Along with physician services to attend to a patient’s medical needs, the skills and caring of a knowledgeable pharmacist are necessary to provide symptom control and pain relief in an end-of-life situation. Pharmacy compounding is quickly becoming a practical and compassionate way to meet these needs. Compounding is the art and science of preparing customized medications for patients, and its resurgence in recent years offers valuable benefits to those in hospice care.
The Compounding Solution
Why should you ask your physician or pharmacist about compounded medications for hospice care? Because compounding is especially suited to the idea of providing personalized individual care to a dying patient. Pharmacists play a major role in the hospice environment, as caring for the hospice patient generally centers around providing comfort by using pharmaceuticals to relieve and manage symptoms.
Every individual is unique, and experiences during the end of life can vary from person to person. However, common symptoms experienced curing end-of-life care include pain, nausea/vomiting, constipation, diarrhea, bedsores and anxiety – all of which are often best dealt with through compounding. By working closely with a compounding pharmacist, a physician can prescribe a regimen of care which is tailored to the hospice patient’s individual needs.
Combined Formulations
Ordinarily, the first symptom requiring relief is pain, and managing it often requires medication around the clock. Compounding pharmacists can often provide specialized medications for patients who suffer from acute and chronic pain. To keep the administration of medicine to a minimum, unique drug combinations can be prepared to allow patients to continue to live normally within their pain threshold.
Alternate Dosages
Many hospice patients have trouble taking medications in traditional dosage forms. In such cases, compounding can provide a more appropriate method of administering medicine. For instance, a patient who is unable to swallow may be given transdermal gels which carry medication through the skin to help provide relief. Other patients may prefer medications prepared in a flavored troche form. A troche is placed between cheek and gum melts slowly, releasing the drug inside the mouth where it is absorbed through the many blood vessels under the tongue. Medications may also be prepared as suppositories, oral suspensions or even as lollipops.
Strength Variations
In hospice care, it remains vitally important to relieve as much pain as possible without causing sedation and adverse side effects. Since patients vary in size and tolerance, commercially available medications often do not provide an appropriate strength. Through compounding, a physician and a pharmacist can design a medication to the exact dosage needed by the patient.
Caring for a loved one in a hospice environment can be both challenging and rewarding. Through the relationship between a caring physician and a compounding pharmacist relief of pain and other symptoms can be tailored to a patient’s specific needs.
Compounding Opportunities in Hospice Medicine
Nausea & Vomiting
Suppositories, troches, suspensions, transdermal gels, rapid dissolve
Excess Salivation
Oral Rinses, capsules, liquids, rapid dissolve
Pain
Transdermal gels, suppositories, extended-release capsules, troches, topical gels, rapid dissolve
Neuropathic Pain
Transdermal gels
Seizures
Suppositories, rectal gels, transdermal gels
Dry Mouth
Saliva substitute gels and liquids, saliva stimulant troches, sprays, capsules
Thrush
Lollipops, troches, oral rinses, topical bases