Certain pharmacies, known as compounding pharmacies, can mix different ingredients together to produce a patient-specific product. Popular compounded products include pain creams and ointments that contain a combination of multiple potent medications. Many include drugs that can cause central nervous system depression or cardiac effects that result in slow breathing, a low heart rate or irregular beat, and drowsiness or a loss of consciousness. These drugs may include:
• Ketamine—a powerful pain reliever that can cause deep drowsiness
• Baclofen and cyclobenzaprine—powerful muscle relaxants that cause drowsiness
• Lidocaine and bupivacaine—local anesthetics that can cause heart rate and rhythm changes
• Tricyclic antidepressants—depression medicines used to treat pain that can cause heart or blood pressure abnormalities
• Gabapentin, clonidine, and nifedipine—pain relievers that are primarily used to control seizures or high blood pressure
• Baclofen and cyclobenzaprine—powerful muscle relaxants that cause drowsiness
• Lidocaine and bupivacaine—local anesthetics that can cause heart rate and rhythm changes
• Tricyclic antidepressants—depression medicines used to treat pain that can cause heart or blood pressure abnormalities
• Gabapentin, clonidine, and nifedipine—pain relievers that are primarily used to control seizures or high blood pressure
Combinations of these and other drugs manufactured by compounding pharmacies are not approved by the US Food and Drug Administration (FDA).
Compounding pharmacies are largely profitable and growing rapidly. Consumers are charged per ingredient even though there is really no proof that more drugs together make the product better. Many compounding pharmacies have a large sales force that conducts an elaborate marketing campaign and will provide doctors with prescriptions that only require their signature to make prescribing of these creams easier. Prospective patients are often receiving unsolicited calls at home, with a promise that the cream can be prescribed after an arranged telephone consultation with a physician. Some compounding pharmacies are even enticing doctors with financial incentives to prescribe these creams, despite an Anti-Kickback Statute. In one high-profile case, the Federal Bureau of Investigation (FBI) recently announced the arrest of one pharmacist with a compounding pharmacy who paid tens of thousands of dollars in cash bribes to physicians for providing patients with pain cream prescriptions. more
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