Pharmacy World and Science

, Volume 25, Issue 6, pp 280–287 | Cite as

Frequency, nature and determinants of pharmacy compounded medicines in Dutch community pharmacies

  • Henk Buurma
  • Peter A.G.M. de Smet
  • Olga P. van den Hoff
  • Henrieke Sysling
  • Michiel Storimans
  • Antoine C.G. Egberts


Aims: To examine the frequency, nature and determinants of pharmacy compounded medicines in Dutch community pharmaciesMethods: A prospective nested case-control study comparing prescriptions for pharmacy compounded medicines (cases) with non-pharmacy compounded medicines (controls) was carried out in 79 Dutch community pharmacies. 991 Prescriptions for compounded medicines (cases), dispensed by the pharmacy on a predetermined day in a specific period (29 March until 11 April 2001), and 993 prescriptions for non-compounded medicines (controls) randomly selected on the same day, were studied. The nature and frequency of compounded medicines as well as patient, drug and prescriber related determinants were assessed. In addition, some organisational characteristics, like compounding site and use of protocols, were investigated. Also, the value of compounded medicines in terms of the availability of an industrially compounded equivalent and patient specific reasons, as perceived by the participating pharmacists, was evaluated.Results: The overall frequency of prescriptions for pharmacy compounded medicines in relation to the total number of prescriptions was 3.4%. This means 12.5 compounded medicines per pharmacy per day on average, but there was a large variation between pharmacies. Excluding the products purchased from specialised compounding companies (28.4%) and the small part of medicines coming from other pharmacies (5.2%), we found an overall frequency of 2.3% of actual compounding in the pharmacy itself.On average, approximately one employee was needed for compounding activities with a large variation between pharmacies. More than 13% of the pharmacists stated that they delivered more than 25% of their compounded medicines to other pharmacies. In 2 pharmacies (2.6%) no actual compounding took place. For 58% of the products manufactured in the pharmacy itself or coming from other pharmacies a (semi-) standardised protocol was used. Compared to non-compounded medicines we found a huge share of dermatological dosage forms among compounded medicines (62.1% versus 5.3%). Oral solutions and ear-nose-throat (ENT) products were also found relatively often. While no ATC class was very pronounced in the control group, the group of dermatologicals was prominently present in the case group (57%) followed by CNS agents (8.4%). The dermatologist was a very strong determinant of compounded medicines compared to GPs (ORadj 12.2 [6.3–23.6]). Patients of 12 years or younger received a significantly higher rate of compounded medicines than persons older than 12 years of age (ORadj 3.4 [2.5–4.8]). Compounding occurred almost twice as often when a medicine was prescribed for the first time compared to a repeat prescription (ORadj 1.8 [1.5–2.2]).In about 63% of the cases the pharmacist judged that an industrially produced medicine could not substitute for the compounded medicine. In about 33% of the compounded products they indicated a patient specific reason. In about 10% this reason concerned a strictly defined pharmaceutical care issue.Conclusions: Based upon our research, all Dutch community pharmacies compound more than 13,000 medicines per day (2.3% of all prescriptions). They consist mainly of dermatological preparations. Younger children (< 12 yr) receive a significantly higher rate of compounded medicines than other people. At least 1.2 compounded prescriptions per pharmacy per day have a specific pharmaceutical care reason according to the pharmacists.

