alone), and these facilities care for approximately 800,000 animals belonging to 6,000 species. When you see the immensity of those numbers, you may be asking yourself, “Why am I not providing custom medication options for those facilities?”

From personal experience, I can share that I was very intimidated by the thought of marketing to practitioners that have reached the top of their professional games. My pharmacy was located in Southern California, and within a 90-minute driving radius, I had four world-renowned zoological facilities: the Sea World Aquarium, the San Diego Zoo, the San Diego Wild Animal Park and the Los Angeles Zoo. As a new startup pharmacy in 1999 filling just a handful of prescriptions my first year, I thought, “Why would any of these powerhouses want to do business with me?” After marketing to them for two years, I was able to get in, build relationships and serve them consistently for the remaining 17 years that I owned my pharmacy. Here is what I learned through the process, and I hope it helps tear down the walls of intimidation that you may have regarding this subspecialty of veterinary compounding.

1. Zoo veterinarians are some of the nicest practitioners you will work with.

I thought it would have been the opposite. I honestly expected this elite group of veterinarians to be rather pretentious, but I was wrong. Zoo vets love their job, the challenges that it brings and the patients they work with. Because of this love for their patients, and ultimately the responsibility of taking care of rare, endangered and often very expensive patients, they need to have a relationship with a compounding pharmacist who will help them meet their patient-specific needs.

2. Even if a zoo has a relationship with another compounding pharmacy, they still may want a relationship with you.

Do not be intimidated by other colleagues that may have marketed before you. Most zoos have relationships with multiple pharmacies. Each pharmacy may have a few specialties that set them apart. That does not mean that you should not be included in that list. Market your services no matter where you are located and what your current volume may be. You might just fill a void that other pharmacies never identified.

3. Zoo veterinarians are not interested in how big your pharmacy is. They just want trust and fast response time.

Trust is a given for any relationship to work, but especially when providing patient care services. Trust is built by being honest and providing these special patients with unique and viable options. And it’s OK if you don’t always have the right answer at the tip of your tongue as long as you research the right answers (which also builds trust).

Response time is crucial when you are dealing with large groups of animals in urgent situations. I was called by a local aquarium to formulate a phenobarbital injection (which was on backorder at the time) when there was an algae bloom that resulted in the release of domoic acid, a neurotoxin for dolphins. The aquarium needed the compound ASAP, or many of the dolphins they were working with would die. Our quick response time built our reputation due to an increase in trust between the aquarium and our staff. That moment solidified our relationship for years to come. This demonstrates that it is not the size of the pharmacy that matters; it is your ability to come by their side at a moment's notice that really counts.

4. Zoos require and crave creativity.

“How do you make a wound-care gel for an eight-ton elephant?” “What can you do to help us medicate 200 penguins with an anti-malarial every other day?” “I have a walrus with 10-inch nostrils that needs a nasal spray for a fungal infection. Can you help?” These are all real questions that local zoos posed to me. As compounders, we take pride in our creativity, and zoo/aquarium compounding allows us to put that skill to practice. Do not be afraid to think outside the box.

5. Relationships with zoo trainers and lab staff are just as important as the ones you build with veterinarians.

The trainers are actually the ones working with the animals. Most vets are not even allowed to work on an animal without the trainer. The lab staff are usually the ones placing orders and checking stock on compounded agents for the zoo. Do not disregard these crucial members of the team.

I hope that these insights and tips are as helpful for you as they were for me. Zoo compounding was one of the most exciting and fulfilling parts of my practice. Step into this marketplace, and you will remember why you entered into compounding in the first place.

Mark Gonzalez, PharmD, is a Clinical Compounding Pharmacist at PCCA. He owned and operated Med Specialties, a pharmacy in Yorba Linda, California, for 18 years before joining the staff of PCCA. His areas of specialty are hormone replacement therapy, dermatology and veterinary compounding.

