A sweet manual to hormone replacement treatment products and services. Call now to speak with one of our clinical specialists now to get you started on the path to youthfullness.

1. Nationwide MD Inc.
(888)959-9304 Office
Hormone Therapy Guide
A basic outline of products/services available through Nationwide MD’s
(888)959-9304 Fax
network of physicians.
www.nationwideMD.net
info@nationwidemd.net

2. Introduction 3
About NATIONWIDE MD 4
Our Mission 5
Administrative Service 6
What is Hormone Replacement Therapy 7
Bto-Identical Hormone replacement Therapy (BHRT 8
Erectile Dysfunction 8
Hypogonadism 8
Hypogonadism Causes Primary -Secondary 8
Testosterone Replacement Therapy 9
Symptoms of Low Testosterone 9
Human Growth Hormone 9
Medications, Indications and Usage for HRT 10
Testosterone Cypionate injections 10
Testosterone Enanthanate Injections 11
Nandrolone Deaconate 11
Armidex 11
HCG 12
Consultant Protocol 13·34
Important Memorandum 35
Injection Reference Sites 36·39
Compounding Definitions 40
Compounding 41·43
Compounding vs. Traditional pharmacy 44·45
Definition of a generic drug and the FDA requirements 46
HRT Q&A 54-57
Medi·Spa and Service 58
Notes 59·64
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3. Introduction
This quick reference guide is a back to the basic reminder of the protocols set in place to guide
the consultants. The reference guide ha s basic reminders of common usage a n d client c a r e as new and
existing client o f Hormone replacement therapy.
This reference guide has pharmacy compounding meaning and definitions. Use this guide as quick
ref erence to medication and its usage. This guide a l s o tells you the company and its mission.
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4. About Nationwide MD
NATIONWIDE MD Inc. addresses the needs of both males and females who wish not only to prevent
disease, but to enhance their health and optimize their genetic aging potential.
We provide skillful management for a wide r a n ge o f hormones. Using a customized high quality bio-
identical hormone replacement treatment approach, sophisticated use of nutritional supplements and lifestyle
changes, including stress reduction and exercise, our medical experts enhance your body's potential to slow
down aging.
As a leader in Advanced Preventive and Rejuvenation Medicine, NATIONWIDE MD is dedicated to
offering successful anti-aging treatment protocols using bio-identical hormones formulated by our network
of compounding pharmacies who uphold our commitment to provide our clients with tailored treatment
plans by maintaining their focus on customizing dosages that are consistent with our physician's
expectations and complementary to our client's needs.
Our staff is headed by a medical director who is a long-standing member of the American Academy of
Anti-Aging M e d i c i n e (A4M). He has extensive background and experience in the key areas of medicine
relevant to this specialty. He is board certified in: Anti-Aging M e d i c i n e , F a m i l y
Practice and Clinical Nutrition Additionally, he specializes in Environmental, Bariatric and
Integrative Medicine.
NATIONWIDE MD clients receive constant support and guidance from our knowledgeable and experienced
staff of service consultants who coordinate the gathering and attainment of all relevant medical information,
laboratory testing, and case assignment to one of our network physicians. Individualized programs are
designed by our leading-edge physicians. Using an instructional approach, they take a f f i r m a t i ve
steps b y working with e a c h client o n a case-by-case basis to determine the most b e ne f i c i a l method
for achieving the desired result.
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5. Our Mission
NATIONWIDE MD's goal is to enhance the physical and mental wellbeing of our clients through
the optimization of their health.
We accomplish this by recognizing the uniqueness of each individual, and then customizing a treatment
regimen to reflect their personal health goals utilizing the latest anti-aging and integrative principles.
Our medical specialty is founded on the application of advanced medical technologies for the early
detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases.
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6. Administrative Services
• Secure Messaging System
• Wellness Tool tracking and communication
• Focus on total body custom software and tracks results
• Keep track of weight-loss and exercise
• Provide advanced efficient, and user friendly ordering and patient management
application.
• Automated Order process
• Role based content and security
• Online facility admin and patient advisor user guides.
• Generated PDF invoices and prescriptions
• Configurable email notifications for special events
• Lead assignment and tracking capability
• Digitally signed prescriptions
• Facility specific product formulary
• Web based application
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7. What is Bio-Identical Hormone Replacement?
NATIONWIDE MD’s patient Network bio identical hormone replacement therapy doctors take an
integrated approach to anti-aging medicine for both men and women. The customized programs
prescribed by our physicians include proper fitness, nutrition and supplements in combination
with possible anti-aging bio identical hormones.
This preventive medical approach helps put an end to suffering and the negative effects caused by
stress induced adrenal fatigue, peri-menopause, menopause, post-menopause, andropause (the
male menopause), hyperthyroidism and hypothyroidism.
Men and women often mistakenly believe that fatigue, low sex drive, insomnia, weight gain and
other symptoms of menopause, andropause, adrenal fatigue and thyroid disorders are just an
inevitable part of getting older. However, these symptoms are in fact caused by imbalanced
hormones of the body.
Many people have found relief with bio identical hormone replacement therapy. This natural
therapy is considered anti-aging because it works to combat the symptoms attributed to aging and
it can improve longevity and quality of life.
Hormones decline as we age. Bio identical hormone therapy serves to replace the hormones that
your body needs to function; mainly estrogen, testosterone, progesterone, a n d cortisol.
NATIONWIDE MD network physician use bio identical hormones versus bio-similar or synthetic
hormone s .
Bio identical hormones a r e molecule-by-molecule, e x a c t l y the same as the hormones p r e s e n t
in the human body. Synthetic hormones a r e intentionally d i f f e r e n t . Because drug companies
cannot patent a bio identical structure, t h e y make synthetic hormones t ha t are patentable. There
are several branded versions now available for use in the kind of hormone replacement therapy
(HRT) typical of synthetic hormones (Premarin, Prempro and Provera are common examples),
however, these are generally a one-size-fits-all dosage regime unlike bio identical hormones.
Although the field of anti-aging medicine has been around for many years many practitioners are
not familiar with it and have not had specific training. Conversely, NATIONWIDE MD has
dedicated network of bio-identical hormone anti-aging physicians have been certified in the field and
are experts in hormone replacement therapy.
NATIONWIDE MD doctors will assess your individual needs and work to restore balance to your
hormones by customizing a bio identical hormone replacement therapy plan integrated with proper
nutrition and fitness that is specifically for you and your particular needs.
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8. Bio-Identical Hormone Replacement Therapy (BHRT)
Bio-identical hormones are those that are molecularly identical to the hormones produced in the
body. These hormones are chemicals that are derived from sources of yam or soybean. Steroids
and hormones are taken from animals and plants then altered to be identical in molecular structure.
Sometimes referred to as natural hormones, are used to treat menopause symptoms, peri-menopause,
and post-menopause. The major benefit of BHRT is that treatment doses are individualized. Bio-
identical hormones are metabolized, stored, and converted into other hormones naturally.
Erectile Dysfunction
Erectile dysfunction, also known as ED, is the inability to achieve and sustain an erection for
sexual intercourse. Erectile dysfunction can happen at any age however it is more common in the
elderly. By age 45, most men have experienced erectile dysfunction at some of the time. ED varies
in severity; some men have a total inability to achieve an erection, others have an inconsistent
ability to achieve an erection, and still others can sustain only brief erections.
Hypogonadism
Male Hypogonadism is a condition in which the body doesn't produce enough of the male sex
hormone testosterone also known as primary testicular failure originates from a problem in the
r'
testicles.
Primary - This type of Hypogonadism - also known as primary testicular failure
originates from a problem in the testicles.
Secondary - This type of Hypogonadism - indicates a problem in the hypothalamus or the
pituitary gland
Either type of Hypogonadism may be caused by an inherited (congenital) trait or something that
happens later in life (acquired), such as an injury or an infection.
Causes of Hypogonadism - Primary and Secondary
Klinefelter syndrome
Undescended testicles
Mumps orchitis
Hemochromatosis
Injury to the testicles
Cancer treatment
Kallmann syndrome
8

9. Pituitary disorders
Inflammatory disease
HIVJAIDS
Medications
Obesity
Normal aging
Testosterone Replacement Therapy
Testosterone is a hormone produced by the testicles and is responsible for the proper
development of male sexual characteristics. Testosterone is also important for maintaining
muscle bulk, adequate levels of red blood cells, bone density, sense of well-being, and sexual and
reproductive function. The options available for testosterone replacement are
• Intramuscular injections - can be injected directly into the muscles, or implanted as pellets
in the soft tissues.
• Testosterone patches - Androderm is a skin patch worn on the arm or upper body.
• Testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.
The symptoms of low testosterone
• Low sex drive (libido)
• Depression
• Irritability
• Low sense of well-being
• Erectile dysfunction
• Fatigue and poor energy level
• Difficulty concentrating
Human Growth Hormone
Human growth hormone is a naturally occurring substance produced by the pituitary glands in
the body; works by increasing the amount of IGF-l that your liver produces. IGF-l prevents
Insulin from transporting glucose to cells. Growth hormone is a peptide hormone secreted by the pituitary
gland that stimulates growth and cell reproduction. Testosterone, HGH (Human Growth Hormone), DHEA
and others, can give men a better opportunity for a healthy and vigorous life. Male hormone
replacement therapy can have a significant and positive impact on men's health including fitness, strength
and sex drive.
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10. For adults who have a growth hormone deficiency, injections of human growth hormone can:
• Increase bone density
• Increase muscle mass
• Decrease body fat
~ • Increase exercise capacity
Human growth hormone is also approved to treat AIDS-or HIV-related muscle wasting.
MEDICATIONS, INDICATIONS AND
USAGE FOR HRT
Testosterone Cypionate injection, USP is indicated for replacement therapy in the male in
conditions associated with symptoms of deficiency or absence of endogenous testosterone.
1. Primary Hypogonadism (congenital or acquired) testicular failure due to cryptorchidism,
bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
2. Hypogonadotropic Hypogonadism (congenital or acquired) idiopathic gonadotropin or
LHRHdeficiency or pituitary-hypothalamic injuryfrom tumors, trauma, or radiation.
TESTOSTERONE CYPIONATE INJECTION, USP
100 mg/ml and 200 mg/rnl
Testosterone Cypionate injection, USP, for intramuscular injection, contains Testosterone
Cypionate which is the oil-soluble 17 (beta)-cyclopentylpropionate ester of the androgenic
hormone testosterone.
Testosterone Cypionate is a white or creamy white crystalline powder, odorless or nearly so and
stable in air. It is insoluble in water, freely soluble in alcohol, chloroform, dioxane, ether, and
soluble in vegetable oils.
INDICATIONS AND USAGE
Males: Androgens are indicated for replacement therapy in conditions associated with a
deficiency or absence of endogenous testosterone
Primary Hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism,
bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy.
Hypogonadotropic Hypogonadism (congenital or acquired) -idiopathic gonadotropin or
LHRHdeficiency, or pituitary hypothalamic injury from tumors, trauma, or radiation.
10