Community pharmacy services Compounding Evaluation studies Outpatients Pharmaceutical care Pharmacists Prescriptions 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tel H. Community pharmacy in the Netherlands. Pharm Weekbl 1992; 127: 956–9.Google Scholar
  2. 2.
    GIPeilingen 1992–2000, Kengetallen farmaceutische hulp. Genees-en hulpmiddelen Informatie Project (GIP)/College van Zorgverzekeringen. Amstelveen, The Netherlands: 2001.Google Scholar
  3. 3.
    Van der Heide H, Tinke JL. Data en Feiten 1999. Kostenontwikkeling van de farmaceutische hulp. The Hague Stichting Farmaceutische Kengetallen [Foundation for Pharmaceutical Statistics].Google Scholar
  4. 4.
    Stichting Farmaceutische Kengetallen [Foundation for Pharmaceutical Statistics]. —Minder bereidingen in de apotheek. [Less compounding in the pharmacy.] Pharm Weekbl 2001; 136: 619.Google Scholar
  5. 5.
    Hansen JMM. —De kwaliteit van de bereidings-en onderzoeksprotocollen in de ziekenhuisapotheek. [The quality of manufacturing and research protocols in hospital pharmacy.] Pharm Weekbl 1993; 128: 1355–7.Google Scholar
  6. 6.
    Wagenaar HWG. —FNA-preparatencontrole 1995. Momentopname van de kwaliteit van enkele apotheekbereidingen. [Snapshot of quality of drug compounding in community pharmacies.] Pharm Weekbl 1996; 131: 1414–7.Google Scholar
  7. 7.
    Bouwman-Boer Y, Wagenaar HWG. —Een Gordiaanse vitamineknoop. Kwaliteitsperikelen van vitamine K-preparaten ontrafeld. [A Gordian vitamin knot. Quality perils of vitamin K products unravelled.] Pharm Weekbl 1999; 134: 609–13.Google Scholar
  8. 8.
    Bouwman-Boer Y. Van de Vaart FJ, Kloeg PHAM. —Samen bereiden geeft kwaliteit. Apotheekbereiding in de geneesmiddelenvoorziening 2. [Compounding together ensures quality. Drug compounding in pharmacies and drug supply 2.] PharmWeekbl 1999; 134: 604–8.Google Scholar
  9. 9.
    Schoenmakers T. —Apotheekbereiding heeft de toekomst. [Pharmacy compounding has good prospects.] Pharm Weekbl 1997; 132: 1876–81.Google Scholar
  10. 10.
    Joosten AAM. —Uiteindelijk beslist de apotheker. [Ultimately the pharmacist decides.] Pharm Weekbl 2000; 135: 18–20.Google Scholar
  11. 11.
    Wissenburg A, Dijkgraaf-Feitsma C. —Wat schrijft u voor? De rol van apotheekbereidingen. [What do you prescribe? The place of pharmacy compounding.] Pharm Weekbl 2000; 135: 12–17.Google Scholar
  12. 12.
    Bouwman-Boer Y. Van de Vaart FJ, Kloeg PHAM. —Alleen beschikbaar als apotheekbereiding. Apotheekbereiding in de geneesmiddelenvoorziening 1. [Only available as a pharmacy preparation. Drug compounding in pharmacies and drug supply 1.] Pharm Weekbl 1999; 134: 578–81.Google Scholar
  13. 13.
    Nordenberg T, Pharmacy compounding: custimizing prescription drugs. FDA Consumer magazine 2000 (July-August) (http: // html).Google Scholar
  14. 14.
    Smith MC, Brown TR. Dermatologists' referrals of prescriptions requiring compounding. Cutis 1984; 34: 489–91.Google Scholar
  15. 15.
    Ling MR. Extemporaneous compounding. The end of the road? Dermatol Clin 1998; 16: 321–7.Google Scholar
  16. 16.
    Thiers BH. Compounding is still appropriate in clinical practice. Dermatol Clin 1998; 16: 329–30.Google Scholar
  17. 17.
    Buurma H, de Smet PAGM, van den Hoff OP, Egberts ACG. Nature, frequency and determinants of prescription modifications in Dutch community pharmacies. Br J Clin Pharmacol 2001; 52: 85–91.Google Scholar
  18. 18.
    Anonymous. ATC Index with DDDs. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, 1999.Google Scholar
  19. 19.
    Guidance for FDA Staff and Industry. Compliance policy guides manual. Section 460.200. Pharmacy compounding (http: // Scholar
  20. 20.
    Altmeyer P, Bergmeyer V, Wienand W. DeAnalyse magistraler Rezepturen von niedergelassenen Dermatologen. [Practising dermatologists and compounding of prescriptions.] Der Hautarzt 1997; 48: 12–20.Google Scholar
  21. 21.
    Crawford SY, Dombrowski SR. Extemporaneous compounding activities and the associated informational needs of pharmacists. Am J Hosp Pharm 1991; 48: 1205–10.Google Scholar
  22. 22.
    Nahata MC. Pediatric drug formulations: challenges and potential solutions. Ann Pharmacother 1999; 33: 247–9.Google Scholar
  23. 23.
    Schirm E, Tobi H, de Jong-van den Berg LTW. Unlicensed and off label drug use by children in the community: cross sectional study. BMJ 2002; 324: 1312–3Google Scholar
  24. 24.
    't Jong GW, Eland IA, Sturkenboom CJM, van den Anker JN, Stricker BHCh. Unlicensed and off label prescription of drugs to children: population based cohort study. BMJ 2002; 324: 1313–4Google Scholar
  25. 25.
    Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharmacol 1999; 47: 695–700.Google Scholar
  26. 26.
    Wright DJ, Aykroyd RG, Chrystyn H. Rating clinical pharmacy interventions by clinical panels which health professionals should be included? Br J Clin Pharmacol 1998; 46: 278P.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Henk Buurma
    • 1
    • 2
  • Peter A.G.M. de Smet
    • 3
    • 4
  • Olga P. van den Hoff
    • 3
  • Henrieke Sysling
    • 1
  • Michiel Storimans
    • 2
  • Antoine C.G. Egberts
    • 2
    • 5
  1. 1.SIR Institute for Pharmacy Practice ResearchLeidenThe Netherlands
  2. 2.Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands e-mail
  3. 3.Scientific Institute of Dutch Pharmacists WINApThe HagueThe Netherlands
  4. 4.Department of Clinical PharmacyUniversity Medical Centre St RadboudNijmegenThe Netherlands
  5. 5.Hospital pharmacy ‘Midden-Brabant’, TweeSteden Hospital and St Elisabeth Hospital, TilburgThe Netherlands

Personalised recommendations