Flavoring Options for Veterinary Compounding

Wed, 27 May 2020 12:45:43 GMT

By Fabiana Banov, RPh, MS, PCCA Senior Formulation Pharmacist

PCCA has different ways to help compounders when they need to flavor a formulation with an active ingredient that does not taste very appealing for an animal. It can be an oral paste for a cat, a treat for a dog or a suspension for a ferret. We carry different liquid and powder flavors that can potentially make that preparation a success. In this blog post, I provide a list of all the PCCA flavors that are indicated for veterinary use along with optional sweeteners and some information on new flavors that we now offer. I will also cover the oral bases compounders can use that will help to incorporate the substances better and will improve the way they provide medication to their furry patients.

Oil-Soluble Liquid Flavors for Animals

Recommended Concentration: 0.5 – 1% (Maximum 3%)

Beef Grilled, Natural (PCCA #30-4786)
Chicken Grilled, Natural (PCCA #30-4757)
Fish, Artificial (PCCA #30-3839)
Liver, Artificial (PCCA #30-3840)

Water-Soluble Liquid Flavors for Animals

Recommended Concentration: 1 – 5%

Beef, Natural (PCCA #30-3866)
Liver (PCCA #30-2905)

Water-Soluble Powder Flavors for Animals

Recommended Concentration: 1 – 6%

Alfalfa (PCCA #30-3745)
Apple (PCCA #30-2896)
Beef-Ade (PCCA #30-3788)
Cherry-Ade (PCCA #30-3451)
Chicken Broth (PCCA #30-3646)
Pork Liver (New) (PCCA #30-5060)
Molasses-Ade (PCCA #30-3448)
Tuna, Artificial (PCCA #30-3239)

Sweeteners for Animals

Sweeteners are the foundation for many flavors, and a combination of them will provide a better final formulation. Below is the list of sweeteners that you can use in a veterinary compounding formula.

PCCA Product Number	PCCA Product Title	Concentration
30-4398	Acesulfame Potassium FCC	0.1 – 0.5%
30-2628	Magnasweet 110® (Liquid)	0.2 – 1%
30-2629	Magnasweet 135® (Powdered)	0.1 – 0.5%
30-4539	Steviol Glycosides 95%	0.1 – 0.6%
30-4432	Stevioside 15%	1 – 4%
30-4948	Dry Powersweet	0.1 – 1%

New Flavors for Animals

PCCA now carries some new liver flavors. One of them is Pork Liver Powder (listed above). This flavor is replacing the Liver Powder (Porcine) that we used to carry. The new powder flavor contains a strong liver taste that will be beneficial in oral veterinary formulas. We also have a new flavored base, PCCA Animal Treat – Liver^™ (listed below), which is replacing the old Animal Treat – Liver base. The new product has an improved taste.

PCCA Animal Treat Base

These powder bases provide solid treats for animals. They come in three different flavors and a flavorless version. The treats are very easy to make, do not require heat and are ready to use.

Animal Treat – Chicken^™ (PCCA #30-3244)
Animal Treat – Fish^™ (PCCA #30-3245)
Animal Treat – Flavorless^™ (PCCA #30-3446)
Animal Treat – Liver^™ (PCCA #30-5065)

Liquid and powder flavors can be added to PCCA’s animal treat bases. Our animal treat general formulas show the process of formulating the animal treats. PCCA has different general formulas based on the type and size of mold used, the flavor of animal treat base (chicken, fish, flavorless, liver) and the type of any additional flavor you may add (oil, aqueous, powder). This will provide all the information that compounders need to start working with these bases. To be able to medicate all different sizes of animals, there are three different types of molds that compounders can use with the animal treat formulations.

