Bupivacaine is one of the local anesthetics, an important class of drugs, administered mostly via injection for pain reduction purposes. Also important in managing different types of pain are compounding pharmacies, especially in the field of surgery medicine. Compounding pharmacies are defined as drugs which are customized by a professional pharmacist or a physician to suit the unique needs of an individual patient. There are many ground for compounding medicines, from changing the aggregation state, eliminating a possible allergic ingredient that is not essential for the medication’s efficacy, to obtaining an accurately dosed drug with lower incidence of side-effects.
Compounding pharmacy origins are far-reaching, it is old as the pharmacy itself, but has went on for a long and intensive evolution. Nowadays, with new modern technologies and equipment, compounding pharmacy is a powerful tool for helping many patients who have specific needs. Compounding medications used to participate in the overall medication market with 60% in the early ages of past century, but the percentage had dropped significantly in the recent years, to a miniature 1% today.
Diverse pharmaceutical formulations can be made as compounding medicines, including sterile intramural preparations for pain management, dermatological preparations, sterile ophthalmics and injectables, preservative-free and hypoallergenic preparations, hormonal preparations, palatable pediatric preparations, wound care preparations, to trans dermal medications etc.
Design and preparation of the medication is done by a professional pharmacist, who can make a medication for the purposes of any area of medicine. These new personalized medications represent the revival and future of medicine and medical treatment. Mass product medications are not helpful to millions of people with specific needs and that is where the compounded pharmacies come in the game, they help those individuals to achieve their health care objectives. Categories of population most affected are elderly, persons with multiple health care problems, allergic persons, hospitalized patients etc.
There are many advantages a compounded medicine possesses in comparison to commercial medications. For example, people who have swallowing disorders are unable to take a medicine in a form of a tablet, so by compounding a medication, pharmacist can change its dosage form. Instead of a tablet to swallow, a patient can take a liquid solution or a rectal suppository. Another advantage would be simplicity in combining different compounds and drugs into one mixture, and production of a more efficient drug.
More advantages of compounding medications worth mentioning are capability to make a medication that is no longer available on the market, and is essential in treatment of some patients. With the necessary chemical compound available, a professional pharmacist can mix and prepare a compounding medication. Some non-essential ingredients in drugs make them less pleasant by giving them a bad taste or smell. With the medication compounding, those ingredients can be removed from the mixture, and substituted with other substances which are more pleasant and tastier.
Treating highly sensitive individuals is problematic, as they can be allergic to many ingredients of the medication. By knowing which substances cause allergies, patients can receive a medicine that is freed of those. Physician in cooperation with the pharmacist can design and prepare a compounding medicine that will suit that particular patient and his health care needs.
Pain management is an area where compounding medications play significant role. Compounding pharmacy provides a broad spectrum of medications that are potent in pain management, no matter of its nature, acute or chronic. Chronic pain is a harder type to treat than the acute pain, it requires multidisciplinary approach and construction of specific protocols to address the individual needs of each and every patient.
Customized medications which are adjusted to the needs of an individual patient, are less prone to cause negative and harmful events. They are more accurate and direct in addressing the underlying problem of a patient. Different formulations are available and utilized in compounding pharmacy, including creams, gels, sprays, capsules, tablets, injections etc. This arsenal of diverse formulations helps physicians to fight diseases and disorders in a more efficient way.
Bupivacaine is a medication that acts on nerve cells, it blocks impulse propagation by increasing the threshold for excitation in the nerve cells and decreasing the rise rate of an action potential. After applications, nerves lose its pain sensitivity and then temperature and touch functions.
The drug can be dangerous if it reaches systemic circulation as it can cause adverse events, most probably on cardiovascular and central nervous system. Lower, therapeutic doses carry almost no risk of these side effects, but an overdose of bupivacaine can be very harmful. A string of serious adverse effects can take place, damages in conduction and excitability of cardiac muscle, which may lead to severe heart disorders (block, ventricular arrhythmia’s and cardiac arrest which may end fatal). Consequences of these events are decreased cardiac output and a low blood pressure.
Bupivacaine side effects on the CNS are paradoxical, after a stimulation stage, patient starts feeling depressed.
has a rapid onset, it starts acting in less than a minute, and lasts long, from 6-8 hours. It is mostly distributed in the highly perfused organs and systems such as hepatic, renal, cardiac and central nervous system. It also enters almost all other organs and tissues of the body. Metabolism of this compound occurs in the liver, it is being conjugated with glucuronic acid and then excreted through the renal system. Compounded medications, applied in the form of creams or ointments that easily penetrate the skin, do not exacerbate unwanted effects and allow physicians to treat the affected areas faster.
Topical gel dosage form are easy to apply and have a faster onset of action. The amount of an active principle in the mixture can be accurately controlled, and adjusted. This route of administration avoids first pass metabolism in the liver and excludes the possibility of a negative effect on gastrointestinal system.
Bupivacaine compounding pharmacies can incorporate other drugs aside from bupivacaine, which are compatible with it and act synergistic-ally. This allows employing lower doses of each individual component in the mixture, what leads to a lower possibility of a side effect exacerbation.