Imagine if your doctor said that you needed a medication but the only ones available contain an ingredient that you are allergic to. Imagine you have a chronic pain condition, but the medications that relieve that pain come with intolerable side effects. Imagine your child with epilepsy requires a medication to be administered during a seizure. Oral suspensions and chewable tablets are not an option in this case.These are just three of the problems that pharmacist Sabrina McLean has solved.

In addition to regular dispensing activities, Sabrina spends much of her day working on finding solutions for patients who have a need for medications that are not regularly available from pharmaceutical companies. She is a problem solver.

She can find ways to compound that medication you need without the ingredient that you are allergic to. She can either find a recipe, or develop one of her own, for a cream compound containing pain medications that can be rubbed on your skin so you don’t have to take a pill and still get the same therapeutic results. She can make medications for children in a suppository so it can be given in a way other than oral liquids or pills and still provide quick results.

She has some patients who have weeping wounds that can’t use a cream because it hurts too much to apply or doesn't stay in place so she has been able to find a way to create a powdered version for the patients’ use.

Pain management is an area that particularly interests her.  Many pain medications that come in a pill format can cause significant side effects for some patients.

“I have two young sisters who have juvenile rheumatoid arthritis and one of them cannot take oral anti-inflammatories because she gets internal bleeding every time" she recalls. “The family was going to Disneyworld and were concerned about the amount of walking they had to.   We were able to make them a cream to help." The family ended up having a great trip.

“Instead of trying to fit the patient to the available medications, we make the medications to fit the patient,” says Sabrina.

Sabrina has a newsletter that she writes and distributes to doctors in her area about what she can do to solve medication problems. She gets calls more and more from doctors who say they have tried everything and are seeking her help.  Sometimes a doctor wants a specific combination of ingredients in a cream that doesn’t otherwise exist without compounding.

Sometimes, medications are hard to get or are impossible to get because they have been discontinued by manufacturers. Through compounding, Sabrina can obtain the raw ingredients and recreate the medication.

Many people with diabetes take a medication called metformin which can cause diarrhea. For some patients, this can be a serious problem.  Compounding the metformin into a cream can prevent this side effect.

When it comes to changing from an oral medication to a transdermal cream version, some calculations need to occur. Not all medications easily cross the skin barrier and the skin also absorbs medications differently than the stomach so Sabrina has to work with the patient and their doctor to find the right dosing.  This means that the cream may start off with a relatively low dose compared to what you would need in pill form and then the dosage will be increased if necessary until the optimal therapeutic results are reached.

Another area in which Sabrina has received additional training is Bioidentical Hormone Replacement Therapy which is used to help women manage the symptoms of menopause. Each product is specially formulated for each woman who needs it.

An area of Sabrina’s practice that is growing is cosmetic compounding.  There is more and more demand for anti-aging creams and skin lightening products. In addition, there are more people who are looking to avoid common additives, allergens and preservatives so a custom made formulation can provide exactly what they want – and don't want.

Medications can have flavours added to them to make them more palatable.  They can be made into a liquid format, versus a pill, to make them easier to ingest. 

There are a couple of places in which Sabrina can obtain formulas.  The IWK has a catalogue of formulas pharmacists can access. The pharmacy in which she works, MacKay’s PharmaChoice, is a member of the Professional Compounding Centers of America (PCCA) which gives Sabrina access to more than 8,000 formulas as well as a team of consultants with many years of therapeutic knowledge and compounding experience. But sometimes there is no formula to access and Sabrina has to make up her own. This is when her knowledge obtained in her chemistry classes really comes in handy.

“Sometimes it is hard to get certain chemicals to dissolve into a suspension, or a cream doesn't have the smooth, elegant feel we want it to have,” she says. Sometimes it takes a little while to get a compound just right, and there can be a few failed attempts in the lab before perfecting a formula and giving it to a patient. Sabrina often finds herself acting like a detective. And every day is different.

"When a compounding inquiry comes in, you never what it could be about. It certainly keeps things interesting" says Sabrina. "The diversity of medication-related problems people are experiencing is vast and I'm honoured to have the opportunity to help”