PCCA Product Number	PCCA Product Title	Calibration
35-2410	Animal Treat Mold	1.12 Gm
35-2489	Rectangular Blister Packs (Amber)	4.2 Gm
35-2512	Round Blister Packs (Amber)	1.35 Gm

PCCA Fixed Oil Suspension Vehicle

Our Fixed Oil Suspension Vehicle is a great choice as a base for veterinary compounding, especially for cats, dogs and ferrets. These animals generally like the taste of oils, and the almond oil used in the base is neutral tasting, so it is palatable for many species. This product is a premade form of the highly used and frequently recommended fixed oil oral suspension formula, so it eliminates the need to make the base yourself. You can just add your active ingredient, sweetener and flavor (the flavor must be oil-soluble or miscible in oil).

For drugs that are known to be unstable in water, or if the aqueous stability is unknown, it is common to prepare an oral suspending vehicle that is oil-based (anhydrous), when appropriate for the patient. Oil bases also can help coat drug particles in suspension, thus making bad-tasting drugs more palatable. The current USP Chapter <795> also allows for a 180-day beyond-use date for non-aqueous liquids such as our Fixed Oil Suspension Vehicle. Therefore, unless there is stability data that states otherwise, this base allows pharmacists to use beyond-use dating that is great for them and their veterinary patients.

PCCA members with Clinical Services access can view our fixed oil oral suspension general formula as a guide for how to use this base with active ingredients.

PCCA SuspendIt^®

SuspendIt is another versatile option for veterinary compounding. It is an all-in-one oral suspension base that has patented anti-sedimentation technology. It uses a natural suspending agent and has a synergistic polymer complex that provides for a unique thixotropic flow — meaning that it thins as it is shaken and thickens upon standing. This allows for rapid redispersion of active ingredients with agitation and minimizes sedimentation.

SuspendIt is also the only compounding suspension base made with an all-natural sweetener derived from monk fruit. You can use oil- or water-soluble flavors in it, but if you use an oil-soluble flavor, you’ll need to add polysorbate 20 to emulsify the flavor into SuspendIt. Use a 1:1 ratio of polysorbate and the flavor in the formulation.

Please note, however, that SuspendIt contains sodium benzoate, a potential toxin for felines when chronically ingested, so use in cats should be limited to two weeks.

If veterinary compounding is an area that your pharmacy is starting to work in or is already part of your daily routine, PCCA is here to help you to succeed with your furry patients. Veterinary medicine is an area that PCCA has been dedicated to for more than 35 years, and we are always improving and adding new ways to help owners medicate their pets. We have a long list of formulas that we’ve tested in the lab. In addition, we have the new digital PCCA Flavor Guide, which lists the most recent findings in how to flavor a compounded medicine. PCCA members with Clinical Services access can view our formulas and the new flavoring guide on our website. They can also call us at any time for patient- and formulation-specific questions at 800.331.2498.

Fabiana Banov, RPh, MS, PCCA Senior Formulation Pharmacist and flavors expert, earned her pharmacy degree from the College of Pharmaceutical Science of the University of Mogi das Cruzes in Brazil. She also obtained specialization in cosmetic science from São Paulo State University and completed post-graduate work in the technology of cosmetic products from Osvaldo Cruz College. Prior to joining the PCCA team, Fabiana was the owner of Fórmula Médica Compounding Pharmacy in São Paulo, where she was instrumental in the development of unique cosmetic products. She is also the author of Pharmaceutical Veterinary Formulary.

This article originally appeared in two parts in PCCA’s members-only magazine, the Apothagram.

Compounding Update: FDA’s Draft Guidance on Veterinary Compounding

Tue, 07 Apr 2020 18:35:11 GMT

By Amy Shank, PCCA Director of Government Relations

This article was updated: September 1, 2020

In November 2019, the FDA released the draft guidance Compounding Animal Drugs from Bulk Drug Substances: Guidance for Industry (GFI) #256. This guidance would severely limit access to compounded medications for animal patients, and it is similar to agency guidance issued in 2015 that the FDA later withdrew.

