Customized Prescription Meet the Unique Needs of the Male Patient

By Monica Zatarski,
Pharm.D., R.Ph
MDCustomRx
Brookfield, Wisconsin

By the year 2030, approximately one-fifth of the American population will be over the age of 65. Men are at greatest risk for several chronic and life-threatening diseases. It is therefore crucial that we evolve practical, applicable and effective treatments for a wide range of the chronic diseases afflicting the aging male population. The compounding pharmacist is well equipped to meet the unique needs of the male patient.

IMPOTENCE

An estimated 10 to 30 million American men suffer from erectile dysfunction (ED), having a tremendous impact on the quality of life and personal well-being of afflicted individuals. It is recognized that a patient enjoying an active sex life, with minimal stress involving that sex life, generally maintains better emotional outlook, tends to remain healthier and tends to heal other illnesses more readily than a patient who is sexually inactive.

In regards to the treatment of ED, the oral phosphodiesterase inhibitors (Viagra, Cialis, Levitra), although popular, have their shortcomings: For maximum effectiveness they must be taken at least one hour prior to sexual activity and high-fat meals may decrease the absorption rate and plasma concentrations of the drug. Even though phosphodiesterase inhibitors possess selectivity for the penis, headaches, vision problems and decreased blood pressure are potential problems. In order to bypass these downfalls, sublingual dosage forms can be compounded, which bypass the problem with high-fat meals and result in an onset of action of 10-15 minutes. Since the gut is bypassed, lower doses can be utilized, lessening the incidence of side effects. Intracorporeal administration of vasoactive alprostadil has proven extremely reliable, with an erectile response rate of 60% to 90%. However, 15% to 75% of patients report an unpleasant to severe burning effect. Compounding a combination of alprostadil, papaverine and phentolamine (Trimix) has been reported to reduce the burning effect because the synergism of the three drugs allows for a reduction in dose.

Since patients with poor eyesight sometimes use these injections, vehicles such as vitamin B-12 injections are used to impart a color to the injection to make it easier for the patient to observe the small volumes used. While penile injections are the most successful therapy for ED, it may cause pain at the injection site, scarring and injection anxiety, making it not a suitable approach for every patient. The commercially available intraurethral alprostadil pellet, Muse, provided an alternative to penile injections. However, Muse was met with its shortcomings (i.e., pain and discomfort, high unit cost, fixed dosage and partial dissolution), which are answered by the ability to compound intraurethralal alprostadil gels. These gels can be inserted with a flexible catheter and the pain issue is addressed by the addition of low concentrations of topical anesthetics. Also, prescription compounding allows for the gel to be made into specific strengths required by the individual patient.

ANDROPAUSE - THE 'MALE MENOPAUSE'

A delicate balance exists between all the different hormones in our body. When in balance, the body systems are stable, but as soon as that balance is lost, unwanted symptoms, disorders and disease occur. With age, hormone levels fluctuate, then decline, triggering what is commonly known as the symptoms of menopause (in women) and andropause (in men).

Typically, men have a slower and subtler hormonal decline compared to the rather sudden hormonal changes women experience at menopause. Over time, however, similar symptoms are experienced, including weakness, fatigue, disturbed sleep, reduced libido, osteoporosis, heart disease, atherosclerosis, irritability, insomnia, erectile dysfunction, slow wound healing, prostate problems, low sperm count, depression, anxiety, reduced muscle mass, memory impairment, impaired cognitive function, and impaired blood cell formation.

On average, a man's testosterone levels begin to decline at a rate of 1 % per year after the age of 40. When hormones are replaced or restored back to physiologic levels, men may experience a dramatic reversal of many of the changes caused by aging. The most prevalent treatment is testosterone supplementation, but men can also benefit from dehydroepiandrosterone (DHEA) and progesterone therapies. Prescription compounding enables for individualized dosing and a variety of possible dosage forms (i.e.,transdermal creams/gels, sublingual troches/drops, capsules, for bio-identical hormone therapy.

Other needs of the male patient that can be met through prescription compounding are verapamil cream for Peyronie's disease, transdermal pain gels for sports injuries and/or arthritis, and customized aftershaves (i.e., for the treatment of skin conditions such as pseudofolliculitis barbae). The compounding pharmacist is in a great position to help meet the unique medication needs of the male patient. Having prescription compounding as an available option results in an extremely successful practice and brings a much-improved quality of life to the male patient.

For more information, please contact the pharmacists at MD Custom Rx, a state-of-the-art compounding-only pharmacy, at 262-373-1050

Keywords: chronic disease, medications for impotence,andropause,lower testosterone,menopause,hormone therapy