11. TESTOSTERONE ENANTHATE INJECTION USP
Testosterone Enanthate Injection is a clear, colorless to pale yellow sterile oleaginous solution of
Testosterone Enanthate for intramuscular use. Testosterone Enanthate is a white or creamy white,
crystalline powder. It is odorless or has a faint odor characteristic of heptanoic acid. It is insoluble
in water, very soluble in ether and soluble in vegetable oils.
INDICATIONS AND USAGE
Males: Androgens are indicated for replacement therapy in conditions associated with a
deficiency or absence of endogenous testosterone
Primary Hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism,
bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy.
Hypogonadotropic Hypogonadism (congenital or acquired) -idiopathic gonadotropin or
LHRHdeficiency, or pituitary hypothalamic injury from tumors, trauma, or radiation.
NANDROLONE DECANOATE INJECTION, USP
Nandrolone deaconate injection is intended for deep intramuscular injection only, into the gluteal
muscle preferably. A sterile oleaginous solution containing per ml: Nandrolone Deaconate 200
mg with Benzyl Alcohol 5% as solubilizer /preservative, in Sesame Oil. Nandrolone deaconate
occurs as a fine, white to creamy white, crystalline powder. It is odorless, or may have a slight odor.
Nandrolone deaconate is soluble in chloroform, in alcohol, in acetone, and in vegetable oils. It is
practically insoluble in water.
Arimidex
Arimidex - also known as Anastrozole also works well as an adjunct to Hormone Replacement
Therapy, It has also been tested to reduce estrogen including estradiol, in men; preventing
possible prostate enlargement. Armidex helps to maintain some natural testosterone production, while
taking an exogenous source of testosterone as well.
HCG
HCG as it is commonly called is really an acronym for Human Chorionic Gonadotropin Hormone. It
has many functions and is used medically to treat a variety of conditions. HCG is a hormone
naturally produced in the body. HCG is a hormone which plays different roles in male and female
sexual development. In men, physicians may prescribe HCG to increase or restore testosterone
production. Both men and women use HCG for weight loss this method is not FDA-approved.
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12. Function
HCG acts like luteinizing hormone (LH). In males, LH tells the testes to produce testosterone. In
men undergoing hormone replacement therapy, their testes may stop producing testosterone, so
HCG can remind their testes to keep producing testosterone. HCG also raises sperm counts, so it
can improve male fertility
Men suffering from androgen disorders take HCG to jump start their testosterone production. A
prescription medication, HCG is injected subcutaneously
Benefits of HCG Therapy for men with low testosterone include the following:
• Improve male sexual performance
• Enhance mood in men
• Reduce depression in men
• Increased energy and vitality
• Increase male bone density
• Improve male fertility
• Increased strength and endurance
• Regulate distribution of body fat
• Increase body hair growth
• Reduce risk of heart disease
• Develops lean muscle mass with exercise
• Increased male sex drive
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13. Consultant Protocol
When NATIONWIDE MD receives a new potential candidate for BHRT, ED, TRT or GHRT we do
a proper pre- screening .
1. Patient Bio
a. Full Name
b. DOB (avg. age 30-70yrs old) (under 30 will need previous medical records with
conditions) rare.
c. Phone
d. Address
e. Email
f. Height
g. Weight
h. History of use (if any)
2. Patient is instructed to either complete the HHQ online or we can email or hard copy mail a
copy for completion.
3. Patient is then instructed in order to become a potential candidate for these therapies they
will need to submit a physical by their medical professional, PCP, RN, ARNP,etc.
4. Patient is then instructed to arrange for diagnostic testing.
I.e. Serum, Saliva, urine (not common).
a. Serum is the preferred method for the initial evaluation of potential patient for males.
They are instructed that they need an Endocrine evaluation for the Physician to
evaluate for possible treatment. Females can either do Serum or Saliva.
b. Patient can be arranged through Labcorp, Access med labs or their PCP.
5. Once all medical records are received, documentation of Physical and Lab analysis are in
then we submit through Our Med soft system for pre-approval from physician. A notation by
the patient care coordinator can be added at this time with any specifics regarding the
possible patient. I.e.; history of use, possible interest for programs, etc.
6. Physician then does an initial review to rule out any possible cross indications of medical
conditions that could hinder or negatively affect the patients program.
7. Physician then sends pre-approval back to PCCfor the follow up regarding pre- approved
therapies. There will be a drop down section of all pre- approved therapies by category
that a patient is pre- qualified for.
8. PCCthen reviews any notations and goes over possible protocols with patient. This can
sometimes be affected by patients financial abilities so all matters are discussed
accordingly.
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14. Medication Protocols:
1. Testosterones: General census is the Test Cypionate is most commonly used for the Majority
of patients. The therapeutically doses vary based on patient body weight and previous usage.
Recommended therapeutically dosage is between .25cc to 3cc's based on patient specific needs.
(i.e.: Hypogonadism patients. HIV positive patient/Muscle wasting patient).
Typical dosage is 1-2 cc pr wk or between 200-500mg. These are the dosages that will
typically
Increase a patients low T levels to a normal range. Alternative testosterones are based on
history and conversion rates.
2. Patient is instructed that a Normal Range is between 700-1000 and should not be higher
For long term therapy. Patient is also made aware of alternative test therapies such as Test
Troches, Topical and Capsules.
3. New patients are instructed to do a follow up lab to check on the CBC/dif and T levels
every 6 months.
Existing patients (Over a year) are then required to do an annual Complete BW to make
sure
No other issues are occurring, including an updated physical.
4. Patients are also instructed that a proper protocol also includes the usage of HCG and anti
estrogens to prevent possible side effects such as Hypogonadism and gynocamastia. This is
also determined by the patient Health History, Labs and previous usage of therapies.
5. Patients are also instructed if they opt out of these therapies (not recommended) that if
they are
Experiencing any of these side effects to contact the office immediately to adjust the
program
According to Dr. Protocols. (i.e.: HCG, Anastrazole/Tamoxifen),
6. All patient s are then told that the possible program has to be finalized by the Prescribing
physician. They have also agreed that these medications if prescribed will be for medicinal
use
Only and will not be prescribed for performance enhancement or aesthetics. (Our
disclosure forms also have this to be signed off by the patient.)
7. Patients will also be notified that the Physician will contact them to discuss therapies via
phone.
They have also been made aware that based on certain states that they will be required to
come into a Face to Face visit with Prescribing Physician on an annual basis. (i.e.: NY,
Oklahoma, etc). ..
8. Added therapies can also include Stanozolol (wasting, edema, shbg levels) Nandrolone
(muscle wasting, joint pain and post injury), Oxandrolone (muscle wasting, weight gain,
post - surgery).
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15. Stanozolol is then explained that should not be on for more than a certain period of time
consecutively (i.e. 3mo) then off for the same period of time. (Dosage range l00mg 3x
prwk).
Nandrolones is also explained on the benefits (increase joint mobility, faster recovery
time, and post injury) and side effects (loss oflibido, potential estrogen builds up). This
medication is not to be used more than 20 weeks consecutively before removing from
program for 10 weeks. Nandrolone will also stay in a patients system for an avg. of 3-4
after discontinued use so they will still experience benefits.
Oxandrolone is an alternative medication for (muscle wasting, weight gain, post- surgery or
illness). This medication is very mild in Oral format so a patient can be on for longer
periods.
Formula: (2 mg per pound - Max allowed within 6 months)
ERECTILE DYSFUNCTION:
1. This is a typical initial complaint that most patients come in with. Loss of erection,
libido, etc.
2. Patient is advised to document any previous injuries to the head or testes to make sure
their
Are no possible pituitary issues. Medications that are available are basic ED meds,
Viagra, Cialis, levitra and now the compounded versions in more specific dosing and
administration (i.e. Troches).
3. The next and last alternative treatment is Injectable Tri-Mix therapy. Very common in
the older population because the other medications will not work based on health
history. The majority of patients requesting these therapies have been diagnosed and
treated for this ailment by other medical professionals. (i.e.: Boston Medical Group) The
patients just seem
To not want to pay the High costs of going to these specialty centers.
ALL ED medications is explained to be used accordingly to instructions and if
experiencing erections longer than 4 hours to go to the emergency room.
GROWTH HORMONE DEFICINECY:
1. Any growth hormone program has to have an IGF-l test to show low levels. The preferred
protocol for a potential new patient seeking these therapies or shown deficiencies is to first
start on the Sermorelin protocol to stimulate the natural secretion from the pituitary. This
program is not advised for candidates over the age of 48 because studies have shown that
at this age group
The pituitary is not secreting enough to justify the stimulation, hence the alternative HGH
programs.
15

