One of the most rewarding areas of compounding practice is helping patients who are dealing with complications of pregnancy. In these cases, a compounding pharmacist can, at times, literally be a lifesaver for women who suffer from luteal phase defect or low progesterone levels during the first trimester, or those who are at high risk for preterm labor. Studies indicate that in certain cases these conditions may be successfully treated with progesterone therapy.1,2
Luteal phase defect occurs when there is an inadequate secretion of progesterone during the menstrual cycle, which causes the uterine lining to develop improperly.3 When this happens, it can lead to infertility or early miscarriage, if the egg is not able to implant in the endometrium or is unable to adhere to the uterine lining due to low progesterone levels. Progesterone levels are usually checked as a part of an initial prenatal screening, and, if the patient's levels are low, the physician may prescribe a progesterone supplement during the first trimester to build up the uterine lining. Patients who have a history of infertility and/or early miscarriage are sometimes prescribed progesterone supplements during the latter half of their menstrual cycle after ovulation to boost the likelihood of implantation occurring, and also to reduce the risk of spontaneous abortion.
In these cases, it is important to prescribe natural progesterone, which is commercially available in oil capsules (Prometrium) or as a mucoadhesive vaginal gel (Crinone). While these products can be effective in treating low progesterone levels, these therapies may be contraindicated or cost-prohibitive for some patients and are limited to strengths available through the manufacturer. In such situations, a compounding pharmacy can be a valuable resource. Some physicians prefer to prescribe progesterone vaginally, and in these cases vaginal suppositories can be prepared in the proper strength for each individual patient. They are easy to use and fairly economical when compared with commercial alternatives. In addition to vaginal suppositories, compounded progesterone troches offer a sublingual delivery of natural progesterone and are also an economical choice. For patients who are in the early stages of pregnancy, the usual course of treatment lasts through 12 to 14 weeks gestation, at which time the placenta will have developed and taken over progesterone production.1
For some patients, risk occurs later in pregnancy with the development of preterm labor and premature delivery. Recently published studies indicate that risk may be reduced in women with a history of preterm labor and/or delivery with weekly injections of hydroxyprogesterone caproate, also known as 17P.4,5 While not all compounding pharmacies have the technology required to produce this medication, many do have the equipment and facilities necessary and can prepare 17P. Initiation of this therapy typically occurs between weeks 16 and 20 for women with a previous history of preterm delivery and in most cases is continued weekly for the remainder of the pregnancy.4
For patients who are experiencing complications of pregnancy or reproductive health issues, a compounding pharmacist may have the answers when commercial medications do not. For pharmacists, these cases are usually among the most fulfilling that they encounter in their practice, if not in their careers.
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.
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The International Journal of Pharmaceutical Compounding (IJPC) is a bimonthly scientific and professional journal emphasizing high-quality pharmaceutical compounding. The journal covers topics relevant and necessary to empower pharmacists to meet the needs of today's patients. For more information, or to subscribe to IJPC, visit www.ijpc.com, or call 888-588-4572.
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