Yes, doctors do recommend compounding pharmacies when regular medications don’t meet your specific needs. However, they only suggest them when truly necessary – like when you need a special dose, have allergies to ingredients, or can’t take pills. Most doctors prefer FDA-approved drugs first, but compounding becomes important when those options won’t work for you.
In this guide, we’ll explain when doctors recommend compounding pharmacies, how safe they are, and what you need to know before using one.
What Are Compounding Pharmacies?
A compounding pharmacy is a special type of pharmacy that makes custom medications just for you. Unlike regular pharmacies that give you pre-made pills, compounding pharmacies mix ingredients to create medicines that fit your exact needs.
According to the American Pharmacists Association, about 7,500 of the 56,000 community pharmacies in the United States offer compounding services. These pharmacies can change how your medicine looks, tastes, or works to make it easier for you to take.
How Compounding Pharmacies Work
Think of compounding pharmacies like custom bakeries. Instead of buying a cake from the store, they make one just for you with the exact ingredients you need. Compounding pharmacists mix, blend, and adjust medicines to create:
- Creams and ointments for your skin
- Liquid medicines for people who can’t swallow pills
- Special doses that aren’t sold in stores
- Flavored medicines for kids
- Medicines without ingredients you’re allergic to
Compounded medicines represent up to 3% of all pharmaceutical prescriptions, showing they serve a small but important role in healthcare.
When Do Doctors Recommend Compounding Pharmacies?
Doctors recommend compounding pharmacies in specific situations when regular medications won’t work for you. Here are the main reasons:
Custom Doses You Can’t Get Elsewhere
Sometimes you need a dose that drug companies don’t make. For example, if you need 15 mg of a medicine but it only comes in 10 mg or 20 mg tablets, a compounding pharmacy can make the exact dose you need.
Allergies to Common Ingredients
Many regular medications contain ingredients like:
- Dyes that cause reactions
- Gluten for people with celiac disease
- Lactose for those who can’t digest dairy
- Preservatives that irritate your skin
Compounding pharmacies can make the same medicine without these problem ingredients.
Different Forms of Medicine
If you have trouble swallowing pills, a compounding pharmacy can turn your tablet into:
- A liquid you can drink
- A cream you put on your skin
- A lozenge that dissolves in your mouth
Medicine Shortages
When regular pharmacies run out of important medicines, compounding pharmacies can often make similar versions. Recently, shortages of popular weight loss drugs such as tirzepatide (Zepbound) and semaglutide led people to compounding pharmacies.
Combining Multiple Medicines
Sometimes you need to take several medicines. A compounding pharmacy can mix them into one pill or cream, making it easier to remember your doses.
Are Compounding Pharmacies Safe?
The safety of compounding pharmacies is a complex topic. While they can be safe when used properly, they do carry some risks that regular pharmacies don’t have.
The Good News About Safety
Compounding pharmacies must follow certain safety rules:
- All compounding pharmacies must be licensed by their state
- They must follow guidelines from the US Pharmacopeia (USP)
- The DEA watches over any controlled substances they use
- Many get extra certifications for quality
The Risks to Know About
Compounded drugs aren’t reviewed by the FDA for purity, safety, or effectiveness. This means:
- You might not get exactly what you think you’re getting
- The medicine might be too strong or too weak
- There’s a higher risk of contamination
- Dosing mistakes can happen more easily
From 2001 to 2019, there were 73 reported compounding errors associated with more than 1,562 adverse events, including at least 116 deaths. However, this represents a very small percentage of all compounded medications made during this time.
The 2012 Meningitis Outbreak
The most serious compounding pharmacy incident happened in 2012. Patients developed fungal meningitis after receiving contaminated spinal injections of a compounded product. Almost 800 people got sick, and 64 died. This led to new, stricter rules for compounding pharmacies.