16. Formula: (Mcg Dosage = LBS/ 2.2 * 3.5)
All HGH possible patients are also told to disclose and hereditary cancer history in their
family.
If no possible cancer factors are involved then the dosage is based on height and weight.
Formula: (IU Dosage = LBS/ 2.2 * 0.03)
ADJUNCT THERAPIES:
Thyroid Dysfunction: Liothyronine.
Vitamin B Deficiency Low Energy: Cyancabolomin Methylcabolomin
Hair Loss DHT Conversion: Finasteride, Propecia, Proscar HCG:
Weight loss program, Dr. Simeon's protocol.
RECEIPT OF MEDICATIONS
Once a patient receives their medication they are sent an email with the protocols
And procedure of administering their therapy.
They are instructed if they have any questions or concerns regarding the therapy
To contact the corporate office.
If one of our Medical Assistants cannot handle the call then it is either forwarded to the
Pharmacy for explanation of the physician.
ALL Clinical Advisors are instructed that they cannot give medical advice nor interpret
and medical Deficiencies. They are instructed to discuss the Benefits of the programs and
possible Side effects of these programs.
Patient is then instructed that we will follow up with them every 4 weeks to note their
Progress and or concerns. They are also explained that at any given time if they have
Any questions to contact the corporate office.
On the 8th week, based on a 10 week program the PCC will contact patient to follow up
And to see if they are ready for their refill.
No refill will be filled until 70-80% usage is completed by law. Exceptions can be made
For loss, breakage or damaged meds but will be noted and the patient is instructed that
this
Is a onetime occurrence and cannot be continued. (This is a case by case scenario)...
All calls and emails are monitored and or recorded for training and compliance concerns.
The med soft system will allow the workflow of the Patient Practice- NATIONWIDE MD
Pharmacy
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17. Workflow to be very dynamic; all actions on Medsoft are time stamped for authentication
Of user ...
NATIONWIDE MD and all of its affiliates and contractors are obligated to follow every
aspect of all state and federal regulations r e g a r d i n g the medicinal therapies a n d
treatment p r o g r a m s .
Cialis Tadalafil
General I n f o r ma t i o n : Used to treat male s e xua l func t i on p r o b l e m s (impotence or
erectile dysfunction). Tadalafil is Cialis active ingredient. Erection lasting longer than four hours
must go to emergency room; epinephrine c o u n t e r a c t s p r o l o n g e d erections.
Directions: As needed 30 minutes before intercourse w i t h or without f ood .
Common side effects: Headache. Stomach upset, back pain. Muscle pain, nasal stuffiness,
flushing, pain in arms or legs, dizziness. Or vision changes.
Clomiphene Citrate
General Information: Used typically for post program helps to clean out receptor s i t e s flush out
extra estrogen from body. 50 mg only compounded, Clomide name brand available in generic
Common side effects: Stomach upset, bloating, abdominal/pelvic fullness, flushing, breast
tenderness, headache, dizziness. Vision changes, eye pain.
Serious s i d e e f f e c t s : Severe pai n /swelling in the lower abdomen ( pelvic) area, sudden/rapid
weight g a i n . Nausea/vomiting, d i a r r h e a , shortness of breath, change in the a m o u n t of
urine, pain/redness/swelling of the legs, chest pain, fast/irregular heartbeat.
Cyanacobalamin Methylcobalamin (Vitamin B-12)
General Infor mati on : Cyanacobalamin (Fast-acting l a s t about 4 8 hours) is a man-made
form of vitamin B12 used to treat l o w levels of this vitamin. Vitamin B12 helps your body use fat
and carbohydrates for energy and makes new protein. It is also important f o r normal blood. Cells
and nerves. This medication i s for intramuscular injection.
Methylcobalamin:_Sustain release stays in your body for about a week (Inject once a week)
Directions: Cyanacobalamin: Inject 1 ml 3 times a week i n t r a m u s c u l a r l y . Methylcobalamin:
Inject 1 ml once a week intramuscularly.
Common side e f f e c t s : Pain/redness at the injection s i t e , mild diarrhea. Itching or a feeling of
swelling all over the body.
Serious s i d e e f f e c t s : This medication may cause hypokalemia. Symptoms are muscle
cramps, weakness, irregular heartbeat
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18. Cytomell Liothyronine
General Information: Liothyronine is used t o treat hypothyroidism. It replaces a hormone that is
normally produced by the thyroid gland. This medication is also used to lower t h y r o i d function in
certain diseases such a s enlarged thyroid gland ( goiter) and H a s hi m o t o ’ s thyroiditis. It is also used
to t e s t thyroid activity. Liothyronine is a man-made hormone that replaces the body's natural
thyroid hormone (T3). Take this m ed i cat i o n by mouth w i t h o r without food, usually i n the
morning. Take t hi s m e d i c a t i o n 4 hours before or after t a k i n g any products containing
aluminum or iron, such as antacids, sucralfate, and vitamins/minerals.
Common side effects: Nausea, in rare instances, some temporary hair loss may occur during the
first few months of starting this drug.
Serious s i de e f f e c t s :Headache, irritability, trouble sleeping, nervousness, increased
sweating, heat intolerance, diarrhea, menstrual changes, chest pain, trouble breathing with exercise,
fast/irregular/pounding heartbeat, swelling of the arms/legs, extreme weakness.
DHEA/Pre~nenolone
General Information: DHEA is a sex hormone and is recommended to be taken while on HCG to
help prevent the shutdown of pregnenolone production in your body; which HCG can cause when
on it for a long period of time.
DHEA also appears to be useful in combating auto-immune disorders, especially lupus (systemic
Lupus e r y t h e m a t o s u s ). DHEA has demonstrated the pote nt ia l for preventing or treating a
broad range of other disorders including cancer (especially breast cancer], obesity, senile
dementia, osteoporosis, chronic fatigue syndrome, depression, and weakened immune
systems. Supplemental DHEA often markedly improves physical flexibility and e n d u r a n c e .
DHEA often decreases appetite by increasing the l e v e l s o f cholecystokinin, the ho r m o ne that
t e l l s y o u r b r a i n that you've had e n o u g h to e a t . It also tends to inhibit the conversion of
glucose to fat, which keeps people from gaining as much weight from eating carbohydrates as
they otherwise would. In some c a s e s , D H E A can significantly improve one's cholesterol
profile, raising HDL levels a n d lowering LDL levels.
Pregnenolone is a p r e c u r s o r to the body's other naturally occurring hormones,
including dehydroepiandrosterone (DHEA), progesterone, estrogen, testosterone, and
cortisol. Pregnenolone is synthesized directly from c h o l e s t e r o l and i s responsible for countless
functions in our b o d i es . Pregnenolone acts t o improve memory and c o m b a t depression and h a s
p o w e r f u l anti-inflammatory arthritis pain r e l i e v i n g properties. Some p e o p l e find
pregnenolone improves energy, vision, memory, clarity of thinking, wellbeing, and o f t e n
sexual enjoyment or libido . It may be considered a good brain e n h a n c e r in those w h o are
deficient.
Directions: Apply 1 ml topically to your wrist or inner thighs every day (rotate sites, best to
apply medication after showering and wait at least 30 minutes after application before you have
any contact with others to prevent transfer of medication)
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19. Side effects: (DHEA) acne, hair loss, stomach upset and high blood pressure. Some women c a n
have changes in menstrual c y c l e , facial hair growth, and a deeper vo i c e . Liver problems:
DHEA might make liver problems w o r s e . Diabetes: DHEA can affect how insulin works in the
body. If you have diabetes, monit or your blood sugar carefully.
Side effects: (Pregnenolone) overstimulation and insomnia, irritability, anger or anxiety, acne,
Headaches, possible scalp hair loss (if used daily for prolonged periods), irregularities of heart
rhythm, heart palpitations.
Danazole
General I n f o r m a t i o n : Danazole is an anabolic used to treat hypogonadism ( when the sex glands
produce little or n o h o r m o n e s ). This m e d i c a t i o n is recommended to b e taken along
w i t h testosterone and does not affect testosterone levels. The available dosages for this medication
are between 5 0 -100 mg.
Directions: 1 tab by mouth every day.
Common side e f f e c t s : Weight gain. Acne, flushing, sweating, voice changes (hoarseness, change
in pitch), a b n o r m a l growth o f body hair (in women), vaginal d r y n e s s /irritation, or decreased
breast size.
Serious side e f f e c t s : Swelling hands/ankles/feet, menstrual changes ( such as spotting, m i s s e d
periods), mental/mood changes.
Finasteride Propecia Proscar (brand name)
General Information: This medication is used to treat male pattern (androgenetic alopecia) at the
crown and in the middle of the scalp. It should be used by adult men only. This medication w o r k s
b y decreasing t h e amount o f a natural b o d y hormone (DHT). Decreasing t h e amount o f DHT
leads to increased hair re-growth and slower hair loss. Hair growth o n other parts o f the body is
not affected by finasteride. You must continue t o take this medication t o maintain your hair
growth. When you stop taking finasteride, a n y gain in hair quantity is generally lost w i t h i n 12
months. This medication is normally t a k e n along wi t h testosterone. Normal ranges for DHT
levels are (40-575)
Directions: Take 1 pill by mouth 3 times a week
Common side effects: Decreased sexual a b i l i t y /desire. In some m e n , t hi s m e d i c a t i o n
can decrease the amount of semen released duri n g sex.
Serious side effects: Lump in the breast, nipple discharge, breast enlargement/tenderness/pain,
pain in the testicles, inability to urinate.
19

