Many medications that are either unavailable in standard pharmacies due to an FDA-declared shortage, or prohibitively costly, may be obtained in generic form by specialized “compounding pharmacies” as prescribed by a licensed healthcare professional.
Examples include:
- Ketamine: Ketamine is a 50:50 (“racemic”) mix of “right-handed” arketamine and “left-handed” Esketamine isomers. As discussed in other “deep dives” on the Sterling website, racemic ketamine is a 75-year old well-known generic long out of patent. The process for creating pure Esketamine has recently been patented and therefore is not available as a generic. But the ar- and es isomers are clinically little different and racemic ketamine has long been used successfully off label as a treatment for depression. This form of ketamine is available from a number of compounding pharmacies across the country at a reasonable cost.
- Semaglutide: The branded, under-patent version of Ozempic and Wegovy is very costly out of pocket and for many people not covered adequately by insurance. However semaglutide is (as the ending ”…tide” suggests) a so-called peptide—a short string of amino acids. Peptides may not be patented, however, the delivery system and dosing can be. Semaglutide mixed with vitamin B is widely available for research purposes only (as a generic) but also from select manufacturers for clinical use. It may therefore be ordered from certain compounding pharmacies.
- Tirzepatide: is the generic name for Mounjaro and Zepbound, another peptide also available in compounded form.
Compounding pharmacies create custom formulations of medications based on prescriptions from healthcare providers. The process and sources for acquiring the raw materials needed for compounding might not be explicitly detailed in public domains due to regulatory and proprietary reasons. Compounding pharmacies are expected to source pharmaceutical-grade ingredients from reputable suppliers to ensure the safety and efficacy of compounded medications. They must comply with regulatory guidelines set by bodies such as the FDA in the United States and similar agencies worldwide, ensuring the quality and safety of compounded medications.