Changing the Route of Drug Administration:
The Advantages of a Compounded Medication versus Off-Label Use

  Many medications are prescribed for "off-label" use or an alternate route of administration in order to improve the therapeutic response, provide an economical alternative to solve a medication problem, or minimize the incidence of side effects, because the desired dosage form is not commercially available (for example, eye drops may be used to treat ear infections). In some cases (e.g., terminal illness), alternate routes of drug administration are used because patients simply cannot take needed medication by the intended route.

   It is essential that consideration is given to the formulation and excipients as well as active ingredients, particularly when prescribing a route of administration that is different than the labeled use. For example, patients have been instructed to instill tablets and syrups rectally. Because syrups contain sugar, they can be very messy and sticky, and syrups may need to be diluted with water since their high sorbitol concentration may cause bowel evacuation (a problem that can be avoided by prescribing a properly compounded rectal formulation). Patients should always check with our pharmacist before making assumptions: for example, although eye drops may be used in the ears, ear (otic) drops can not be used in the eyes because otic preparations may not be isotonic, which means that significant problems can occur due to differences in concentration gradients, and ear drops may also contain preservatives that can be harmful to the eyes.

   Many anticonvulsants, analgesics, and sedatives are given rectally when patients can't take oral meds. The dosage of medication must be individualized as drug absorption via the rectum can be highly variable, i.e., delayed or almost as fast as an intravenous bolus. Therefore, the dose or dosing interval may need to be adjusted when the route of administration is changed.

Our compounding pharmacy can obtain the necessary drug as a bulk chemical and prepare a customized medication in the most appropriate strength and dosage form to solve each patient’s specific medication problems. Please contact us for more information.

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