20. General Information: Various brands o f this medication are used for the treatment of one of the
following m e di c a l c o n d i t i o n s : growth failure, growth h o r m o n e deficiency. Intestinal
disorder (short bowel syndrome) o r HIV-related weight loss or wasting.
Common side effects: Headache. Nausea, vomiting, fatigue. Muscle pain, or weakness.
Serious s i d e e f f e c t s : Development of a limp, persistent fatigue, unusual/unexplained
weight gain. Persistent cold i ntol erance , persistent slow he a rt be a t , fast h e a r t b e a t , e a r
pain/itching.Hearing problems, joint/hip/knee pain. Numbness/tingling, unusual increase in
t h i r s t or urination, swelling h a n d s /ankles/feet. Change i n the a ppe a ra nc e or size of any
mole, severe headache, persistent nausea/vomiting, severe stomach/abdominal pain, vision
problems or changes, seizure.
Ghrelin
General I n f o r m a t i o n : Ghrelin i s a p o t e nt stimulator of growth hormone from t h e
anterior pituitary g l a n d . This medication c a n be taken every day; inject medication a t bed time
because your body secrets growth hormone while sleeping. This medication m a y also cause
drowsiness.
Mixing instructions: Depressurize Ghrelin vial first. Slowly inject 3ml of bacteriostatic water
into Ghrelin vial do not shake vial gently swirl vial between h a n d s to dissolve medication. Once
the medication h a s been mixed store me dica ti on i n refrigerator. Inject 300- 600 mcg per day at
bed time. Every 10 on insulin syringe is 100 units.
Directions: Inject .25 ml sub-q every day at bed time.
Side effects: Increased appetite
General I n f o r m a t i o n : HCG works b y causing t h e t e ste s t o release m a l e sex hormones.
This medication i s also used in women t o treat fertility problems. So both male and female
patients should take extra precautions w h e n on this medication to prevent a n y unwanted
p r e g n a n c y . It is recommended that you take this medication while taking testosterone; 4-5
weeks after starting testosterone your body starts to recognize the free flowing testosterone
which in turn causes your body to stop production of its natural LH hormone. HCG helps to
prevents t h i s so your LH levels do not plateau and everything s t a ys in balance. It is also
recommended t h a t you inject HCG one day before testosterone injection.
Mixing instructions: Start by depressurizing your HCG vial, next you draw up the correct
amount of bacteriostatic water (depending the amount of units per vial normally 1:1 follow
doctors sig) slowly inject water into HCG vial, do not shake vial you gently swirl vial between
hands to dissolve medication once the medication has been mixed it is to be stored in
refrigerator. Medication should be clear if cloudiness is noticed then medication is no good.
Directions: Inject 250 IV (25 on insulin syringe) sub-q twice a week.
20

21. Common side e f f e c t s : Headache. restlessness, tiredness, mild swelling or water weight
gain; depression; breast tenderness and swelling and or injection site inflammation and pain,
ovarian hyper-stimulation syndrome, multiple births in pregnancy.
Serious s i d e effects: swelling of the ankles/feet mental/mood changes.
HGH/Tev-Tropin
General Information: Various brands of this medication are used for the treatment of one of the
following medical conditions: growth failure, growth hormone deficiency. intestinal disorder
(short bowel syndrome) or HIV-related weight loss or wasting. HGH should be taken 5 days on 2
days off. HGH contains 191 amino acids. Tev-Tropin contains 192 amino acids.
Mixing Instructions: Depressurize Tev-Tropin vi a l first. Slowly inject 1 . 5 m l of bacteriostatic
water into vial do not shake vial gently swirl vial between ha nd s to dissolve medication. Once the
medication ha s been mixed store medication i n refrigerator. Inject at bed time on empty stomach.
Every 10 on insulin syringe is 1 unit.
Common si de effects: Headache, Nausea, vomiting, fatigue, muscle, pain, or
weakness.
Serious side effects: Development of a limp, persistent fatigue, unusual/unexplained weight
gain, persistent cold intolerance, persistent slow heartbeat, fast h e a rt b e a t , and ea r
p a i n /itching. Hearing problems, joint/hip/knee pain, numbness/tingling, unusual increase in t h i r s t
or urination, swelling h a n d s /ankles/feet. Change i n the a ppe ara nce or size of any mole, severe
headache, persistent nausea/vomiting, severe stomach/abdominal pain, vision problems or
changes, seizure.
Hydrocortisone
General I n f o r m a t i o n : Hydrocortisone is a natural subst a nc e (corticosteroid hormone)
m a d e by the adrenal gland.
It is used to treat conditions such as adrenal fatigue syndrome, arthritis,
blood/hormone/immune system disorders, skin and eye conditions, breathing problems, cancer
and severe allergies. It decreases y o u r immune system’s response t o various diseases t o reduce
symptoms s u c h as pain, swelling and allergic-type reactions. Hydrocortisone i s also used to treat
low hydrocortisone levels caused b y diseases o f the adrenal g l a n d ( such as Addison’s disease.
adrenocortical insufficiency). Corticosteroids are needed i n many ways for the body to function
well. They are important f o r salt and water balance and keeping blood pressure normal. Because
this drug works b y weakening t h e immune s yst e m , it may lower your ability to fight infections.
This may make you more likely to get a serious infection or make any infection you have worse.
Use of this medication f o r prolonged or repeated periods m a y result i n oral thrush or a yeast
infection. This medication may infrequently m a k e your blood sugar level rise, which can cause or
worsen d i a b e t e s (symptoms o f high blood sugar increased t h i r s t a n d urination). If you
already have diabetes, be sure to check your blood sugars regularly.
21

22. Common side effects: Nausea, heartburn, h e a d a c h e , dizziness, menstrual p e r i o d change,
trouble sleeping, increased s w e a t i n g , acne.
Serious side effects: Unusual tiredness, swelling ankles/feet, unusual weight gain, Vision
problems, easy bruising/bleeding, puffy face, unusual hair growth, mental/mood changes, muscle
weakness/pain, thinning skin, slow wound healing, bone pain, black/bloody stools, vomit that
looks like coffee grounds, stomach/abdominal pain.
Letrozole
General Inf or mati on : Letrozole d e c r e a s e s the amount o f estrogen t h e body makes. It is
the strongest anti e s t r o g e n on the m a r k e t and m o s t e x p e n s i v e . Used when A n a s t r o z o l e
is not working.
Common side effects: Hot f l a s h e s , hair loss, j o i n t /bone/muscle pain, tiredness,
unusual sweating, nausea. Diarrhea. Dizziness and trouble sleeping.
Serious side effects: Bone fractures. Mental/mood changes, swelling of arms/legs,
blurred vi sion .
General Information: If patient has sulfa allergies this medication ca nnot be taken.
Methionine: it assists in the breakdown of fats and thereby prevents the build-up of fat in the
arteries, as well as assisting with the digestive system and removing heavy metals from the body
since it can be converted to cytosine, which is a precursor to gluthione, which is of prime
importance in detoxifying the liver.
Inositol: helps to m a i n t a i n proper electrical energy and nutrient transfer across the
cell membrane. It also acts as a lipotropic w h i c h converts f a t s into other u s e f u l products.
Inositol helps establish healthy cell membranes, w h i c h facilitate nerve impulses.
Choline: Assists in controlling your weight as well as cholesterol l e v e l s , keeping cell membranes
healthy a n d in preventing gallstones. It is also most useful in the maintenance of the nervous
system, assisting memory and learning, and may help to fight infections, including hepatitis and
AIDS. Choline is critical for normal membrane s t r u c t u r e a n d function.
Choline: is the major precursor of betaine, and it is used by the kidneys to maintain water
balance and by the liver as a source of methyl-groups for methionine formation. It is also used to
produce the important n e u r o t r a n s m i t t e r acetylcholine.
Side effects: Possible could burn while injecting, Redding of injection site
22

23. Minocycline
General Information: Minocycline is used to treat a wide variety o f infections, including acne.
This medication belongs to the class of antibiotics known as tetracycline. It works by stopping the
growth o f bacteria. Swallow this medication whol e . Take each dose with a full glass of water ( 8
ounces) u n l e s s your doctor directs yo u otherwise. Do not lie down for 10 minutes a f t e r taking
this medication. For this reason, d o not take it right before bedtime. You may take minocycline
with food or milk if stomach upset occurs, unless your doctor directs you otherwise.
Common side effects: Nausea, vomiting, diarrhea, lightheadedness, dizziness, unsteadiness,
drowsiness, mouth sores, or cough.
Serious side effects: Sunburn (sun sensitivity), muscle pain, difficult or painful swallowing,
change in the amount of urine, pink urine, brown/gray tooth discoloration, blue/gray/brown
discoloration of the skin/lips/tongue/gums, numbness/tingling of the hands/feet.
Unusual fatigue, new signs of infection, hearing changes, easy bruising/bleeding, headache, vision
changes.
Nandrolone Deconate
General Information: Known c o m m o n l y as “ Deca” flushes estrogen through your
s y s t e m lubricating j o i n t and aiding in muscle repair. This is a short acting medication if
used for long periods of time it can cause muscle wasting. This medication should b e
taken in 3 month increments.
Side effects: Estrogen build up, Fluid buildup (edema), low libido.
Oxandrolone
General Information: This medication i s used to help people regain weight they have lost due to
certain medical conditions (such as s u r g e r y , chronic infection, trauma, long t e r m use
o f corticosteroid medication such as hydrocortisone/prednisone). It is also used to relieve bone
pain due to bone loss (osteoporosis) and muscle wasting. Oxandrolone belongs to a class of drugs
known as anabolic steroids. These drugs are similar to male hormones made by the body. This
medication can cause your body to hold on to extra body water (edema). This can increase your
risk of heart failure. Tell your doctor immediately if any of these unlikely but serious signs of
water retention or heart failure occur, decreased exercise ability, hands/ankles/feet swelling,
unusual tiredness, shortness of breath while lying down. This medication can also decrease
sperm production in males.
Common side effects: Nausea, vomiting, skin color changes, oily skin, acne, hair loss,
increased/decreased sexual interest
Serious side effects: Mental/mood changes, trouble sleeping/snoring, signs of serious liver
disease (persistent abdominal pain/nausea, unusual tiredness, yellowing of the eyes/skin, dark
23

