Learning Center

Why Prescribers Use It

Commercial medications come in a limited set of strengths and forms. Compounding lets a pharmacist prepare the strength a prescriber writes, combine more than one active ingredient into a single preparation, leave out dyes, gluten, lactose or preservatives for patients who react to them, and prepare a medication as a topical or vaginal preparation for someone who cannot swallow a capsule.

The Compounding Process

Every compounded medication begins with a prescription from a licensed prescriber. Our pharmacists select pharmaceutical-grade ingredients, calculate the quantities the prescription calls for, and prepare the formulation in our Johnson City lab. Potency testing is performed periodically through a third-party laboratory, depending on the preparation. We have a 48-hour compounding time on most preparations; shipping time is additional.

503A and 503B Are Different Things

A 503A pharmacy, which is what ProCompounding is, prepares medications against individual patient prescriptions. A 503B outsourcing facility prepares larger batches without a patient-specific prescription, for use in clinics and hospitals. Neither is a better version of the other; they are built for different jobs. We explain Section 503A in full on our what is a 503A pharmacy page.

What Bioidentical Means

Bioidentical hormones are derived from plant sources, usually wild yam or soy, and are processed to be molecularly identical to the hormones the body makes, including estradiol, estriol, progesterone, testosterone and DHEA. Because the molecule is the same, it binds to the same receptors.

The Hormones We Prepare

Estradiol (E2) and estriol (E3), including Bi-Est, which is estradiol and estriol together. Progesterone. DHEA. Testosterone, including a cream prepared for women. Which hormone, which strength and which base are your prescriber's decisions, written on the prescription; we prepare what is written.

The Dosage Forms

Estrogens and testosterone are prepared as topical or vaginal preparations: a hypoallergenic cream, an olive oil base topical, or a vaginal preparation. Testosterone is poorly absorbed when it is taken by mouth. Oral capsules are used for progesterone and DHEA. What we do not make: hormone pellets, hormone patches, injectables of any kind, and troches or lozenges.

Lab Work Belongs to Your Prescriber

Your prescriber orders and interprets any lab work and decides what your results mean for your therapy. We prepare what the prescription specifies. If you want to understand the panels prescribers commonly use, see our pages on labs for bioidentical hormone therapy and saliva hormone testing.

Labs for bioidentical hormone therapySaliva hormone testing

Sensitivities We Can Work Around

If you react to dyes, fillers, preservatives or a particular base, tell your prescriber and tell us. A hypoallergenic base exists for exactly this reason, and a pharmacist reviews every formulation before it is prepared.

What GLP-1 Means

GLP-1 stands for glucagon-like peptide-1, a hormone the gut releases after eating. It is involved in signaling fullness to the brain, in the rate at which the stomach empties, and in insulin regulation. Semaglutide is a GLP-1 receptor agonist, meaning it acts on that same receptor.

Dual GLP-1/GIP

Tirzepatide is a dual GLP-1/GIP receptor agonist, meaning it acts on two receptor pathways involved in appetite regulation and blood sugar control. GIP stands for glucose-dependent insulinotropic polypeptide.

This Is a Prescriber's Decision

A licensed prescriber decides whether any of this is appropriate for a particular patient, what is prescribed, and at what strength. We prepare what the prescription specifies.

Retinoids

Tretinoin and other vitamin A derivatives are among the most studied topical dermatology ingredients; they act on the rate at which skin cells turn over. Compounded tretinoin can be prepared at the concentration your prescriber specifies, which matters for patients whose skin does not tolerate a standard commercial strength.

Antioxidant Ingredients

Vitamin C as L-ascorbic acid, along with niacinamide, vitamin E and melatonin, are antioxidants used in topical preparations. We prepare them singly or in combination, in the base and at the concentration the prescription calls for.

Pigmentation Preparations

For melasma and uneven pigmentation, prescribers commonly write hydroquinone, on its own or combined with tretinoin and a corticosteroid, and niacinamide. Each ingredient acts on a different step in how pigment is produced and transferred, which is why they are often combined in a single preparation.

The Hair Cycle

Hair grows in a cycle: anagen (growth), catagen (transition) and telogen (rest and shedding). DHT (dihydrotestosterone), stress hormones, nutritional deficiency and inflammation can all shift more hairs into the shedding phase. Which of those is behind a particular person's hair loss is what a prescriber works out first.

Multi-Ingredient Topical Preparations

A compounded hair preparation can bring together ingredients that act at different points: minoxidil, which acts on blood flow at the follicle; finasteride or dutasteride, which act on DHT; tretinoin, which affects how the other ingredients are absorbed; and latanoprost and melatonin, which act on the growth phase. Your prescriber chooses the combination and the strengths.

