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HeadWay, Issue #042 -- Same drug, new delivery, big difference
January 22, 2007

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In this month's issue:

Same drug, new delivery, big difference

The secret life of Compounding Pharmacists

Say what?! Bioavailability

Same drug, new delivery, big difference

You take a certain medicine for your headache, and it's no help at all.  A year later you take the same medicine, and it's a big help.  Why the difference?  There could be a lot of reasons - you've changed, your diet has changed, or perhaps it was actually a different kind of headache.  But you could also be taking a new version of the drug.  Same drug, same dose, different delivery.

What is drug delivery?  And does it really make that much of a difference?  For some people, it makes very little difference.  For others, it's the difference between a drug that actually makes things worse, and a drug that solves the problem.  But I would guess most people never even realize they have a problem with drug delivery - they just assume that aspirin or sumatriptan or whatever just doesn't work for them.  A little digging and they may find that there's help for their migraine or headache after all.

Drug delivery is not how the drug is delivered to your door (although that can be important too), but how it's delivered to the part of the body that needs it.  Here are two examples:

  • Speed:  For most headaches, as well as for migraine attacks, speed can make a big difference.  A drug taken now might make your symptoms disappear, but a drug taken an hour later may make no difference.  In the same way, if it takes an extra few minutes to get into your system, it may no longer be effective.  It may be that your symptoms are too advanced, or the drug itself is mostly lost in the wrong parts of your body before it gets to where it's needed.
  • Problem ingredients:  Some people find that those "non-medicinal" ingredients cause problems.  Those "extra" ingredients used to help delivery the drug are called excipients. Those excipients may be ineffective for them, or they may be allergic.
  • A few examples

    Every type of drug delivery has its pros and cons. For example:
  • Topical delivery: This would be something like a patch, or an inhaler, where the drug more or less goes directly to the part of the body that needs it. Very fast, but usually only small doses can be given at a time.
  • Oral delivery: We all know about these - this would include tablets or liquids that you swallow. These widely vary in how effective they are. The problem can be that a lot of the drug gets destroyed in the stomach or cleaned by the liver before reaching its destination.
  • Injections: The drug goes directly into the blood stream. Again, very fast. It works well for some drugs, but most people have trouble with taking an injection for a headache. It's often painful, and may be difficult when you're already sick.

  • But that's only the beginning! A lot of today's technology is focused on making that tablet (or whatever) more effective in itself. So ingredients are added that protect it in the stomach, or that allow it to release at the right speed, or make it absorb faster. There's also the toxiicty of the drug - how much can you have before it starts making matters worse? This is a huge topic, but as you know it can make all the difference!

    I'm confused - what should I do?

    If you're serious about getting rid of painful symptoms, this one may take a little work.  But here are some ideas in a nutshell:

  • 1. Be aware that the same drug can have very different results depending on how it's delivered.  That means a different brand or type of drug (ie nasal spray vs. tablet) could make all the difference.
  • 2. Talk to your doctor or pharmacist about the options.  Some will know more than others.  Read labels and visit the websites of the brand.  It's not all hype - that company may just have a better delivery method (for you) than its competitor.  (And though generic versions of drugs are often identical, that's not always the case.  This 2001 study is a good example.)
  • 3. Read the ingredients list, and find out what it means.  This one could be a lot of work, but it may be the only answer to someone who is sensitive to certain ingredients.  Again, talking to your doctor or pharmacist may shorten the process - they may know certain ingredients that you need to watch out for.

  • A few examples of drug delivery that makes a difference - Effervescent aspirin, and a new Rapid-Release Sumatriptan.

    The secret life of Compounding Pharmacists

    For some people who are very sensitive to certain ingredients in today's drugs, there are only two answers.  One, don't take the drug - great, but what if there's no other help and the symptoms are severe?  The other solution is to come up with your own custom-made drug soup.

    No, I'm not suggesting you pull out your childhood chemistry set and start mixing drugs.  That could be dangerous - and deadly.  Besides, it's not a matter of mixing drugs necessarily, but mixing the ingredients that go with them.

    Very few people are trained in this art today.  Most pharmacists have some idea how it works, but probably only a few in your country could actually do it for you.

    This is called compounding.  Christen L. Brownlee, an associate editor of Modern Drug Discovery, writes:

    Compounding means to prepare a medication from scratch using raw chemicals, powders, and devices.  It allows a pharmacist to customize a drug for patient use according to the individual's needs or the doctor's specifications and was the only way to prepare medications until the advent of commercial manufacturing.

    Compounding is helpful when a patient needs a strength of medication that isn't commercially available or when a medication's instability makes it preferable to prepare small amounts to be used more frequently.  However, it is an ideal practice for patients who want to be able to take an active ingredient but still avoid a specific excipient.  By using preparations that are missing the offending ingredient, a patient who is allergic can still consume a drug’s active ingredients without suffering an allergic reaction.

    Read more of this helpful article on drug delivery here.

    If you need to find a compounding pharmacist, visit the International Academy of Compounding Pharmacists here. They can help you find a compounding pharmacist in your area.

    Say what?!  Bioavailability

    Bioavailability refers to how much of the drug actually makes it, in a usable form, into the blood stream or its destination versus how much you took in the first place.  If you're taking a large dose, but most of it is just going right through you, you're wasting your money.  This is why the dosage isn't all that matters - how much of that dose is actually getting to where it needs to go?
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