The FDA does not have the statutory authority to regulate animal compounding from bulk ingredients, and Congress had previously cautioned the agency that any new guidance document should be grounded in statute. As written, the draft proposal:

Requires compounds made for individual animal patients to be made from FDA-approved products unless a clinical need demonstrates why it has to be made from the bulk drug substance. The FDA has not demonstrated that the active ingredients from approved products are of higher quality or that final compounds prepared from FDA-approved products are of higher quality. Pharmacies also do not generally have access to FDA-approved animal drug products to compound with them if they were required to do so
Would create a positive list and negative list of bulk drug ingredients for medications compounded for office use, which would limit treatment options for animal patients
Singles out veterinarians as the only practitioners required to demonstrate a clinical need for a patient to receive a compounded medication
Requires that formulations that have a USP compounded finished product monograph must follow that monograph, which would expose some animals to inappropriate ingredients and remove the option for customization to the animal patient
Establishes a significantly more restrictive framework for compounding medications for animal patients than for humans, since the Drug Quality and Security Act authorizes compounding from bulk drug substances for human patients

The public comment period for the FDA draft guidance on veterinary compounding was originally set to end on February 18, 2020, but in response to feedback from numerous stakeholder organizations, the FDA has extended the comment period to October 15, 2020. This gives compounders more time to voice their concerns about this issue.

How You Can Stand up for Veterinary Compounding
It is important for you to provide your feedback to the FDA by October 15, 2020, in order to protect your veterinary patients’ access to compounded medications. To help with this, we have prepared a customizable GFI #256 letter template that you can download. You can share it with your local veterinarians, too.

Want to Learn More?
PCCA members can watch our informational webinar on GFI #256 in PCCA Play, our educational media library. It features Matt Martin, PharmD, PCCA Clinical Services Manager, and Chris Simmons, RPh, PCCA Vice President of Creative Development. They can also visit the PCCA Public Affairs page on our Members-Only Website or email us at publicaffairs@pccarx.com.

Amy Shank, PCCA’s Director of Government Relations, previously served as Vice President of Capitol Hill Consulting Group (CHCG), where she advised pharmacy, pharmaceutical and university clients on federal legislative priorities. Amy also has over 10 years of experience in the United States Senate. She was the Director of Oversight and Investigations for the Senate Health, Education, Labor and Pensions Committee. She was also a senior policy advisor to the Senate HELP Committee. Amy was a senior analyst for the Chairman of the Senate Budget Committee, former Senator Don Nickles, R-OK, and began her legislative career in his Republican Whip Office as a policy advisor.

New Episodes Added to The Mortar & Pestle: A PCCA Podcast — June 2019

Wed, 26 Jun 2019 13:26:38 GMT

by PCCA

The Mortar & Pestle is a podcast for the pharmacy compounding world. Whether you are a pharmacy owner, staff pharmacist, technician, marketer or patient using personalized medicine, this is a home for you. Co-hosts Mike De Lisio and Sebastian Denison, RPh, along with a guest list of the industry’s most influential leaders, explore a cross-section of topics impacting today’s compounders.

This is your front-row seat to conversations with pharmacists at the forefront of science and medicine; experts in the fields business, marketing and entrepreneurship; and visionary leaders who share the belief that custom medicine is the future.

New Podcast Episodes for June 2019

Episode 20: Autoimmune Disorders and Compounding with Sara Hover
Sara Hover, RPh, FAARM, PCCA Clinical Compounding Pharmacist, joins Mike and Sebastian to discuss the world of autoimmune disorders and how Sara thinks compounding may be able to help patients with them. She also goes over a few conditions she’s heard about from pharmacies around the world and what she has done to help patients through compounding.

Listen to Episode 20

Episode 19: Compounding for the Veterinary World with Deborah Clark
Deborah Clark, BSPharm, RPh, PCCA Clinical Compounding Pharmacist, joins Mike and Sebastian to discuss customized medicine for veterinary needs. In addition to interesting compounding options, Deborah also shares marketing ideas she’s seen and used.

