One of the most rewarding areasof compounding practice ishelping patients who are dealingwith complications of pregnancy. Inthese cases, a compounding pharmacistcan, at times, literally be a lifesaver forwomen who suffer from luteal phasedefect or low progesterone levels duringthe first trimester, or those who are athigh risk for preterm labor. Studies indicatethat in certain cases these conditionsmay be successfully treated withprogesterone therapy.1,2
Luteal phase defect occurs whenthere is an inadequate secretion of progesteroneduring the menstrual cycle,which causes the uterine lining to developimproperly.3 When this happens, itcan lead to infertility or early miscarriage,if the egg is not able to implant inthe endometrium or is unable to adhereto the uterine lining due to low progesteronelevels. Progesterone levels areusually checked as a part of an initialprenatal screening, and, if the patient'slevels are low, the physician may prescribea progesterone supplement duringthe first trimester to build up theuterine lining. Patients who have a historyof infertility and/or early miscarriageare sometimes prescribed progesteronesupplements during the latter half oftheir menstrual cycle after ovulation toboost the likelihood of implantationoccurring, and also to reduce the risk ofspontaneous abortion.
In these cases, it is important to prescribenatural progesterone, which iscommercially available in oil capsules(Prometrium) or as a mucoadhesive vaginalgel (Crinone). While these productscan be effective in treating low progesteronelevels, these therapies may becontraindicated or cost-prohibitive forsome patients and are limited tostrengths available through the manufacturer.In such situations, a compoundingpharmacy can be a valuable resource.Some physicians prefer to prescribeprogesterone vaginally, and in thesecases vaginal suppositories can be preparedin the proper strength for eachindividual patient. They are easy to useand fairly economical when comparedwith commercial alternatives. In additionto vaginal suppositories, compoundedprogesterone troches offer a sublingualdelivery of natural progesterone and arealso an economical choice. For patientswho are in the early stages of pregnancy,the usual course of treatment laststhrough 12 to 14 weeks gestation, atwhich time the placenta will have developedand taken over progesterone production.1
For some patients, risk occurs later inpregnancy with the development ofpreterm labor and premature delivery.Recently published studies indicate thatrisk may be reduced in women with ahistory of preterm labor and/or deliverywith weekly injections of hydroxyprogesteronecaproate, also known as 17P.4,5While not all compounding pharmacieshave the technology required to producethis medication, many do have the equipmentand facilities necessary and canprepare 17P. Initiation of this therapy typicallyoccurs between weeks 16 and 20for women with a previous history ofpreterm delivery and in most cases iscontinued weekly for the remainder ofthe pregnancy.4
For patients who are experiencingcomplications of pregnancy or reproductivehealth issues, a compounding pharmacistmay have the answers whencommercial medications do not. Forpharmacists, these cases are usuallyamong the most fulfilling that theyencounter in their practice, if not in theircareers.
Ms. Fields is with the InternationalJournal of Pharmaceutical Compoundingand is a pharmacy technicianat Innovative Pharmacy Servicesin Edmond, Okla.
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The International Journal ofPharmaceutical Compounding(IJPC) is a bimonthly scientific andprofessional journal emphasizinghigh-quality pharmaceutical compounding.The journal covers topicsrelevant and necessary toempower pharmacists to meet theneeds of today's patients. For moreinformation, or to subscribe toIJPC, visit www.ijpc.com, or call888-588-4572.
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