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Pharmacy preparations and compounding
  1. Tjalling van der Schors1,
  2. Steffen Amann2,
  3. Despoina Makridaki3,
  4. Stephanie Kohl4
  1. 1Hospital Pharmacy, Dijklander Ziekenhuis, Hoorn, The Netherlands
  2. 2Krankenhausapotheke (Hospital Pharmacy), München Klinik gGmbH, Munich, Germany
  3. 3Pharmacy Services, "Sismanoglio- Amalia Fleming", General Hospital of Attica, Athens, Greece
  4. 4Policy & Advocacy, European Association of Hospital Pharmacists, Brussels, Belgium
  1. Correspondence to Stephanie Kohl, Policy & Advocacy, European Association of Hospital Pharmacists, Brussels 1200, Belgium; Stephanie.Kohl{at}eahp.eu

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EAHP Position Paper on Pharmacy Preparations and Compounding

Making a difference in medication by delivering tailor-made medicines for the benefit of patients

The patient-oriented preparation of medicines is anchored deeply in pharmacy practice. Since the establishment of the profession, hospital pharmacies have manufactured, prepared and compounded medicines to adequately respond to patient needs, especially for those individual patients or patient groups whose medical requirements cannot be met by industrially manufactured medicines.1

The term ‘compounding’2 is frequently used in the English speaking literature, while in continental Europe the term ‘pharmacy preparation’3 is mainly applied. This position paper regards both the term ‘pharmacy preparation’ and the term ‘compounding’ as interchangeable but will mainly refer to ‘compounding’. Another process related to preparation is ‘reconstitution’.4 This process is not necessarily confined to a pharmacy. Reconstitution entails, for example, adding a diluent to a powdered medication to prepare a solution or suspension.

Due to the shift towards personalised medicines, including advanced therapy medicinal products (ATMPs), the strain on national healthcare budgets and medicines shortages, compounding has regained significance in Europe. The position paper of the European Association of Hospital Pharmacists (EAHP) aims at providing information about this practice in hospitals and asks for a stronger embedment of compounding and reconstitution practices in European hospital pharmacies, linked to increasing capacity and training.

To further enhance patient care in Europe, EAHP

  • calls on health systems to create an environment which enables the provision of compounding services by hospital pharmacists based on the European Statements of Hospital Pharmacy;

  • encourages health authorities to facilitate the delivery of pharmacy preparations between hospitals and to invest in compounding services, since only by building sufficient capacity will hospitals be equipped to better respond to patient needs and extraordinary situations like pandemics and shortages of essential medicines;

  • recommends the revision of pharmacy curricula and the expansion of training opportunities for the pharmacy workforce to account for the growing demand for pharmacy preparations;

  • encourages the appointment of a hospital pharmacist …

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Footnotes

  • Collaborators Delegates of the 50th EAHP General Assembly.

  • Contributors The position paper was approved and adopted by the delegates of the 50th EAHP General Assembly in October 2020.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • The term ‘pharmacy preparation’ is not uniformly used throughout continental Europe when referring to medicines prepared or manufactured by a pharmacist. For this position paper, the term ‘pharmacy preparation’ shall encompass all wordings referring to pharmacy-made preparations, including but not limited to hospital preparations, individual preparations and large batch preparations, (small) stock preparations, magistral preparation, officinal preparation, extemporaneous preparations, preparations from raw materials and preparations to modify already marketed medicines.

  • Compounding’ is defined as the process of combining, mixing, or modifying ingredients to create a medication tailored to the needs of an individual patient [US Food and Drug Administration, Compounding and the FDA: Questions and Answers. Available at: https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers%23what].

  • Literature divides pharmacy preparations into ‘preparation by adapting an existing product’ (“reformulating a licensed product into a different dosage form suitable for the intended use”) and ‘preparation from raw materials’ (“formulating active substances and excipients into a dosage form suitable for the intended use”) 9 (p4). European law covers compounding/pharmacy preparations and distinguishes between two types, namely the ‘magistral formula’ (“any medicinal product prepared in a pharmacy following a prescription for an individual patient”) and the ‘officinal formula’ (“any medicinal product which is prepared in a pharmacy in accordance with the prescriptions of a pharmacopoeia that is intended to be supplied directly to the patients served by the pharmacy”) [Article 3 of Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use].

  • ‘Reconstitution’ is defined as the “manipulation to enable the use or administration of a medicinal product for products with a marketing authorisation issued by any competent medicines regulatory authority, the reconstitution is carried out in accordance with the instructions given in the summary of product characteristics (SmPC) or the package leaflet.” [Council of Europe. Resolution CM/Res(2016)2 on good reconstitution practices in healthcare establishments for medicinal products for parenteral use], including also pharmacy preparations and investigational medicinal products (IMPs).

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