Listen to Episode 19

In Case You Missed It
Listen to our 18th episode with Gus Bassani, PharmD, Chief Scientific Officer of PCCA, where he tells the story of how he started his compounding career at a pharmacy in Alaska. Gus, Mike and Sebastian also discuss the value that the FormulaPlus™ database brings to PCCA members and how Gus leads his team with the goal of innovating everywhere. Listen here.

Lipoderm®: Still the Standard in Topical Pain Management Compounding

Mon, 18 Mar 2019 16:38:10 GMT

This article was updated October, 29, 2020

In 2018, we introduced the pharmacy compounding world to PermE8^® Anhydrous Gel, a new permeation-enhancing topical base that holds a lot of potential for compounding pharmacies and their patients. While PermE8 delivers active pharmaceutical ingredients very well, and provides prolonged beyond-use dates by default, the experts in our Clinical Services and Formulation Development departments still recommend Lipoderm as a first choice for customized permeation-enhancing medications. Here’s why.

Incomparable Support

Lipoderm has provided important options for many patients over the years as the premier base used in deep-penetrating topical compounds for local absorption or systemic absorption. It is scientifically proven to deliver active ingredients through the skin, even up to four at one time. It is also supported by a significant portfolio of peer-reviewed publications. In fact, it has been included in over 30 journal articles. Most recently, the United States Pharmacopeial Convention included Lipoderm in an official USP compounded preparation monograph, “Ondansetron Compounded Topical Gel (20 mg/mL).”

Don’t Forget the Pets

Many compounders are familiar with Lipoderm for human use, but some don’t know that it has also been third-party tested for feline use , and that it is safe for topical use in dogs, cats and horses as well as certain exotic species. This means it provides options that can be easier for a pet owner to apply to the patient than administering pills or liquids.

Numerous Formulas

We have developed over 150 formulas with Lipoderm, including many for veterinary use. We have studied over 20 of those in our FormulaPlus ^™ program, and they have extended beyond-use dates backed by stability-indicating methods. Four of those are bracketed studies, offering compounders extended beyond-use dates in a range of active pharmaceutical ingredient concentrations. These FormulaPlus beyond-use date studies can save compounders thousands of dollars in stability testing because we’ve already taken care of it. PCCA members with Clinical Services access can find all of our Lipoderm formulas , including those with extended beyond-use dates, in the PCCA formula database.

Meet the Family

The technology at the core of Lipoderm has been so powerful that we have used it to develop a line of bases to give compounding pharmacies even more options:

Lipoderm ActiveMax^® is appropriate when compounding with ingredients in salt form at high concentrations
Lipoderm HMW^™ can accommodate ingredients with high molecular weight
Anhydrous Lipoderm is useful when working with ingredients that are unstable in aqueous environments, similar to our newer base, PermE8 Anhydrous Gel

If PCCA members have questions about Lipoderm , they can contact us at 800.331.2498. Not a member? Learn more about all that comes with PCCA membership, including access to Lipoderm and other exclusive compounding bases.

Pictured in the banner: David, a patient who has benefited from compounded permeation-enhancing medication. Watch David’s story .

Atopic Dermatitis in Veterinary Patients: What Compounders Can Offer

Mon, 11 Mar 2019 13:25:11 GMT

By Deborah Clark

Atopic dermatitis is the most common reason for dog and cat owners to visit their local veterinary clinic. It also affects other species, such as horses and ferrets. In many cases, pet owners will approach a compounding pharmacist first before going to see their local veterinarian. This is a great opportunity for the compounder to show their value to the pet owner as well as the veterinarian who cares for the animal.

What Is Atopic Dermatitis?
Atopic dermatitis is an inflammatory, pruritic, allergic skin disease characterized by a hypersensitivity reaction of the skin to causative agents found in the environment of the animal.¹ These “triggers,” or allergens, can be present in the air—in the case of dust and pollen—in food or in grooming products, similarly to the triggers that we find in human patients.

