The History of Compounding

January 14th, 2008

On a regular basis I am asked about the Pharmaceutical Compounding available here at the CD Whyteridge Pharmacy. Basically Pharmaceutical Compounding is the oldest element of pharmacy practice; at its base it is the practice of building or creating medicines at the request of doctors for the use of patients. These days it is done by a relative minority of pharmacists yet throughout history Compounding Pharmacists have played key roles in developing and delivering important drugs to patients. Some examples include ASA, Opium and Coal Tar; all drugs that have helped mankind but which required extensive Compounding before being truly useful.

ASA
Originally Greek physicians (including Hippocrates), and earlier ones, used the inner bark of the willow tree to treat pain. However there were many side-effects to using the medicine that sometimes included cause skin rashes, stomach irritation, nausea, vomiting, kidney inflammation, and tinnitus (ringing in the ears). Early pharmacists attempted to compound a better drug by mixing willow bark with other ingredients to limited effect.

Finally, in the 1830’s, the active ingredient of the bark (salicin) was isolated and, in 1897, the German Bayer laboratories synthesized a stable form of the powder. Later this became known as “Aspirin” and was sold to pharmacists as a pain relieving drug and quickly became the number one selling drug worldwide.

Opium
Opium (and its related forms of Codeine and Morphine) is another drug that required compounding. The poppy was a plant whose analgesic effects had long been known by doctors and scientists but an effective and precise delivery system was difficult to find. Finally Paracelsus (Philippus Aureolus Theophrastus Bombastus von Hohenheim, 1490-1541) compounded a substance called laudanum, a mixture of opium with brandy. Later the recipe was standardized by Thomas Sydenham (1624-1689). His recipe was:

“2 ounces of opium; 1 ounce of saffron; a drachm of cinnamon and cloves - all dissolved in a pint of Canary wine.”

In that form the drug was used (and abused) for the next two hundred years. Today a descendent of laudanum is still available (in a very different form) as deodorized tincture of opium which is a very valuable therapeutic drug indeed for treating diarrhea. Opium is also the parent drug of such common drugs as Codeine and Morphine.

Coal Tar
Coal Tar was commonly used for a variety of medicinal purposes as it contains hundreds of various chemicals. When applied topically, for example, Coal Tar is an effective treatment for many skin conditions like dandruff and therefore Tar was researched thoroughly by compounding pharmacists as they attempted to find out all its secrets.

Finally in the 1930’s Gerhard Johannes Paul Domagk (1895-1964), a German chemist, led a team of chemists who isolated the different constituents of coal tar and developed synthetic dyes from them. One of these synthetic dyes was the first sulfa drug and that drug gave rise to modern antibiotic therapy.

The Decline of Compounding and it’s Resurgence
By the early 1900’s active chemicals of various drugs were being produced by companies like Merck and Eli Lilly and the pharmacists would then compound them. By the 1950’s though pre-made compounds became more available and Compounding, which every pharmacist had practiced, became less common and finally almost died out.

More recently however patients and doctors have rediscovered the value of Compounding and now there are thousands of pharmacists around the world trained in Specialty Compounding. Specialty Compounding involves the pharmacist changing the medicine they are dispensing (with the approval of the attending physician). The pharmacists can remove unpleasant (or allergy-causing) dyes or preservatives, add new flavours and change delivery systems (for example turning a hard to swallow pill into a lollipop!) It is even possible for a pharmacist trained in Specialty Compounding to create brand new medicines for their patients to reduce side-effects.

Conclusion
So that, in a nutshell is what Compounding is. If you have any more questions please come down to CD Whyteridge Pharmacy, or call us, and let us help you!

Sidebar
Compounding Pharmacists and Soda Pop
Not many people know that Compounding Pharmacists are responsible for the creation of soda pop but it’s true. Compounding Pharmacists had to conceal the flavors of many drugs and, in the 1800’s, started to combine soda water with syrup. It was soon discovered that these syrups and soda water tasted great when combined so the soda fountain was born.

Indeed Coca-Cola was originally made with coca leaves (the source of cocaine) and kola nuts (a source of caffeine) to provide a stimulant effect. At that time it was marketed as a headache remedy and general tonic! It is rumored that today Coca-Cola is made with coca leaves that are treated to remove any of the dangerous active alkaloid.

By Dennis Wong