Types of Compounding Pharmacies
There are two main types of compounding pharmacies, and they have different safety standards:
503A Pharmacies (Traditional Compounding)
These are your local compounding pharmacies. They:
- Make medicines one at a time based on your prescription
- Are regulated by state pharmacy boards
- Follow less strict manufacturing rules
- Are good for most personal needs
503B Pharmacies (Outsourcing Facilities)
These are larger facilities that:
- Make medicines in bigger batches
- Are inspected by the FDA
- Follow stricter manufacturing rules
- Supply hospitals and clinics
- Are generally considered safer
How to Choose a Safe Compounding Pharmacy
If your doctor recommends a compounding pharmacy, here’s how to pick a good one:
Look for Proper Certifications
The best compounding pharmacies have:
- Pharmacy Compounding Accreditation Board (PCAB) certification
- Board-certified sterile compounding pharmacists (BCSCPs)
- State pharmacy board licenses
Ask the Right Questions
Before using any compounding pharmacy, ask:
- Are you licensed in my state?
- What training do your pharmacists have?
- Do third-party labs test your medicines?
- What safety certifications do you have?
Avoid Risky Online Pharmacies
When buying drugs online, you may not know whether the drug was produced by a compounder whose drugs meet appropriate quality standards, according to FDA guidance. Only buy from pharmacies that:
- Require a prescription from your doctor
- Have licensed pharmacists on staff
- Provide a real US address and phone number
- Are properly licensed and accredited
What Doctors Say About Compounding Pharmacies
Medical professionals have mixed feelings about compounding pharmacies. Here’s what they typically think:
When Doctors Support Compounding
Doctors are more likely to recommend compounding when:
- You truly need something that isn’t available commercially
- They know a reliable compounding pharmacy
- The benefits outweigh the risks for your specific situation
- You’ve tried regular medications without success
When Doctors Are Cautious
Many doctors prefer to avoid compounding when:
- A regular FDA-approved medicine would work just as well
- The compounding pharmacy isn’t well-known or certified
- You’re considering expensive compounded versions of cheap regular medicines
“It’s best to use a compounding pharmacy only when truly necessary — that is, when you need a medication that is not commercially available through a regular pharmacy”, says Dr. Robert Shmerling from Harvard Health Publishing.
Common Types of Compounded Medications
Certain types of medicines are more commonly compounded than others:
Pain Management
The pain management segment held a market share of 33.3% in 2023. Compounding pharmacies often make:
- Custom pain creams with multiple ingredients
- Special doses for chronic pain patients
- Medicines without ingredients that cause stomach problems
Hormone Replacement Therapy
Many women and men use compounded hormones for:
- Menopause symptoms
- Testosterone replacement
- Bioidentical hormone therapy
Pediatric Medicines
Children often need compounded medicines for:
- Liquid versions of adult medicines
- Flavored medicines that taste better
- Doses based on their weight
Veterinary Compounding
Pet care is a growing area for compounding. Animals often need:
- Flavored medications they’ll actually take
- Specialized dosages based on their size
- Transdermal gels for cats that won’t take pills
Cost Considerations
Compounded medications usually cost more than regular medicines. Here’s what to expect:
Why Compounded Medicines Cost More
- They’re made one at a time, not in large batches
- Special ingredients and equipment are needed
- More skilled pharmacists are required
- Testing and quality control add to costs
Insurance Coverage
Insurance companies often don’t cover compounded medicines the same way they cover regular ones. Some may:
- Require you to try regular medicines first
- Cover only part of the cost
- Not cover compounded versions of available medicines
Always check with your insurance before getting compounded medicines.