Usually, there is a genetic predisposition to atopic dermatitis, and in dogs, there are several breeds that are prone to this condition: Chinese Shar-Pei, Wirehaired Fox Terrier, Golden Retriever, Dalmatian, Boxer, Boston Terrier, Labrador Retriever, Lhasa Apso, Scottish Terrier, Shih Tzu and West Highland White Terrier. Compromise of the normal barrier function of the skin can also occur in many animals due to licking and biting of the affected areas. Immunologic abnormalities may also be present.

Clinical signs usually occur on a seasonal basis, but may become year-round over time. Pruritus, or itchiness, is the classic sign of atopic dermatitis. In canines and felines, the feet, face, ears, flexible surfaces of the front legs, axillae and abdomen are the most commonly affected areas.1 Lesions can range from red, inflamed, itchy patches to infected sores that may be crusted over or open. In many cases, alopecia occurs, as well as darkening of the affected skin areas. Most of the lesions are caused by the licking and biting that the animal does to alleviate the itching.

Common Treatment Options
The main goal of treatment is to alleviate pruritus in order to allow the skin to heal appropriately. The first measure of treatment is to remove any allergens that may be the causative agents. Removing certain things from the animal’s diet, such as grains, can many times help reverse the process. Environmental allergens, such as pollens, sometimes are not as easy to remove, and measures have to be taken to prevent reactions to them by the immune system.

Treatment can be initiated several different ways. In many cases, veterinarians will treat atopy with systemic medications, such as Apoquel® (oclacitinib), a Janus kinase inhibitor used in canines. Atopica® (cyclosporine, modified), a calcineurin inhibitor, is another agent used in canines and felines for treatment of atopy. These medications work well for many patients.

However, Apoquel has a history of being unavailable for periods of time, which is a frustration for veterinarians. Barriers to oral administration, such as biting, clawing, scratching or hiding, can also be issues for pet owners having to give these medications to their pets.

Compounding Ideas
The compounding pharmacist can be a huge aid to the owner and the veterinarian by offering different dosage forms, active pharmaceutical ingredients and bases that have advantages in these cases. Apoquel tablets can be compounded into a fixed oil suspension formula to aid in administration. PCCA Formula #9271 would be appropriate to use in this case, and PCCA members can access it here. When a more concentrated solution of cyclosporine is needed to aid administration, PCCA Formula #4815, an oral veterinary solution, is an option. PCCA members can access it here. As with any dosage-form changes, it would be important to monitor the patient in these situations because altering the dosage form may change the pharmacokinetics of the active ingredient.

Topical medications can be helpful for veterinary patients with atopic dermatitis either alone or in conjunction with the two previously mentioned drugs as well. Creams, gels, ointment and shampoos are the various dosage forms that can be compounded. However, one major issue with using creams, gels and ointments is they can mat the fur and make it greasy or sticky when applied. This is very undesirable for many owners, especially those with show animals where appearance is extremely important. The compounder can reformulate these products for the veterinarian using a base that soothes skin and does not mat the fur, such as PCCA’s ZoSil®.

ZoSil is a silicone hydrogel base designed specifically for animal skin. It’s rich in fatty acids, such as omega 3, omega 6 and conjugated linoleic acid. It also contains shea butter and hyaluronic acid. ZoSil uses Smart Diffusion Technology™ to release these ingredients, which are important in soothing and moisturizing, and help improve the appearance of red, flaky and irritated skin. The Smart Diffusion Technology works by encapsulating the previously mentioned ingredients in microscopic spheres that dissolve in the presence of lipases and phospholipidases normally released by the inflammatory response of the skin. However, this technology works in the absence of inflammation as well, as the spheres dissolve over time in the absence of the enzymes.

This combination of ingredients nourishes the skin and makes ZoSil a great choice in formulations for veterinary patients experiencing atopic dermatitis. Active pharmaceutical ingredients such as antibiotics, antifungals, anti-inflammatories, anesthetics, antiseptics and mast-cell stabilizers can be used in formulations with ZoSil.

