Compounding for
Palliative and Hospice Care

The World Health Organization has defined palliative care as: “ the active total care of patients whose disease is not responsive to curative treatment."  Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount.  The goal of palliative care is the achievement of the best possible quality of life for patients and their families.

Palliative Care:

  • Affirms life and regards dying as a normal process
  • Neither hastens nor postpones death
  • Provides relief from pain and other distressing symptoms
  • Integrates the psychological and spiritual aspects of patient care
  • Offers a support system to help patients live as actively as possible until death
  • Offers a support system to help the family cope during the patient’s illness and in their own bereavement.”

 

At Share ‘n Care Compounding Pharmacy we can offer the patient and families of palliative and hospice care customized medications to make the end of life period as painless as possible.  Our staff can accommodate the patient in the following ways:

  • Change in Route of Administration - The medications the patient takes may be available in a commercial form such as oral or injectable.  We can compound most medications into an alternative form such as a transdermal gel.
  • Combination Preparations - To improve compliance of the patient, we will combine several compatible drugs into a single dosage, such as suppository, capsule, troche, or transdermal gel.
  • Unavailable Medications -  We can usually obtain medications in bulk powder form and compound a preparation for the times when a commercial medication is not available.
  • Flavoring -  In many cases, the palliative or hospice patient finds an oral medication not palatable.  In those instances Share ‘n Care Compounding Pharmacy will add flavoring to the medicine to assist in  compliance.
  • Elimination of Problem Causing Excipients -  We will formulate the dosage without dye, sugar, lactose, alcohol, or preservatives.
  • Dosage Modification - We can compound a medication that contains the most appropriate strength of the medication to provide therapeutic benefit but avoid adverse side effects. This can be particularly helpful to a liver or kidney patient.
  • Change in Dosage Form -  Medications can be altered to meet each patient’s needs.  Many times doses need to be gradually increased to control pain.  Freeze-pops, lollipops, or lozenges can be particularly useful in these situations.

 

Symptom Relief Kit (SRK)
Patients receiving palliative care oftentimes experience dramatic and unexpected changes in their condition.  Quite often there may be an emergency when contacting the doctor for medications is not possible. At Share ‘n Care Compounding Pharmacy, we can prepare a Symptom Relief Kit per prescription order based on the patient’s needs.

We recommend that the SRK be dispensed early in the patient’s care, so that the patient and the family can become familiar with its contents.  The SRK contains an emergency supply of medications that will provide relief for 12-16 hours for the following problems:

  • Pain
  • Dyspnea
  • Nausea and vomiting
  • Agitation
  • Excessive secretions


Please contact us to customize a SRK to meet the needs of your loved one.

Pain Management

Treatment of pain often involves the use of non-steroidal anti-inflammatory drugs and opioid analgesics.  The best treatment for a particular form of pain can often include medications that contain pain-relieving properties, such as ketamine, gabapentin, and lidocaine.  When combining these medications in various forms to control pain, doctors have found that less of each medication can be used.

“Pain can be managed.  Physicians must determine the severity and frequency of their patients’ pain experience to prescribe the most appropriate and effective pain management regimen.  Pain treatment needs to be individualized”¹

Nausea and Vomiting

Lorazepam, diphenhydramine, haloperidol, and metoclopramide are the drugs contained in the compounded gel commonly referred to as ABHR.  The gel was named after the brand names Ativan, Benadryl, Haldol, and Reglan, under which these drugs were originally marketed.  This gel is an option that has proven highly effective for relieving the symptoms of nausea and vomiting for terminally ill hospice patients.  This combination of drugs works to block each physical pathway that is responsible for nausea and vomiting.

Dry Mouth and Stomatitis

The technical term for mouth sores is stomatitis (an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth.).

This can be caused by chemotherapy, radiation, bone-marrow transplant, and other conditions such as oral infection, allergy, Behcet's Disease, or AIDS.  These sores can be disabling and may interfere with speaking and eating.

Mouthwashes and rinses can be compounded to help ease the pain associated with the ulcer and, in some cases, to help prevent or cure the problem.

Decubitus Ulcers

A variety of therapies exist to help ensure the proper healing of a wound, to include surgeries using vascular reconstruction techniques to create new arterial pathways that can increase blood flow to the wound.  In addition, the use of growth factors such as keratinocyte-2 and interleukin-6 is being studied.  These therapies appear promising but they are expensive; therefore, many patients are left to use the few commercially available topical gels such as Regranex (0.01% becaplermin) to achieve some relief.

These alternatives include compounded topical products, which can consist of phenytoin, misoprostol, metronidazole, or some combination of the three, and nifedipine.  Reports tend to show positive outcomes with the use of these products with little to no adverse effects.  The effectiveness of these topically applied medications can be traced to their mechanisms of action:

  • Phenytoin- Promotes granulation in a wound while providing antimicrobial effects and counteracting inflammation.
  • Misoprostol is a synthetic prostaglandin that accelerates wound healing.
  • Metronidazole exerts an antimicrobial effect to assist in wound care.16
  • Nifedipine blocks the calcium influx into smooth muscles, thereby decreasing the vascular tone, which in turn increases blood flow.

 

Odor Control

Fungating tumors, pressure ulcers, and other chronic wounds are frequently the source of offensive odors that distress patients, family, and healthcare professionals.  These odors often limit the patients' contact with others and have a negative psychological impact on all concerned.  The social embarrassment caused by a malodorous wound heightens the misery of advanced and uncontrolled disease, deepening the person's sense of helplessness, worthlessness, and social isolation at the time when support of family and friends is crucial.  Smell carries a social stigma and may cause a patient to feel guilty and ashamed. It can inhibit sexuality and intimacy with a loved one resulting in depression.  Topical metronidazole is one medication that has been used to eliminate this odor, greatly improving the patient’s quality of life.