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  Last Updated on 07/13/2018

Process Makes Swallowing Bitter Pills a Bit Easier

by Joe Kraus, Wilkes-Barre Times Leader, June 22, 2004

Victoria Dunbar used to have her hands full making sure that her two children, both diagnosed with autism, took all of the medicines their doctors prescribed for them. Then she discovered that some local pharmacies can make those medicines with flavors and textures that her children are happy to take.
"My son won't tolerate certain tastes or smells. He can't take pills," she said. Then a friend suggested she contact Harrold's Pharmacy near her home in South Wilkes-Barre. "They made a solution of Adderall that has no taste, no smell, and it's amazing. It works."
According to Bruce Lefkowitz, owner and head pharmacist at Harrold's, Dunbar's experience is common. Many children resist taking their medicine and many elderly are unable, so he has found a local market for hand-processing mass-produced drugs into creams, liquids or capsules in a wide variety of flavors.

Such procedures, called compounding, are about more than pleasing a patient, Lefkowitz said. When drugs come in forms that people refuse to take, it complicates treatment.

"A lot of kids and adults, too, in nursing homes, will 'cheek' their pills - put them in the pouch of their cheek where you'd chew tobacco," he said. "It looks as if the pill's taken, but it isn't."

In extreme cases, caregivers can go through a variety of treatment possibilities without realizing that the patient hasn't actually tried any of them. Lefkowitz said that he knew of a situation in which the parents of a child diagnosed with attention deficit disorder were nearly at their wits' end.

"They were trying everything, different therapies, different prescriptions. Then one day the mom found a pile of pills behind the couch," he said.

After that, they decided to try compounded drugs for their son.

"So they went right back to the beginning and tried the first drug again. We made it into a bubble-gum Adderall suspension. After three days, the child did a 180-degree turnaround," Lefkowitz said. "The mother came in and gave me a big hug."

Dunbar tells a similar story. She said that her son is particular about what he will eat and drink, and that before she and her husband tried the compounded drugs they had to work as a team to trick him into taking the bitter-tasting Adderall.

"One of us would have to sneak his medicine into his white grape juice or water, and the other would try to distract him," she said. "Now he sees us putting the medicine into his drink, but he doesn't care because he knows it won't change the taste."

Georgia Liberatori, assistant administrator and director of hospice for Northeast Health and Hospice Care in Pittston, said she confronts some of the same challenges with the patients in hospice care, many of whom have difficulty swallowing.

"(Compounding is) the best kept secret," she said. "We use it all the time."

Liberatori gave an example of how compounding can comfort people who are already suffering.

"We just had a patient who had to take three large capsules a night along with another medicine," she said. Harrold's was able to combine them all into a single suppository. "It saves us from having to use more invasive procedures, like injection, which can be very painful," she said.

Jim Gaudino, owner and chief pharmacist of Cook's Pharmacy in Kingston, said that compounding drugs is one way a local pharmacy can provide extra service. He said that he and his staff do not flavor oral medications. They mix creams for topical application or suppositories, which often work well with progesterone therapy for women trying to conceive.

Gaudino said that his customers seem appreciative of the specialized service. "A lot of them tell us they've gone to five pharmacies and no one could do it," he said. "They're glad we do it and they come back."

Lefkowitz said that he sees his work with compounding drugs as a return to the old days of being a pharmacist.

"My grandfather in the 1940s was compounding because there weren't commercially available products," he said. Then, during his father's career, drug companies began to mass-produce medications, and pharmacists' jobs shifted more to dispensing drugs and information about drugs.

"Now it's come full circle. We're compounding for special needs," he said.



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