Farmville — When the H1N1 outbreak and the normal flu season collided this fall, drug maker Roche ran short of liquid Tamiflu for children.

To fill the gap, thousands of pharmacists nationwide returned to the roots of their profession to combine adult strength pills with syrups to create their own pediatric potions.

The practice, called compounding, allows doctors to prescribe medicines that aren’t commercially available. In Pitt County, drug stores such as Greenville’s Healthwise Pharmacy, Farmville’s Best Value Drug and Compounding Center and Ayden’s Edwards Wellness Pharmacy have made compounding an important component of their work.

“Doctors have always prescribed compounds because one size doesn’t fit all,” said Bob Crocker, owner of Best Value, which he opened in 1976.

Pharmacy compounding is the customized preparation of a prescription medicine that is not otherwise commercially available, according to the International Academy of Compounding Pharmacists, a nonprofit association of 2,000 pharmacists that promotes the compounding profession.

“I think it gives you another niche in the community and it helps your community,” said Marcie Parker, Healthwise’s pharmacy manager.

Compounding is mainly practiced by pharmacists who own or work at independent drug stores but that is changing, said Loyd V. Allen Jr., editor-in-chief of International Journal of Pharmaceutical Compounding, an Oklahoma-based, bimonthly professional journal devoted to pharmacy compounding. About 10 percent of Walgreens pharmacies are compounding centers, he said. Walmart also is opening compounding centers.

Although there are no industry numbers, Allen said the demand for compounded medicines is growing.

“The pharmaceutical industry is discontinuing drugs that are not profitable,” Allen said. However, doctors and patients favor these medicines. “Anything that is deleted or discontinued, the only way physicians can continue to prescribe it is through compounding.”

Crocker said he gets many prescriptions for compounds with short shelf lives and aren’t feasible for drug companies to produce in bulk. He also makes drugs for diseases or health conditions that affect a small percentage of the population and aren’t profitable for large pharmaceutical companies.

The compounding trend also is growing because people are more active participants in their health care, Parker said.

“I think the baby boomer generation is a lot more computer savvy and they are going on the Internet to explore alternative treatment options,” she said. Local doctors, for the most part, are open to alternatives.

She estimates about 25 percent of the non-intravenous prescriptions filled by Healthwise are compounds. A large percentage of that compound business involves hormone replacement therapy creams or gels.

Crocker said long before Viagra or Cialis became marketing phenomenons he compounded both injectables and creams that treated erectile dysfunction.

Most pharmacists do simple compounding such as flavoring children’s medicine or creating a liquid form of a pill for people who can’t swallow.

Crocker started compounding several years after opening Best Value.

“Back then we did very rudimentary stuff; creams, suspensions. You might make a crude suppository, but you were limited,” Crocker said.

After hundreds of hours of training and an investment of more than $100,000, Crocker and his pharmacists now makes eye drops, injectables and other sterile compounds.

At the University of North Carolina at Chapel Hill’s Eshelmaman School of Pharmacy, students spend five semesters, 2 1/2 years, studying compounding, said Kelly Scolaro, an assistant professor.

“UNC is probably farther ahead than some universities in investing in compounding,” she said.

“There is a lot of debate about whether we need to teach compounding, but I believe it is an important skill for meeting the needs of the community,” Scolaro said.

The pharmacy industry has no mandatory training or educational requirements for pharmacists who make compounds.

Last year, Crocker took 65 hours of continuing education, most of it involving compounding; in previous years he’s taken more than 100 hours of continuing-education training with most of it focusing on compounding.

The state requires pharmacists to have 15 hours of continuing education each year to maintain their license.

“It is the roots of pharmacy,” said Scolaro. “My grandfather was a pharmacist in North Carolina and he had to make all his medicines.”

However, compounding is time-consuming, she said, and the ready-made drugs supplied by the pharmaceutical industry free up pharmacists so they can spend more time consulting with patients.

Compounding is time-consuming, Parker concedes, but disagrees it takes time from patients.

“I work closely with the doctors in creating the right dosage for patients,” she said. When making hormone-replacement creams or gels Parker said she urges patients to tell her how symptoms are responding or if side effects are developing so she and the doctor can adjust the dosage.

Parker said it’s a thrill when a woman reports that her hot flashes, irritability, sleep problems and low libido have disappeared because of their customized treatment.

Occasionally pharmaceutical manufacturers take notice of the work being done by compounders.

Crocker said for years he and other pharmacists created an eye drop for people with severe dry eyes using cyclosporine, an immunosuppressive medicine. It sold for $39.95, he said.

Today, drug maker Allergan Inc. uses that formulation in Restasis, which sells for more than $100, he said.

Preserving the ability to compound requires constant vigilance among its practitioners. Parker said there have been so far unsuccessful attempts to legislate against the preparation of HRT compound preparations.

Allen said while most large drug makers have good relationships with compounding pharmacists, — after all, their drugs are used in pediatric preparations — there have been notable exceptions. Several years ago Wyeth petitioned the Food and Drug Administration to regulate compounding pharmacies. At this time states remain the primary regulators of pharmaceutical compounding.

Another problem for compounding pharmacists is insurance reimbursement.

Crocker said one of his great frustrations is the insurance industry’s unwillingness to compensate pharmacists for the time spent preparing compounds.

“I think the reimbursement could be higher but I think it’s that way across the board,” Parker said.

Contact Ginger Livingston at glivingston@reflector.com or (252) 329-9570.