Last modified: Wednesday, August 6, 2008 9:57 AM PDT Technician Rachel Garcia drops empty capsules into a loader at Ontario Pharmacy Tuesday morning. The pharmacy has a compounding room to produce specialty medications for its customers. A blend of talent By Johna Strickland Argus Observer Ontario — Each day at Ontario Pharmacy, Sue Reynolds and Rachel Garcia visit the past as they blend chemicals to create different applications for known drugs. Creating a quality product from approved recipes to fit a customer’s specific need is a specialty service, Ontario Pharmacy business development manager Jaren Reyna said. “This is really the way we do it, meet each patient’s needs one at a time,” Reyna said. “There’s a huge need for it.” From the compounding room on Southwest Third Avenue, for example, Reynolds and Garcia can create an alternative to a capsule for a patient who cannot swallow, Reyna said. The active ingredients of the prescribed drug can be changed to a topical cream, a lozenge, a spray or a suppository. “(We’re) taking a medication that is already there and changing the application,” Reyna said. “This was done from the beginning.” Pharmacies compounded their own drugs until about the 1960s, Reyna said, when drug manufacturing began. The nearly 102-year-old Ontario Pharmacy left compounding but returned to the practice 10 years ago. Other small pharmacies have gone back to compounding also to separate themselves from chain drugstores, Reyna said. “If we weren’t doing this, we might as well close the doors,” Reyna said. “Ones that are doing the compounding are gonna be here 10 years from now. The ones who aren’t, won’t.” Ontario Pharmacy’s first specialty drugs were mixed in the store’s kitchenette, Reynolds, an employee for 31 years, said. Now she, Garcia and other certified technicians blend recipes approved by the Professional Compounding Centers of America in a larger room filled with flavoring, empty capsules, ingredients and machinery. “We’re the cooks,” Reynolds said, noting a pharmacist will go over a recipe for the first time with a technician. The PCCA tests each formula and ingredient as a drug manufacturer would to meet Food and Drug Administration requirements. Compounding centers, though, are inspected by state boards, Reyna said. The modern equipment has enhanced their work, Reynolds said, pointing out the equipment Tuesday morning as Garcia used it to prepare a hormone replacement therapy cream. Garcia started by measuring each compound within a filtered tube designed to suck especially fine powders away from the technician. She then placed the medication in a stirring container and attached it to the mixer, which can be formatted by revolution and time. Next she sent it through a mill resembling a clothes wringer before loading it in measured syringes for adminstration. “We run it through this mill to reduce it to that fine, fine texture,” Reynolds said of the white cream. Although the ingredients have already been micronized to the most absorbable levels, the mill breaks them down even more. The cream Garcia compounded combines a couple of medications, Reynolds said. “(The patient) doesn’t have to swallow two to three pills. She’s just going to apply it on one spot on her body,” she said. Topical application drives the active drugs directly to the afflicted area faster and with more potency, Reynolds and Reyna said. A topical cream doesn’t need to travel through the blood, upset the stomach or strain the liver and kidneys before taking effect, Reynolds said. The drug may hit the bloodstream at 100 times more concentrated levels once it has penetrated the skin, Reyna said. Also, the compounding room can produce discontinued drugs for customers by purchasing the powder and capsulizing it, Reyna said. Another advantage of customized drugs is the pharmacy can alter the strength of a dosage and the medication’s flavor. Usually they use chemicals, but for one bitter drug commonly prescribed to children, pharmacist and owner Bob Wheatley worked with technicians to add Hershey’s chocolate syrup and peppermint. Reynolds said she will taste a medication, if it will not harm her. She even tries the veterinary compounds flavored like grilled chicken, beef and fish. She ate one of the beef–flavored capsules once but found it had only a light beef taste. Garcia, who said she has a weaker stomach, doesn’t taste and leaves when Reynolds opens pungent ingredients. Patients, medical doctors and veterinarians appreciate the specialized service, Reynolds said, noting the pharmacy mails drugs to Baker City, Burns and towns north of Weiser. Reynolds said she finds her work rewarding, especially when she can help a patient in a special way. Once a nurse called the pharmacy about a medication called blue goo that she had heard about from an East Coast nurse. After a call to the PCCA to obtain the recipe, Reynolds and other technicians compounded a batch of blue goo and sent it off with the patient’s husband. Within 30 minutes, he called to thank them, saying his wife was smiling again. Garcia likes the daily challenges in figuring out which chemicals can be blended by reading workbooks and talking with pharmacists. “Everything’s a challenge, trying out something different to see if we can do it,” she said. “I think it’s just making our patients happy.”