Benefits of Compounding Pharmacies
When used appropriately, compounding pharmacies offer several benefits:
Personalized Medicine
You get exactly what your body needs, not a one-size-fits-all approach. This can mean:
- Better results from your treatment
- Fewer side effects
- Medicines that are easier to take
Access to Unavailable Medicines
When regular pharmacies can’t help, compounding pharmacies often can. This is especially important for:
- Rare diseases
- Discontinued medications
- Drug shortages
Better Compliance
When medicines are easier to take, people are more likely to take them regularly. This leads to:
- Better health outcomes
- Fewer missed doses
- Less waste from unused medicines
Risks and Limitations
It’s important to understand what compounding pharmacies can’t do:
Not FDA-Approved
Compounded drugs aren’t FDA-approved, which means:
- No guarantee of safety or effectiveness
- Less quality control than regular medicines
- Potential for contamination or wrong doses
State-by-State Differences
Each state has different rules for compounding pharmacies. Some states have:
- Stricter safety requirements
- Better inspection programs
- More pharmacist training requirements
Limited Research
Unlike regular medicines, compounded drugs usually don’t have:
- Clinical trials proving they work
- Studies showing they’re safe
- Data on long-term effects
Working with Your Doctor
If you think you might need compounded medicine, here’s how to work with your doctor:
Be Honest About Your Needs
Tell your doctor if you:
- Have trouble swallowing pills
- Are allergic to certain ingredients
- Need a different dose than what’s available
- Aren’t getting better with regular medicines
Ask About Alternatives
Before jumping to compounding, ask if:
- There’s a regular medicine that might work
- A different brand might have fewer problem ingredients
- Changing how you take your medicine might help
Follow Up Regularly
When taking compounded medicines:
- Tell your doctor about any side effects
- Keep all follow-up appointments
- Don’t change your dose without talking to your doctor first
The Role of Specialized Compounding
Some medical conditions especially benefit from compounding:
Dermatology
Skin conditions often need custom treatments that combine:
- Multiple active ingredients
- Special bases that don’t irritate skin
- Specific concentrations for your skin type
Endocrinology
Hormone problems often require:
- Exact doses based on your blood tests
- Special forms your body can use better
- Combinations not available in regular medicines
Geriatrics
Older adults often need:
- Medicines without ingredients that cause confusion
- Different forms because of swallowing problems
- Lower doses because their bodies work differently
Quality Assurance in Compounding
Good compounding pharmacies follow strict quality rules:
Testing Requirements
Quality compounding pharmacies:
- Test ingredients before using them
- Check finished medicines for strength and purity
- Use sterile techniques when needed
- Keep detailed records of everything they make
Equipment Standards
Professional compounding requires:
- Clean rooms for sterile preparations
- Precise measuring equipment
- Proper storage conditions
- Regular equipment calibration
Staff Training
Compounding pharmacists need:
- Special training beyond regular pharmacy school
- Continuing education on new techniques
- Understanding of how different ingredients work together
- Knowledge of safety procedures
Finding Compounding Services
If you need compounded medicines, here are good places to look:
Through Your Doctor
Your doctor might already know reliable compounding pharmacies in your area. They can:
- Recommend pharmacies they’ve worked with before
- Help you understand if compounding is right for you
- Monitor your progress with compounded medicines
Professional Organizations
Several groups maintain lists of quality compounding pharmacies:
- Alliance for Pharmacy Compounding
- Pharmacy Compounding Accreditation Board
- International Academy of Compounding Pharmacists
Local Options
Many regular pharmacies also offer compounding services. These can be convenient because:
- You might already know the pharmacists
- They’re familiar with your other medicines
- It’s easier to pick up all your prescriptions in one place
The Future of Compounding
The compounding pharmacy industry continues to evolve:
Technology Improvements
New technology is making compounding:
- More precise and consistent
- Safer through better testing
- More accessible through automation
Regulatory Changes
Rules for compounding pharmacies are becoming:
- More standardized across states
- Stricter for safety reasons
- Clearer about what’s allowed
Growing Acceptance
More doctors and patients are learning about:
- When compounding is helpful
- How to choose safe compounding pharmacies
- The benefits of personalized medicine
Final Thoughts
Doctors do recommend compounding pharmacies, but only when you truly need something that regular pharmacies can’t provide. While compounding can be very helpful for people with specific needs, it’s not always the best choice for everyone.
The key is working with your doctor to decide if compounding is right for you, then choosing a reputable, well-certified compounding pharmacy. Remember that compounded medicines carry some risks that regular medicines don’t have, but for many people, the benefits outweigh these risks.
If you’re considering compounded medicines, talk to your doctor about your specific needs and concerns. They can help you understand whether compounding is the best option for your situation and guide you toward safe, reliable compounding pharmacies in your area.
Whether you need custom pet medications, pain management solutions, or specialized pediatric formulations, working with qualified professionals ensures you get the safest, most effective treatment possible.