24. urine), trouble urinating (male only), breast swelling/tenderness (male only), to
frequent/prolonged erections (male only)
In females: Deepening of the voice, hoarseness, unusual facial/body hair growth, enlarged
Clitoris, and irregular menstrual.
Oxytocin Nasal Spray
General Information: Oxytocin is best known for its roles in sexual reproduction, in particular
during and after childbirth. It is released in large amounts after distension of the
cervix and uterus during labor, facilitating birth. And after stimulation of the nipples.
Facilitating breastfeeding. Recent s t u d i e s h a v e begun t o investi gate oxytocin’s role in
various behaviors, including orgasm. Social recognition, pair bonding. Anxiety. And
maternal behaviors. For this reason, it is sometimes r e f e r r e d t o as the “love hormone". Oxytocin
causes a euphoria effect increasing y o u r l i bi do . Oxytocin is destroyed in the gastrointestinal
t r a c t , and therefore m u s t be administered by injection or as nasal spray. Oxytocin has a half-
life of typically about three minutes in the blood.
Side effects: Nausea, vomiting, more intense or abrupt contractions o f the
Phosphatidylserine
General Information: Phosphatidylserine is a chemical. The body can make phosphatidylserine,
but gets most of what it needs from foods. Phosphatidylserine supplements were once made from
cow brains, but now are commonly manufactured from cabbage or soy. Phosphatidylserine is
used for Alzheimer's disease, age-related decline in mental function, improving thinking skills in
young people, attention deficit-hyperactivity disorder, depression, preventing exercise-induced
stress, and improving athletic performance.
Side effects: Insomnia and stomach upset, particularly at doses over 300 mg.
Progesterone
General Information: Progesterone is a type of female hormone ( progestin). This medication is
similar to the progesterone that your body naturally makes and is given to replace the hormone
when your body is not making enough of it. In women who are not pregnant and not going
through menopause, this medication is used to restore normal menstrual periods that have
stopped for several months (amenorrhea). Progesterone is also used as part of combination
hormone replacement therapy with estrogens to reduce menopause symptoms. Progesterone is
added to estrogen r e pl a c e m e nt t h e r a p y t o reduce the risk of cancer of the uterus.
Common side effects: Nausea, bloating, breast tenderness, headache, change in
v a g i n a l discharge, mood swings, blurred vi si on , dizziness, or drowsiness.
Serious side effects: Unusual vaginal bleeding, mental/mood changes, swelling of the
hands/feet, frequent/burning/painful urination, breast lumps, dark patches on the skin or face,
24

25. Yellowing eyes /skin, stomach/abdominal pain, persistent nausea/vomiting, dark urine,
unusual tiredness.
Sermorelin GHRP
General Information: Stimulates your pituitary to produce your own natural HGH. Sermorelin,
which was first developed in the 1970's is a peptide which contains a total of 29 amino acids and
encourages the pituitary gland to produce more Human Growth hormone. Today, Sermorelin is
combined with GHRP-6 which is a growth hormone releasing peptide (also known as growth-
releasing factor). This combination, when administered via daily injections, will encourage your
pituitary gland to secrete HGH at a much higher rate.
Mixing instructions: Depressurize Ghrelin vial first. Slowly inject 3ml of bacteriostatic water
into Ghrelin vial do not shake vial gently swirl vial between hands to dissolve medication. Once
the medication has been mixed store medication in refrigerator. Inject 300- 600 mg per day at
bed time. Every 10 on an insulin syringe is 100 units
Side effects: Headache. Flushing, increase in activity (hyperactivity). GHRP: Increased appetite
Serious side effects: Trouble swallowing, vomiting, tightness i n the chest.
Triamterene H C T Z
General i n f o r m a t i o n : This d r u g i s used t o treat high bl ood p r e s s u r e . Lowering h i g h
blood pressure helps prevent stroke s , heart attac ks and kidney problems. This combination i s used
by people who have developed or are at risk for having low potassium levels
on hydrochlorothiazide. It causes you to make more urine, which helps your body get rid of extra
salt and water. This medication a l s o reduces e x t r a fluid in the body caused by conditions s u c h
as heart f a i l u r e , liver disease or kidney disease. This can lessen symptoms s u c h as shortness
o f breath o r swelling in your ankles or feet. It is best to avoid taking this medication w i t h i n 4
hours of your bedtime to prevent having to get up to urinate.
Common side effects: Dizziness, lightheadedness, headache or upset stomach.
Serious side effects: Fainting muscle cramps/weakness, slow/fast/irregular heartbeat,
u n u s u a l decreased u r i n a t i o n , unusual dry mouth/thirst, decrease i n vision, eye pain.
Tamoxifen
General information: Used to remove estrogen from your body. Also helps to lower LDL levels.
Common s i d e effects: Hot flashes, Nausea, leg cramps, hair thinning, or headache. A loss o f
sexual ability/interest may occur in men.
Serious s i d e e f f e c t s : Vision changes, eye pain, easy bruising/bleeding, mental/mood
changes, swelling of ankles/feet. Unusual tiredness, s t o m a c h /abdominal pain, persistent
nausea/vomiting, dark urine, yellowing eyes/skin, s i g n s of infection.
25

26. Testosterone
General Information: This medication is used in men who do not make enough of a natural
substance called testosterone. In males, t e s t o s t e r o n e is responsible for many normal
functions, including growth and development of the genitals, m u s c l e s , and bones. It also helps
c a u s e no r m a l sexual development (puberty) in b o y s . Testosterone belongs to a c l a s s of
d r u g s known as androgens. It works by affecting many body s y s t e m s so that t h e bo d y c a n
develop and f unct i o n normally. This medication can cause y o u r b o d y to hold o n to extra b o d y
water (edema). This can increase your risk o f heart failure (signs of water retention/heart
failure; decreased exercise ability, hands/ankles/feet swelling, unusual tiredness, shortness of breath
while lying d o w n ). This medication can also decrease sperm production in males.
Recommendations: Inject 4-5 d a y s apart from e a c h other intramuscularly (gluteus maxim
us, vastus lateralis, lateral deltoid muscle) store a w a y f r o m s u n l i g h t and heat. Patient should
n o t go over 6 0 0 mg a week.
Common side effects: Nausea, vomiting, skin color changes (red can mean Bop is up), oily
skin, acne, hair loss, increased/decreased sexual interest, testicular atrophy (increase HCG),
puffiness of face, chest, and abdomen (estrogen builds up).
Serious side e f f e c t s : Mental/mood changes, trouble sleeping/snoring, signs of s e r io us
liver disease (persistent abdominal pain/nausea, unusual tiredness, yellowing of the ‘eyes/skin,
dark urine), trouble urinating (male only), breast swelling/tenderness (male only),
to frequent/prolonged erections (male only)
In female: Deepening of the voice, hoarseness, unusual facial/body hair growth, enlarged clitoris,
irregular menstrual periods.
Reaction times
Aqueous suspension: 1- days fast acting
Cypionate: 3-5 days slow acting
Proprionate: 1-2 days fast acting (increase swelling and soreness)
Enanthate: 5-7 days slow acting
Proplonate /Cypicnate: (Bi-mix) Fast/slow acting
Enanthate/Propionate: 200/50mg Fast/slow acting
Enanthate /Cyplonate/Propionate: 100/100/50 (higher risk of side effects, patient must be on all
3 types oftestosterone before they can go on this mix)
Testosterone cream: Available from 1 - 25% Female 2% average Male 5 - 20% average
26

27. Viagra Sildenafil
General Information: Sildenafil (active ingredient) i s used to treat male sexual function
problems ( impotence or erectile dysfunction) by blocking a certain enzyme (phosphodiesterase-
PDE5) in the body. In combination wit h sexual stimulation, s i l d e n a f i l works by helping
the blood flow into the penis to achieve and maintain an erection. If you have erections lasting
longer than four hours go directly to the emergency room. Epinephrine counteracts the effects of
prolonged erections.
Common side effects: Dizziness, lightheadedness, headache, flushing, heartburn, nosebleeds. Trouble
sleeping, or swollen hands/ankles/feet. Vision changes such as increased sensitivity to light,
blurred vision, or trouble telling blue and green colors apart.
Vitamin D3
General Information: Vitamin D is a vitamin. It can be found in small amounts i n a few foods,
including fa t t y fish such as herring, m a c k e r e l , sardines a n d tuna. But most vitamin D - 80%
to
90% of what the body gets - is obtained through exposure to sunlight. Vitamin D is used for
preventing and treating rickets, a disease that is caused by not having enough vitamin D. Vitamin
D is also used for treating weak bones (osteoporosis), bone pain (osteomalacia), bone loss in
people with a condition called hyperparathyroidism, and an inherited disease (osteogenesis
imperfecta) in which the bones are especially brittle and easily broken. It is also used for
preventing falls and fractures in people at risk for osteoporosis, and preventing low calcium and
bone loss (renal osteodystrophy) in people with kidney failure. Vitamin D is used for conditions
of the heart and blood vessels, including high blood pressure and high cholesterol. It is also used
for diabetes, obesity, muscle weakness, lubricating joints, multiple sclerosis, rheumatoid arthritis,
chronic obstructive pulmonary disease, asthma, bronchitis, premenstrual syndrome and tooth
and gum disease.
Recommended: 50000 units weekly
Common side effects: (when taking too much) weakness, fatigue, sleepiness, headache, loss of
appetite, dry mouth, metallic taste, nausea, vomiting.
Kidney disease: Vitamin D may increase calcium levels and increase the risk of "hardening of the
arteries” in people with serious kidney disease. This must be balanced with the need to prevent
renal osteodystrophy, a bone disease that occurs when the kidneys fail to maintain the proper
levels of calcium and phosphorus in the blood. Calcium levels should be monitored c a r e f u l l y in
people with kidney disease.
High levels of calcium i n the blood: Taking vitamin D could make this condition worse.
Atherosclerosis: Taking vitamin D could make this condition worse.
Sarcoidosis: Vitamin D may increase calcium levels in people with sarcoidosis. This could lead to
kidney stones and other problems. Use vitamin D cautiously.
27

