A compounded preparation is needed when no commercially manufactured medication is available to adequately address a patient's medical needs. Among the greatest therapeutic challenges faced by both patients and caregivers is the treatment required by individuals who have a terminal condition. It is difficult to find evidence-based studies on the management of end-of-life situations because each patient's medical case is unique. In addition, maintaining a controlled environment for such patients is difficult. End-of-life care is multifaceted and people with a terminal illness are among the most vulnerable patients in need of effective and compassionate care. When those patients suffer in spite of commercially available therapies, the innovation and experience of clinicians and compounding pharmacists can often yield a solution to the most challenging treatment problems. Compounds are often used in outpatient hospice and palliative care to treat common conditions such as ulcers/wounds, pain and dyspnea, intractable cough, nausea and vomiting, depression, bladder infections caused by an indwelling catheter, and rectal pain.

Int J Pharm Compd. 2014 May-Jun;18(3):190-200.

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   Despite their use of prophylactic antiemetic therapies, cancer patients continue to consider chemotherapy-induced nausea and vomiting (CINV) to be a significant problem. Patients frequently use various "breakthrough" medications for these symptoms. Unfortunately, there is a paucity of trials regarding treatment of breakthrough CINV. This study investigated the efficacy of "ABH," a topical gel containing lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®), in reducing breakthrough CINV. Adults receiving standard recommended prophylactic antiemetics as outpatients were instructed to use 0.5 mL of the gel topically when they experienced significant CINV. Patients then were contacted retrospectively to respond to a questionnaire rating their nausea and/or vomiting and their response to ABH gel treatment. The results were collected during two trials. During Trial I, 23 patients were evaluated; 17 patients (74%) reported that use of the gel decreased their CINV, with 15 (70%) reporting relief within 30 minutes of its application. Three patients believed that the gel caused sedation; no troubles with skin irritation or muscle spasms were reported. In Trial II, all 10 patients believed that the treatment was effective. When the severity of CINV was quantified on a scale of 0-10, the mean CINV score decreased significantly from a 6.1 before gel application to a 1.7 as evaluated 30 minutes following gel application. Topical use of ABH gel appears to be a promising and safe rescue therapy for breakthrough CINV that occurs despite prophylactic antiemetic therapy. These results warrant further confirmation in a large, randomized, placebo-controlled trial.

J Support Oncol. 2008 Jan;6(1):27-32.

      Pharmacologic treatment of chronic pain is challenging. Oral therapy may require multiple medications; each has side effects, dose limitations, and limited efficacy. Compounded topical formulations have evolved as potential treatment options. The objective of this study was to evaluate the efficacy of 2 compounded topical creams, "Cream I" and "Cream II", in patients with chronic extremity, joint, musculoskeletal, neuropathic, or other chronic topical pain conditions and compare their efficacy with Voltaren® gel. The primary efficacy outcome was the change in visual numeric pain intensity score from pretreatment to posttreatment. The Cream I contained flurbiprofen (20%), tramadol (5%), clonidine (0.2%), cyclobenzaprine (4%), and bupivacaine (3%). The Cream II contained flurbiprofen (20%), baclofen (2%), clonidine (0.2%), gabapentin (10%), and lidocaine (5%). The Voltaren® gel contained 1% diclofenac sodium. A total of 2177 patients were evaluated, 826 males and 1351 females. During their medical treatment, 1141 patients received Cream I, 527 patients received Cream II, and 509 patients received Voltaren® gel. After treatment, the pain intensity score decreased by 3.11 ± 1.65 (37%) with Cream I (from 8.44 ± 1.19 to 5.33 ± 2.0), by 2.93 ± 1.58 (35%) with Cream II (from 8.42 ± 1.27 to 5.50 ± 1.96), and by 1.49 ± 0.73 (19%) with Voltaren® gel (from 7.93 ± 0.81 to 6.44 ± 1.14). Cream I and Cream II did not differ significantly in efficacy, and both provided greater pain relief than was reported with Voltaren® gel.

Am J Ther. 2015 Sep-Oct;22(5):342-9.

   A patient-specific, stepped approach to topical and intranasal analgesic pharmacotherapy was effective in reducing refractory postherpetic neuralgia (PHN) not responding to the current standard of care for PHN. The use of topical analgesic therapy allowed for higher concentrations of medication locally while reducing the likelihood of systemic side effects common to the drugs used. No adverse effects were noted for either topical or intranasal drug therapy. This approach resulted in clinically significant decreases in pain on the visual analog scale (VAS), with the use of intranasal ketamine 10% solution and topical gabapentin 6%, ketoprofen 10%, lidocaine 5%, and ketamine 10% cream.

We can compound customized medications in  the optimal dose and dosage form to meet specific patient needs.