Getting started in veterinary compounding? PCCA Clinical Compounding Pharmacist Mark Gonzalez has some advice.

Naltrexone is one active ingredient that may be helpful for patients experiencing atopic dermatitis. In a study published in the Journal of the American Veterinary Medical Association, canine patients were successfully treated with oral naltrexone for acral lick granulomas that were a result of atopy. The licking behavior may be reinforced by a decrease in pain perception due to the release of endogenous opioids. The theorized mechanism of action is that the naltrexone blocked the release of endogenous opioids, which increased the perception of pain and abated the licking behavior.² Naltrexone may be used topically in this same manner.

Tranilast,* a mast-cell stabilizer, is also a good option. It may be used orally or topically. In cases where the skin barrier has been compromised and infection has set in, antibiotics and antifungals may be used as well. Active pharmaceutical ingredients that address itching and inflammation may also be helpful.

Formulas to Consider
PCCA has a number of formulas that may be clinically relevant for veterinary patients with atopic dermatitis, including some that have been evaluated in our FormulaPlus™ program and have extended beyond-use dates backed by stability-indicating assays. PCCA members can access them here.

If PCCA members have any questions about ZoSil or compounding for veterinary atopic dermatitis, please call our Clinical Services department at 800.331.2498.

Deborah Clark, BSPharm, RPh, is a Clinical Compounding Pharmacist at PCCA. She previously worked in two independent hybrid pharmacies in Charlotte, North Carolina, managing compounding operations. While there, she worked with a local veterinary specialty and emergency hospital providing compounded medications for challenging veterinary patients. She also worked with the Carolina Raptor Center and several smaller veterinary clinics in the Charlotte Metro area. Deborah’s compounding experience also includes hospice, hormone replacement therapy, pain management, wound care, sterile products and pediatrics. She is certified in medication therapy management, and she is an associate member of the Society of Veterinary Hospital Pharmacists.

A version of this article was originally published in the Apothagram, PCCA’s members-only magazine.

References
1. Moriello, K. A. (n.d.). Overview of atopic dermatitis. Merck Veterinary Manual. Retrieved from http://www.merckvetmanual.com/integumentary-system/atopic-dermatitis/overview-of-atopic-dermatitis
2. White, S. D. (1990). Naltrexone for treatment of acral lick dermatitis in dogs. Journal of the American Veterinary Medical Association, 196(7), 1073-1138.

*In February 2019, the U.S. Food and Drug Administration announced that it would not add tranilast to its list of bulk drug substances that can be compounded in medications for human use. However, this ruling does not affect compounded medications for veterinary patients. Therefore, tranilast is still an option in veterinary compounding.

These 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 references cited did not necessarily evaluate PCCA products or formulas included in these statements. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment.

PCCA Play: February’s New Releases

Mon, 11 Feb 2019 17:20:19 GMT

PCCA Play is our members-only, educational media library. It offers tens of thousands of dollars’ worth of free educational content available on desktop, tablet or smartphone. PCCA members can also access premium content through a subscription or a la carte rental.

PCCA Play includes everything from main-stage presentations at our live events to our recorded webinars, bringing PCCA members the information they need, when and where they need it.

New Release for February 2019

Compounding for Exotics
With Gary Riggs, DVM

How to Build a Niche Vet Practice [Available February 19, 2019]
With Mark Gonzalez, PharmD

How to Get Started in Veterinary Compounding

Thu, 10 Jan 2019 19:41:13 GMT

How to Get Started in Veterinary Compounding

By Mark Gonzalez

Over the past 20 years, I have seen the pharmacy compounding industry experience shifts and changes in many different ways. There have been shifts in legislation, technology and the demand for certain types of compounds. Through it all, however, there have been many constants as well. One of those constants is the area of veterinary pharmacy compounding. The need will always be there, and the demand only grows year by year. The American Veterinary Medical Association acknowledges this on its website when it states that “compounding is a needed tool and provides much-needed therapeutic flexibility for veterinarians, especially considering the wide range of species and breeds veterinarians treat.”¹

Veterinary compounding can also be intimidating for those who have yet to venture into it. The fear of a general lack of veterinary knowledge can often stop compounders from discussing customized medication with veterinarians. But by not exploring this specialty, compounding pharmacies may be missing out on what could become a very exciting, helpful and financially beneficial addition to their practices.