28. Histoplasmosis: Vitamin D may increase calcium levels in people with histoplasmosis. This could
lead to kidney stones and other problems. Use vitamin D cautiously.
Over-active parathyroid gland ( hyperparathyroidism): Vitamin D may increase calcium
levels in people with hyperparathyroidism. Use vitamin D cautiously.
Lymphoma: Vitamin D may increase calcium levels in people with lymphoma. This could lead to
kidney stones and other problems. Use vitamin D cautiously
L-Arginine
General Information: L-arginine is a chemical b u i l d i n g b l o c k ca lled “ an amino a c i d .” It
is obtained f r o m the diet and is necessary f o r the body to make proteins. L-arginine is found in
red meat, poultry, fish, and dairy products. It can also be made in a laboratory a n d used as
medicine L-arginine i s used for heart and blood vessel conditions i n c l u d i n g congestive h e a r t
f a i l u r e . Chest pain. High blood pressure a n d coronary artery di sease. L-arginine is also used
for recurrent p a i n in the legs due to blocked arteries, d e c r e a s e d m e n t a l capacity in the
elderly, erectile dysfunction and m a l e infertility. Some people u s e L-arginine f o r preventing the
cold, high blood pre ssure , improving a t h l e t i c pe rform a nc e , boosting t he immune s yst e m . You
can also apply L-arginine to the skin to speed wound healing and for increasing blood flow to cold
hands and feet. Especially in people with diabetes. It is also used as a cream for sexual problems in
both men and women and to stimulate IGF-levels. Patients who have HSV should not take L-
arginine; it can sometimes c a use an outbreak.
Side effects: Abdominal pain, bloating, diarrhea, gout, blood abnormalities, allergies, airway
inflammation, w o r s e n i n g of asthma, and low blood pressure.
L-Carnitine
General Information: L-carnitine is an amino acid (a building block for proteins) that is
naturally produced in the body. Carnitine is a substance t h a t helps the body turn fat into energy.
Your body makes it in the liver and kidneys and stores it in the skeletal muscles, heart, brain, and
sperm. Some studies do show that oral carnitine r e d u c e s f a t mass; increases m u s c l e mass, and
reduce fatigue, which may contribute t o weight loss in some people. Some people use L-carnitine
for muscle disorders a s s o c i a t e d w i t h certain AIDS medications, m a l e infertility, and anorexia.
Chronic fatigue syndrome, diabetes, overactive thyroid. Attention deficit-hyperactivity
disorder, leg ulcers, Lyme disease. And to improve a t h l e t i c performance and endurance.
Preliminary s t u d i e s suggest propionyl-L-carnitine may help i m prove m a l e s e x u a l
functi on . One study found that carnitine improved the effectiveness of sildenafil (Viagra) in
men with diabetes who had not previously responded to Viagra. In another study, a
combination of propionyl-L carnitine and acetyl-I-carnitine improved the effectiveness of Viagra
in men who had erectile dysfunction after prostate surgery. Some research suggests that L-
carnitine may help prevent or reduce symptoms of an overactive thyroid, such as insomnia,
nervousness, heart palpitations, and tremors.
28

29. Side e f f e c t s : Nausea, vomiting, s t o m a c h u p s e t , h e a r t b u r n , diarrhea, and s e i z u r e s . It
can also cause the urine, breath, and sweat to have a "fishy" odor.
L- Glutamine Powder
General Information: Glutamine i s an amino acid, found naturally i n the body. It is the most
abundant f r e e amino acid in the body. Glutamine is produced i n the muscles and is distributed b y
the blood to the organs that need it. Glutamine might help gut function, the immune system, and
other essential processes in the b o d y , e speciall y i n times o f stress. It is also important
for providing “ fuel" (nitrogen a n d carbon) to many different cells in the body. Glutamine is needed
to make other c he m i c a l s in the body such as other a m i n o acids and glucose (sugar). Glutamine
is used to counter s o m e of the side effects of medical treatments. For example, it is used for
side effects of cancer chemotherapy including diarrhea, pain and swelling inside the
mouth (mucositis), nerve pain (neuropathy), and muscle and joint pains caused by the cancer
drug Taxo!. Glutamine is also used to protect the immune system and digestive system in
people undergoing radio chemotherapy for cancer of the esophagus. Additionally, glutamine is
used for improving recovery after bone marrow transplant or bowel surgery, increasing well-
being in people who have suffered traumatic injuries, and preventing infections in critically
ill people. Some people use glutamine for digestive system conditions such as stomach ulcers,
ulcerative colitis, and Crohn's disease. It is a l so u s e d f o r d e p r e s s i o n , moodiness,
irritability, anxiety, insomnia, and e nha nci ng exercise p e r f o r m a n c e . People who have
HIV (AIDS) sometimes use glutamine to p r e v e n t weight loss. Glutamine is also used for
attention deficit-hyperactivity disorder, a urinary condition called cystinuria, sickle cell
anemia, and for alcohol withdrawal support.
Side effects: Potential side effects of glutamine are not known.
Milk-Thistle
General Information: Milk thistle is a plant. The above ground parts and seeds are used to make
medicine the seeds are more commonly used. Milk thistle is used most often for liver disorders,
including liver damage caused by chemicals, Amanita phalloides mushroom poisoning, jaundice,
chronic inflammatory liver disease, cirrhosis of the liver, and chronic hepatitis. Nevertheless,
researchers have not yet concluded with certainty that milk thistle is effective for any of these
uses. Milk thistle is also used for loss o f appetite, heartburn (dyspepsia), and g a l l b l a d d e r
complaints. Some people use milk thistle for diabetes, ha ngove r , diseases of the spleen, prostate
cancer, malaria, depression, uterine complaints, increasing breast milk f l o w , a n d starting
menstrual flow. Milk thistle s e e d might protect l i ve r cells from toxic chemicals and drugs. It
also seems to have antioxidant a n d anti-inflammatory effects. Milk thistle plant extract might
enhance the effects of estrogen.
Side e f f e c t s : Sometimes causes a laxative e f f e c t , nausea, d i a r r h e a , indigestion, intestinal
g a s , bloating, fullness or pain and loss of appetite.
29

