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.