So how can you break down this barrier and start to introduce your valuable services to the veterinary community? My recommendation is to dream big, but start with the basics.

Dream Big

First, look at all of the veterinary compounding opportunities that exist in your immediate area. Veterinary offices, specialty practices (dermatology, avian, ophthalmology, etc.), zoos, aquariums, pet stores, shelters and many other facilities can open you to a patient population of thousands just miles from your front door. Although all of these animals may vary in size and physiology, they have one thing in common with your human patients: They have medication problems related to side effects, dosage restrictions, hard-to-find medication and many more issues. You may not be a veterinarian, but you do have the ability to solve many of these problems very easily, and over time, your experience and knowledge will grow.

Start by searching online for facilities in your community that work with animals, and make a list. Trust me, these places need your help, and veterinarians are great to work with.

Starting with the Basics

When you begin visiting veterinary facilities from your list, present basic and unique solutions that will fulfill the majority of the problems that they face. While it is common practice to offer a list of popular formulas, I have found that this can leave the veterinarian with a limited perception of what the compounder is truly able to provide.

My goal was to always make sure that I left every practitioner with an understanding of the broad scope of what compounding was able to provide their practice. The most effective way of communicating this was by leaving non-medicated samples of compounding bases as well as clear educational materials about them. If I left veterinarians with a list of my top five compounds, it could result in a few prescriptions if they ever needed those compounds. But if I left them with a clear understanding of five bases, I could begin to help them think outside the box, and this could result in hundreds of potential prescriptions.

Leaving samples of bases allows the veterinarian to use all five of their senses when evaluating what they are left with. This adds another level of depth to your marketing that is not possible if you simply leave them with a list of formulas.

To start, I would recommend showing up to your local veterinary office with 10 mL samples of the following:

PCCA Fixed Oil Suspension Vehicle
Lipoderm®
ZoSil®
PCCA Poloxamer 20% Gel
PolyOx® WSR-301 insufflation powder with collapsible 30 mL bottle

Each of these bases provides the practitioner with a means of medication administration that is unique and beneficial to their patients.

You could also provide an information sheet on the properties of each base and how it is used to solve medication problems. I used to place all of these items in a small box, wrap it with generic wrapping paper, and leave it as a gift to the practitioner with a card saying, “Give your patients and customers the gift of compliance!” This separated my marketing piece from all of the others the practitioner was receiving and almost guaranteed that they would open it. And who doesn’t like to receive a present? This gift opened up many conversations with veterinarians when medication problems came their way.

Veterinary compounding is not only exciting, but it can be a profitable part of any compounding practice. Dream big, start with the basics, and you may see this specialty grow to new levels within your pharmacy.

PCCA members, do you want to learn more about veterinary pharmacy compounding? Join us for the PCCA Veterinary Symposium in San Diego, California, from March 28–30, 2019. Learn more and register here.

Mark Gonzalez, PharmD, is a Clinical Compounding Pharmacist at PCCA. He owned and operated Med Specialties, a pharmacy in Yorba Linda, California, for 18 years before joining PCCA. His areas of specialty are hormone replacement therapy, dermatology and veterinary compounding.

A version of this article was originally published the Fall 2018 issue of the Apothagram, PCCA’s quarterly, members-only magazine.

Reference

American Veterinary Medical Association. (n.d.). Compounding. Retrieved from https://www.avma.org/KB/Resources/Reference/Pages/Compounding.aspx