30. Saw Palmetto
General Infor mati on : Saw palmetto i s a plant. Its ripe fruit is used to make medicine. Saw
palmetto is best k n o w n for its use i n decreasing symptoms of an e n l a r ge d prostate. Saw
palmetto i s used for treating c e r t a i n types of prostate infections. It is also sometimes u s e d ,
in combination w i t h other herbs, to treat prostate c a n c e r . Some people use saw palmetto for
colds and coughs, sore throat, asthma, chronic bronchitis, c hronic pelvic pain syndrome, and
migraine headache. It is also used to increase u r i n e flow, to promote r e l a x a t i o n a n d to
enhance se xua l drive (as and aphrodisiac) a n d can help with baldness. Some men report that
using saw palmetto with beta-sitosterol makes them grow more and better h a i r . Saw palmetto
s e e m s to decrease estrogen l e ve l s in the body. Taking saw palmetto along with estrogen pills
might decrease the effectiveness of estrogen pills. Surgery: Saw palmetto might slow blood
clotting.
Common side effects: Dizziness, headache, nausea, vomiting, constipation, a n d diarrhea. Some
people have reported that saw palmetto causes impotence
Anastrozole
General Information: Anastrozole h e l p s to lower estrogen l e v e l s in your body to help
prevent estrogen b u i l d up for patients w h o are taking testosterone signs of estrogen b u i l d up
are a puffy face/abdomen redness o f face or gynocamastia. It is recommended t h a t you take this
medication one day after testosterone injection.
Directions: Capsules by mouth two times a week.
Common side effects: Constipation. diarrhea, nausea, vomiting, upset stomach, loss of appetite,
body aches and pains, breast swelling/tenderness/pain, headache, dry mouth, scratchy throat,
increased cough, dizziness, trouble sleeping, tiredness/weakness, flushing and sweating (hot
flashes/hot flushes), vaginal bleeding, hair thinning, and weight change.
Serious Side effects: Mental/mood changes, numbness/tingling/swelling of the hands or feet,
persistent cough, unusual vaginal discharge/burning/itching/odor, unusually stiff muscles,
pain/redness/swelling of the arms or legs, vision changes, bone pain, bone fracture, signs of
infection.
Androgel
General Information: This m e d i c a t e d gel c o n t a i n s testosterone. It is used for
hormone replacement in men who are not able to produce enough testosterone
(hypogonadism). In patients with d i a be t e s , e s p e c i a l l y t h o s e t a k i n g i n s u l i n ,
t e st o st e r on e may decrease y o u r blood sugar. Symptoms of low blood sugar include
shakiness, n e r v o u s n e s s , rapid pulse and sweating. Androgel is a topical medication and it is
recommended that you apply medication to your wrist or inner thigh (rotate locations) after
showering; avoid direct contact with other persons for at least 30 minutes after application to
avoid transfer of medication to others.
Common side effects: Redness/irritation at the application si te or acne may occur.
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31. Serious side e f f e c t s : Persistent nausea/vomiting, severe stomach/abdominal pain, dark urine,
yellowing eyes/skin, swelling hands/ankles/feet. Breast pain/enlargement, very
slow / shallow/difficult breathing (possibly while sleeping), difficulty urinating, increased
urination ( especially at night), change in the amount o f urine, pain/swelling/redness in the legs,
mental/mood change, testicle pain/tenderness.
Armor Thyroid
General Information: Thyroid hormone i s used to treat hypothyroidism . It is a natural
product made from animal thyroid gl ands (usually a pig's). It replaces or provides more thyroid
hormone, which is normally produced by the thyroid gl a nd . Having enough thyroid h o r m o n e i s
important for maintaining normal m e n t a l a n d activity. This medication is also used to treat
other types of thyroid disorders (such as certain types of goiters, thyroid cancer). Armour
thyroid is sometimes g i v e n to patients who are on HCG because H C G has a tendency o f
lowering thyroid production l e v e l s . Take medication o n an empty stomach, if patient has allergies
to pork products then medication should not be taken.
Common si de effects: Hair loss may occur during the first few months of treatment. This effect is
usually temporary a s your body adjusts to this medication.
Serious side effects: High thyroid hormone levels occur: increased sweating, sensitivity to heat,
mental/mood changes, tiredness, diarrhea, shaking, headache, shortness of breath.
B-Complex
General Information: The vitamin B-complex refers to all of the known essential water-soluble
vitamins except for vitamin C. These include thiamine (vitamin Bl, riboflavin (vitamin
B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin,
folic acid and the coalmines (vitamin B 1 2 ). It is recommended that you take B-complex when
o n testosterone; testosterone can lower B-complex production.
Health benefits: Support and increase the rate of metabolism, Maintain healthy skin, hair
and muscle tone, Enhance immune and nervous system function, Promote cell
growth and division, including that of the red blood cells that help prevent anemia. B vitamins
have also been hypothesized t o improve the symptoms o f attention de fi c i t hyperactivity di sorder .
Caverject Impulse/Tri-Mix
General I n f o r m a t i o n : This medication is used to treat male sexual function. It works by
helping the blood flow into the penis to achieve and maintain a n erection. This medication i s not
recommended for use in men with penile implants. This medication is given by injection into the
penis as directed by your doctor. This medication s h o u l d usually work within 5 to 20 minutes to
produce an erection that lasts for about 1 hour. The manufacturer recommends t h a t this
medication b e used no more than 3 times a week with at least 1 day between e a c h dose. Make
sure your medicine is stored at room temperature. Do not use any leftover Caverject solution. Do
not use other medical treatments for ED while you are using Caverject. For erections lasting for
more than four hours go to emergency room.
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40. Compounding
Compounding is the method of preparing c u s t o m i z e d medications t o help meet unique
physician and patient needs.
Compounding pharmacists w o r k closely with physicians to assure that the medicines are created
and administered while providing great benefit to the patient with least amount of side-effects.
Just about any kind of medication ca n be formulated a nd compounded t o meet specific
medication need. Whether it’s a suppository, t r a n s d e r m a l cream, lozenge or solution,
physicians and their patients c a n obtain results by choosing a compounded a p p r o a c h .
Human preparations that are currently compounded:
Sterile injections
Oral suspensions and pastes
Capsules
Topical creams, ointments and lotions
Ophthalmic preparations
Optic solutions and non-aqueous suspensions
Transdermal
Flavor specialization
Sugar-free formulations
Combination medications
Customized dosage forms
Lollipops
Troches
Preservative-Free Medications
Suppositories
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41. Press in Bottle Adapters
Make measuring s i m p l e , accurate and prevents t h e mess and spillage associated with conventional
dosing tools. Adapters are available in assorted sizes and tightly screw onto the medication bottle
with a convenient flip top cap which are custom fit to oral dosing syringes (also available in
numerous sizes).
Creams / Ointments
Transdermal o r vaginal application to deliver a variety of medications s u c h as hormones, st e roi ds
and antibiotics. Once a cream or ointment is prepared, it is then run through an ointment mill
which essentially pulverizes the powdered drug to eliminate the potential for a gritty texture
making the preparation smooth and silky.
Powders
Medication powders m a y be mixed with flavored or effervescent ba se s which are later measured
and dissolved in water, juice or applesauce f o r oral administration. Powders can also be placed in
an insufflators f or "puffing" a drug directly onto a wound which requires h e a l i n g (such as a
diabetic ulcer) without adding unnecessary moisture to the treatment area.
Solutions
Typically are for topical use (aqueous based) although oral solutions in place of suspensions a r e
quite common depending on the nature of the d r u g being compounded. Bottles for dispensing are
available in various sizes with specialized closures such as an enema tip, nasal spray tips, throat
Or topical spray tips and pumps dispensers. Flip top caps, roll-on applicators a n d many
more available to solve a patients m e di c a t i on d e l i v e r y needs.
Powder and Oil Capsules
Made custom to order, and are available in clear gelatin, vegetarian, o r color coded capsules in a
multitude o f sizes depending o n the amount of drug required. Capsules are quality control tested for
accurate weight and even drug distribution. Various fillers are available for special needs such as
dye free, lactose free, and sustained release bases can be added to prolong the metabolization
Of the medication.
Transdermals
Transdermal creams, ointments, lotions, solutions and gels are available for the effective delivery
of many medications and can be dispensed in jars, tubes, syringes, roll on applicators and Boston
round bottles for example.
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42. Troches
Gelatin based sublingual squares that can be easily cut into halves or fourths to adjust dosing.
They are artificially sweetened a n d flavored to patient preference a n d will dissolve under the
tongue in less than a couple of minutes, Ideal for children or patients u n a b l e to swallow capsules
or tablets.
COMPOUNDING DEFINTIONS
Compounding
Compounding is the branch of medicine in which a pharmacist formulates and makes a
Medication for his/her p a t i e n t .
Compounding Pharmacist
A compounding p h a r m a c i s t i s a specialized healthcare profe ssi onal w h o has received
special education and training in the art of pharmaceutics a n d medication p r o du c t i o n .
Pharmaceutics
Pharmaceutics i s the science of medication d e l i ve r y forms. Capsules or injections are examples of
A medication deli ve ry form.
Delivery Form
A delivery form is a method or device by which a patient receives a medication.
Compounding Overview
Compounding is a branch of medicine in which a pharmacist formulates and makes a medication
For his/her patient. A compounding p h a r m a c i s t i s a specialized healthcare p r o f e s s i o n a l who
has received special education and training i n the art of pharmaceutics. Pharmaceutics i s the
science of medication de l i ve r y forms. Capsules or injections are examples of a medication
delivery form.
Compounding and Healthcare
Compounding allows a patient to receive the correct drug amount in a delivery system tailored
To an individual to aid in the treatment, a m e l i o r a t i o n o r prevention o f a medical condition.
Under the current healthcare system medication are manufactured to accommodate the majority
of potential patients without regard for individual variability. Most medications come in only a
small variety of strengths a n d dosage forms so a patient that requires a strength or dosage form that
in unavailable i s forced to accept the second-best opt i on that is commercially available.
Compounding provides the individual a way to receive a tailored dr ug regimen that is outside of
the scope of the c om m e rc ia l pharmaceutical company’s domain.
Compounding also allows a patient to receive a medication that is not available such as an
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43. Investigation drug or a discontinued drug. A compounding pharmacist can purchase lab tested
bulk chemicals and formulate a medication in such a case.
Compounding Pharmacy
A compounding pharmacy is a specialized pharmacy that h a s professional staff proficient in the
art of compounding.
Compounding Pharmacist
A compounding pharmacist is a healthcare provider, who is specialized in the branch of
medicine, involved in the production of individualized medications. A compounding pharmacist
has typically taken s e v e r a l hours o f specialized training in the art of compounding.
Additionally, a compounding pharmacist usually devotes a great d e a l of his/her practice of
pharmacy to the art of compounding.
Compounding Innovation
Compounding innovation is the central feature of a compounding practice. Often a request is
made t h a t c a u s e s a compounding pharmacist to research and formulate a specific
c o m p o u n d . The innovations made in the field of compounding are usually shared with
colleagues thus expanding the potential impact compounding has upon the lives of pharmacy
patients.
Compound Formulation
A compound formulation is the recipe t h a t i s created to direct t h e compounding pharmacist
in the production of the specific m e d i c a t i o n .
Under system t h r o u g h reduction of costs g e n e r a t e d by improving patient outcomes.
Compounding Education
Compounding education involves the s t udy of pharmaceutics, pharmacy calculations,
pharmacokinetics, continuing education and compounding seminars to improve the ef f icacy
of the compounding pharmacist.
Compounding resources
Compounding resources include many p h a r m a c y publications such as Martindale’s,
Remington's, the USP, the Inter national Journal of Compounding Pharmacy and collaborative
exchanges between pharmacists specialized in the practice of compounding. Additional
compounding resources include t h e International Academy of Compounding Pharmacists,
PubMed, P C C A and various Internet sites d e v o t e d to the transferable of compounding
information.
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44. Compounding equipment i n c l u d e s something a s simple as an electronic balance to
something a s complicated as an automated c a p s u l e -filling machine.
Compounding Supplies
Compounding supplies are items that are indirectly necessary f or the production o f a
compounded m e d i c a t i o n . Examples of such item include weight boats, spatulas and mortar
and pestles.
Compounding Calculations
Compounding calculations are mathematical c o m p u t a t i o n s t h a t are performed e a c h time
a medication i s compounded t o ensure accuracy of the prescribed c o m p o u n d . Compounding
calculations include weight to weight, volume to volume and weight to volume ratios.
Additionally, compounding c a l c u l a t i o n s often involve calculating proper dosing, expected
yields and expected losses.
Aseptic Compounding USP 797 United States Pharmacopoeia 795 and 797
Aseptic compounding is the practice and art of preparing p r e s c r i p t i o n s t h a t need to be
sterile. Current United States Pharmacopoeia guidelines in USP 797 chapter on sterile or aseptic
compounding gi ve standards t h a t need to be followed to be able to fill sterile compounded
prescriptions. Along with sterile irrigation prescriptions, the Minnesota State Board of Pharmacy
requires that pharmacies compound sterile inhalation solutions, sterile baths and soaks for
organs and tissues, sterile injections, sterile powders for injection, sterile metered sprays, and