Types of Hair Loss

Androgenetic alopecia, or pattern hair loss, is the most common form and is linked to genetics and DHT sensitivity. Telogen effluvium, triggered by stress, illness, surgery or hormonal change, causes widespread temporary shedding. Alopecia areata is an autoimmune condition causing patchy loss. Iron stores are worth discussing with your prescriber as well.

Low ferritin and hair loss

If the Strength Changes

If your prescriber adjusts the formula or the strength, send us the new prescription and we will prepare it to match. We fill the number of refills your prescriber approves. When those run out, or the strength changes, a new prescription is needed for the next fill.

Testosterone

Testosterone is a Schedule III controlled substance and is prescribed by a licensed prescriber. We prepare it as a hypoallergenic cream, an olive oil base topical or a topical gel, at the strength on the prescription. Testosterone is poorly absorbed when it is taken by mouth, so we do not compound it as a tablet or an oral capsule.

Alongside Testosterone

Prescribers also write clomiphene, which acts on the hypothalamic-pituitary axis and is sometimes used where fertility is a consideration, anastrozole, which acts on the conversion of testosterone to estrogen, and DHEA. Finasteride and dutasteride are written for hair. Each of these is a prescriber's decision for an individual patient.

Commercially Available Products

Some of what a men's health prescription calls for is a commercially manufactured product rather than a compounded one. Sildenafil and tadalafil tablets are examples; we dispense those on a prescription rather than compounding them.

Why It Has to Be Compounded

Naltrexone is commercially manufactured in a single, much higher strength, and the low strengths used in low dose therapy are not available as a manufactured product. Preparing a strength no manufacturer offers is exactly what Section 503A allows when a prescriber writes for it.

How We Prepare It

We prepare LDN as an oral capsule or a tablet, depending on the strength your prescriber specifies. It is a non-sterile preparation, made to order for the patient named on the prescription. Your prescriber decides whether LDN is appropriate for you, at what strength, and for how long.

Low dose naltrexone

How Antiparasitics Work

Ivermectin binds to glutamate-gated chloride channels in parasite nerve and muscle cells, which paralyzes the organism. Mebendazole interferes with glucose uptake in parasites. Both are long-established medications, prescribed by a licensed prescriber for a particular patient.

The Forms We Prepare

We prepare ivermectin as a tablet. Mebendazole is prepared as an oral capsule. Your prescriber specifies the strength and the quantity, and that is what we prepare.

Where a Prescription Is Required

Outside Tennessee, ivermectin requires a prescription from your own licensed prescriber, who can send it to us. For patients in Tennessee, some protocols are covered by our collaborative pharmacy practice agreement (Tenn. Code 63-10-224), where a licensed pharmacist reviews your request and decides whether dispensing is appropriate. Dispensing is never guaranteed.

Compounded ivermectin tabletsIvermectin in Tennessee

Nasal and Sinus Preparations

Prescribers write combination nasal sprays, such as azelastine with mometasone, or olopatadine with mometasone and montelukast; nasal irrigation preparations, including budesonide as a rapid-dissolve tablet and levocetirizine as a capsule, both of which dissolve into a saline rinse; and antimicrobial irrigations where a prescriber has identified a specific organism. Betahistine tablets are also compounded.

Who Decides What Goes In

The combination, the strengths and the organism being targeted are decisions your ENT or prescriber makes and writes on the prescription. We prepare it. If your practice wants to work through its formulary with us, our ENT practice page covers how that works.

Compounding for ENT practices

How to Use a Sinus Rinse

Using a sinus rinse correctly matters. The video below, from Mayo Clinic, is a step-by-step demonstration of the technique with a saline or medicated solution.

USP Standards

The United States Pharmacopeia sets the standards compounding pharmacies work to. We compound under USP 795 for non-sterile preparations and USP 800 for hazardous drugs. Those standards cover ingredient sourcing, environmental controls, staff training and documentation.

PCAB Accreditation

PCAB accreditation is voluntary and involves an on-site survey of how a pharmacy actually compounds, plus a documented quality assurance program. Fewer than 1% of compounding pharmacies are PCAB accredited. You can verify our accreditation, our LegitScript certification and our state licenses yourself.

PCAB-accredited compounding pharmacyVerify a pharmacy's license

Ingredient Sourcing

Every active pharmaceutical ingredient we use comes from an FDA-registered, cGMP-compliant supplier. We check the certificate of analysis for identity, potency and purity before a raw material is accepted into inventory.

Testing and Dating

Potency testing is performed periodically through a third-party laboratory, depending on the preparation. Our quality program also covers weight checks, documented batch records and beyond-use dating.