sterile ophthalmic and sterile otic, ear, preparations. A pharmacy that engages in sterile aseptic
compounding n e e d s to comply with both USP 795 and USP 797 guidelines.
Soderlund Village Drug
• Committed to your health and safety
• Committed to complying with the USP 797 rules and guidelines to ensure sterility of your
Prescription
• Committed to complying with the USP 795 rules and guidelines to ensure potency and quality
of your compounded p r e s c r i p t i o n
• Committed to complying with the Minnesota Board of Pharmacy sterile compounding
requirements
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45. • Committed to continued professional aseptic training
• Committed to facility and equipment that meets or exceeds the sterility requirements
• Committed to quantitative analysis both with our own professional chemistry lab and outside
confirmatory labs
• Committed to sterility testing of both sterile compounds and procedures
• Committed to accepting referrals for sterile compounding from our colleagues in Mankato and
surrounding areas
• We are committed to you!
Compounding Dosage Forms
Compounding dosage forms are the types of delivery methods used to dose a patient. Examples
of a compounding dosage form include capsules, tablets, transdermal vehicles, gels, creams,
ointments, injections, drops, inhalants, suppositories, troches, powders, decoctions, concoctions,
suspensions, solutions, nasal sprays, shampoos, sublingual and other delivery methods.
Additionally a compounding d o s a g e form includes a devise such as a dropper b o t t l e , an
applicator, a syringe, etc.
Compounding Technique
Compounding technique is the procedure and methodology that is employed by the
Compounding p h a r m a c i s t t o produce a compounded m e d i c a t i o n . Compounding
technique includes experiential judgment as to the amount of liquid needed to produce
cohesion while avoiding encrustation of a tablet triturate and various other learned methods
necessary to produce a suitable compound.
Compounding Triad
The compounding triad is the three-part relationship b e t w e e n the patient, physician and
pharmacist. The physician prescribes t h e medication; the pharmacist c o m p o u n d s a n d
dispenses the medication to the patient a f t e r a consultation. The patient receives the type of
personalized care they deserve and allows compounding pha rm a ci st s to provide exceptional,
patient-oriented service.
Compounding Referrals
Compounding referrals are guidance from a medical professional directing a patient toward an
Individualized t h e r a p y via compounding. Compounding referrals are also made
through education a nd publications.
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46. Compounding Law
Compounding law involves the regulations that govern the practice of pharmacy. Many
government a g e n c i e s such as the FDAoften get involved or intervene i n the practice of
compounding when they believe the compounding p h a r m a c y or pharmacist i s acting outside
their realm of practice.
Compounding and the Patient
Compounding owes its entire existence to the satisfaction of the patient. Patients have become
educated through various ways as to the health benefits of compounding. Spokes people like
Suzanne Summers have explained publicly the benefits of natural hormone r e p l a c e m e n t
t h e r a p y . The increased awareness a m o n g patients a nd physicians regarding the positive
effects of compounding ha s created a desire for personalized m e d i c a t i o n s . The reality is that
patients are driving the compounding i n d u s t r y by demanding i n d i vi d u a l i z e d therapies.
Compounding and the Physician
Many physicians have become well aquatinted w i t h the advantages of compounding a nd regularly
prescribe c o m p o u n d e d p r e s c r i p t i o n s for their patients. In today's consumer driven
healthcare system a patient desiring to be prescribed a compounded prescription can often call a
compounding pharmacy for a referral to a physician versed in compounding benefits.
Compounding Pharmaceutics
Compounding pharmaceutics is the science of medication delivery forms; recipients a nd devices
used in the practice of compounding t o produce an efficacious compounded m e d i c a t i o n .
Definition of a generic drug and the FDA requirements
A generic drug is the chemical equivalent of a drug that has an e x p i r e d patent. When a brand
name drug’s patent expires, other pharmaceutical companies can produce the same active chemical
compound and sell the drug under its generic name. In the United States, the Food and Drug
Administration ( FDA) requires that all drugs, whether b r a n d s name drug or a generic drug, meet
standards o f safety, strength, purit y and effectiveness. A drug may be chemically exact but not
bioequivalent. In other words, two different products of the same drug may not get into the body
in exactly the same way. Bioequivalence depends on how the drug is formulated a nd how it is
absorbed a n d eliminated by the body. Other ingredients c a n affect the absorption o f the drug.
These include starch fillers, gum-like substances a n d other products which allow a drug to be
formulated i n t o a pill or capsule. Factors such as a person’s age, body mass, kidney, liver and
intestinal fu n c t i o n can also affect the absorption o f the drug by the body.
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47. For a drug to be marketed u n d e r a generic label, the manufacturer must comply with FDA
standards. The FDA states that generic drugs must be therapeutically equivalent to the brand
name drug. Numerous studies have attempted t o show differences in brand and generic drugs.
With a few exceptions, most studies have not shown true statistical differences between brand
name drugs and generic drugs. The few cases where differences exist occur mostly in drugs that
have a narrow “therapeutic index." The "therapeutic index" is the difference between the drug's
Effective amount in the body and the level at which the drug causes an undesirable o r toxic effect.
In order to ensure its safety and effectiveness, a generic drug undergoes i n t e n s i v e testing. The
FDA sets up guidelines and requires st ric t testing in order to determine w h i c h drugs act the same
way in the body. Generic drugs that have been tested and approved by the FDA to be
therapeutically equivalent t o brand name drugs are published in a guide that is updated monthly
and is found in most pharmacies. The guide lists drugs classified as therapeutically equivalent to
each other, and gives them an "A"rating. If the FDA does not consider a drug therapeutically
equivalent, it is given a "B" rating. Most pharmacies purchase drugs with an "A"rating to dispense as
generic. Ask your pharmacist about the rating of your particular generic medication.
Drug costs continue to rise
Price appears to be the real difference between most brand and generic drugs. Rising health care
costs -- and the cost of drugs in particular - have received a lot of media attention. The fastest
growing segment of health care costs is prescription benefits, which is increasing at an average rate
of 11.2% annually. Senior citizens are especially at risk for rising drug costs. Drug costs for seniors
are rising faster than for any other age group. Among patients 70 years and older, drug costs rose
14% in 1999, while the average drug costs for all other age groups rose 9.6%. In late July 2000,
several health maintenance o r g a n i z a t i o n s ( HMOs) announced t h e y would pull out of the
Medicare program by the end of the year, affecting nearly a million senior citizens. The HMOs state
that they can no longer
Afford to insure seniors. A number of factors account for these rising costs. Advances in
technology (gene therapy and biotechnology, for
Example) have contributed t o the increases. People are living longer and using more drugs to do
so. It is fair to add that some of the new expensive drugs are actually less costly overall than
conventional t he r a pi e s , s u c h as surgery.
Generic drugs are less expensive than brand name drugs
Generally, generic drugs are less expensive than brand name drugs. On average, most generic
Drugs are approximately h a l f the price of their brand name counterparts. Based on 1999 values of
the Average Wholesale Price, the brand name blood pressure drug called Hydrodiuril® was eight
times more expensive than its generic counterpart, hydrochlorothiazide. The anti-depressant
Elavil® was twice the cost of its generic amitriptyline. However, tamoxifen is an exception to the
rule. Here, the brand name manufacturer b o u g h t exclusive rights to the generic. Since the same
company owns the rights to both brand and generic tamoxifen, the price for the generic is only 1
cent less! Currently, the Federal Trade Commission is investigating the manufacturer's actions,
since they appear to have discouraged o t h e r companies from marketing ge ne r i c tamoxifen.
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48. Presently, many drug companies are merging, with larger companies acquiring smaller generic
companies. These changes have affected the price difference between b r a n d and generic
products. Since a company may own both the brand and generic names, it prices the generic at a
higher price to discourage sales of the generic. Because of this, people may not get the savings
benefits of generic drugs.
What contributes t o the cost of drugs?
Why are drugs so expensive? There are various answers to this question. Technology has played
a role in the development o f more effective medications. Creation of larger manufacturers
through mergers and buy-outs of smaller pharmaceutical companies has provided the
Opportunity t o increase the cost of generic medications. Annual inflation plays a role, as does the
increased utilization of drugs by the American public. Pharmaceutical companies explain the
need for making a profit as being tied to the research and development costs for newer, more
Effective medications. The estimated c os t of research and development i n the year 2000 is
estimated a t $38 billion. To put this in perspective, the budget for federal research is approximately
a third of this figure. It takes an average of seven years for a drug to go through t he FDA approval
process, thus delaying any potential p r o f i t s . The marketing of drugs by
Pharmaceutical companies a re expensive. Marketing strategies i nc l u de advertisements in all of
the media, weekend and dinner meetings for physicians and pharmacists t o promote specific drug
"give-a ways" with the pharmaceutical company’s logo (pens, magnets, pads of paper, etc.) and
drug samples to physicians. These promotions a r e intended to increase physician and consumer
exposure to information a b o u t a particular d r u g . This exposure to information m a y increase
consumer requests f o r certain drugs that have not been previously prescribed b y the physician.
Pharmaceutical c o m p a n i e s a l so provide grants to medical groups, universities a n d hospitals to
develop educational p r o g r a m s f o r patients w i t h specific disease conditions. These grants assist
in the
Development c o s t s and ongoing costs of programs a n d services that help patients
maintain optimal healthy living. These funds are provided a s a part of the community
benefit monies pharmaceutical companies d e s i g n a t e as efforts to partner wi t h physicians.
Should consumers p a y more for brand name drugs?
The human body is always changing, and factors such as diet, metabolic rate and hormones c a n
affect how a drug acts in the body. For the most part, these changes are not cause for alarm, but it
is important t o realize that a person may try the same brand or generic medication and have a
different experience a t different times. However, in most instances, the generic and brand name
drugs are both working in the body.
Without much success, a number of studies have attempted t o prove particular b r a n d drugs are
more efficacious than their generic counterparts. Of particular c on t r o ve r s y i s one well-
publicized story in which a brand name manufacturer paid a university researcher to prove the
brand drug was superior to the generic. The researcher actually found the generic to be equivalent
and even
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49. Somewhat better. What resulted was a long battle between the researcher and the manufacturer,
because the manufacturer refused to publish the data to support that the generic was superior to
their brand name drug. Seven years later, the brand manufacturer published another study
opposing the researcher's results. However, the FDAis now requiring all manufacturers of that
drug to demonstrate that their products are equivalent.
To summarize, generic drugs, if they have been approved by the FDA, are as safe and effective as
the brand name product. Pharmacists, using scientific information, ensure patient safety. This
often means recommending alternative therapies to providers and patients. A final note to think
about is that receiving a generic drug is not like shopping at a discount retailer for a pair of jeans.
If the clothing industry had guidelines similar to drug manufacturers, copy-cat jeans would be
required to use the same material, thread, stitching and so on that higher end manufacturers use
to make a pair of famous-name pants. Of course, one cannot compare a drug's effect on the body
to the appearance and durability of a pair of jeans, but if the government required both pairs of
jeans to be exactly alike, would you still want to pay the higher price?
Compounding vs. Traditional Pharmacy
Traditional pharmaceutical needs mean that your physician prescribes you a dose and form of a
specific medication. For example ...you are prescribed 2 capsules of your medication three times
per day with food. Now, you may not be able to tolerate the casing of the capsule, or your
Schedule may be such that you can't eat those three meals a day at the appropriate times. So, you
aren't as compliant with these instructions and therefore, the effect of the prescription is not as
effective.
So, your physician contacts one of the compounding pharmacists at Precision Compounding
Pharmacy and working together as a team, you, your physician, and our pharmacist determine a
better solution. You are given an effervescent powder to mix with water and drink once daily.
Now, with this customized solution, you are able to take the entire regime of your prescription
and made well.
Life's Problems
Some patients do not respond to traditional methods of treatment manufactured by drug
companies. Many patients are allergic to preservatives or dyes, or are sensitive to standard drug
strengths, or cannot tolerate a specific dosage form. These unique medical problems can be
solved with the triad relationship of patient, physician, and pharmacist working closely together.
With a physician's consent, a compounding pharmacist can compound preservative or dye free
medications, customized strengths of medications, or different dosage forms. Children and the
elderly population often benefit the most from customized compounded medications.
Common areas of compounding include:
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