Therapy Areas

Therapy Areas

Sterile Compounding

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Riverpoint Pharmacy is proud to provide Sterile Compounding services.

We have a state-of-the-art Clean Room Suite and specially trained and tested personnel.

Our procedures insure that your medication meets the highest quality standards.

We use the highest quality starting chemicals

We follow strict gowning procedures

We follow standardized formulas for consistent products

We perform in house and independent testing for bacterial contamination of our facilities

We have random independent lab testing and perform in-house quality checks on sterile and non-sterile products

We follow strict cleaning procedures to maintain the sterility of our facilities

Low Dose Naltrexone

Naltrexone is a medication licensed in 1984 by the FDA as a treatment for heroin and alcohol addiction in a daily dose of 50 to 100mg. When used in a lower dose of 3-4.5mg, naltrexone may help to relieve pain associated with inflammatory conditions and improve autoimmune diseases such as systemic lupus, rheumatoid arthritis, Bahcet’s syndrome, Wegner’s granulomatosis, psoriasis, and Crohn’s disease. Low dose naltrexone (LDN) has also been used successfully in the treatment of neurodegenerative diseases such as multiple sclerosis, Parkinson’s disease and amyotrophic lateral sclerosis (ALS).

Mechanism of action

Naltrexone is a long-lasting opiate receptor antagonist in high doses. However, at lower doses, its opiate antagonist activity turns into an agonist. This triggers a prolonged release of endogenous opioids such as β-endorphins (3).

More specifically, LDN will temporarily block opioid receptors and may then induce β-endorphins and µ, đ, and ƙ opioid receptors after 6 hours (1). The temporary blockade of opioid receptors may cause an up-regulation of mood enhancing endorphins, augment dopamine activity and may also reduce inflammatory mediators in the immune-related diseases.

Fibromyalgia

A recent study concluded that LDN may be an effective highly tolerable, and inexpensive treatment for fibromyalgia (5). Low dose naltrexone reduced fibromyalgia symptoms overall in the entire group, with a greater than 30% reduction of symptoms over placebo. Specific symptoms including pain, fatigue and stress, were also significantly impacted by LDN. The observed effects were accompanied by a very low incidence of side effects, suggesting LDN may be an effective and well tolerated treatment for fibromyalgi8a (5).

Multiple Sclerosis

Some clinical studies suggest that endogenous opioids, such as β-endorphins, may be involved in multiple sclerosis (MS). These β-endorphins are peptide neurotransmitters produced by pituitary and hypothalamic neuronal cells. Recent evidence suggests that these endorphins may exert peripheral anti-nociceptive action and possess ant-inflammatory activity (2). In patients with multiple sclerosis, LDN may enhance the immune system, reduce disease progression, spasticity and fatigue and improve bladder control, heat tolerance, mobility, sleep, mood, pain and tremor. (2).

Crohn’s Disease

A randomized double-blind placebo controlled study demonstrated that LDN improves clinical activity index scores and improves gastrointestinal mucosal inflammation in subjects with moderate to severe Crohn’s Disease (4). The healing of the mucosal lining was evaluated by endoscopic appearance and histology from biopsies obtained during colonoscopies. The patients’ treated with LDN showed significant reversal of gastrointestinal inflammation and the placebo-treated group had no improvement (4). This study found that using LDN to alter the endogenous opioid system decreases inflammation and provides promise for the treatment of Crohn’s disease.

References

  1. Sharafaddinzaden,N. Moghtaderi, A. Kashipazha, D. Majdinasab, Shalbafan, B.The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial. Mult Scler (2010 June) 16:964.

  2. UK Multiple Sclerosis resource centre. LDN treatment, Feb 2006. Date accessed 7/5/11. http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=651

  3. Gironi,M, etal. A piot trial of low-dose naltrexone in primary progressive multiple sclerosis. Mult Scler (2008) 14:1076.

  4. Smith, Jill P, et al. Therapy with opioid antagonist naltrexone promotes mucosal healing in active Crohn’s disease: A randomized placebo-controlled trial.Dig Dis Sci(2011) 56:2088-2097

  5. Younger, Jarred, PhD, Mackey, Sean, MD, PhD. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. (2009) ID (4):663-672.

Hormone Therapy for Women

Restoring Hormone Balance

Bio-Identical Hormone Replacement Therapy (BHRT) is the replacement of deficient hormones with hormones that are chemically identical to those the body produces, but which have declined due to aging or hysterectomy.

Customized BHRT has improved the quality of life for many women who suffer from hormonal imbalance. The ideal process for achieving hormone balance includes an assessment of hormone levels (lab work) and an evaluation of signs and symptoms. Replacement of deficient hormones is begun with the most appropriate dose using the most appropriate dosage form for each woman. Monitoring using patient feedback and repeat lab work allows fine tuning of replacement therapy.

All steriod hormones are created from cholesterol in a hormonal cascade. The first in the cascade is pregnenolone, which is subsequently converted into other hormones including DHEA, progesterone, testosterone, and several forms of estrogen. These hormones are interrelated, yet each performs unique physiological functions. A sound hormone replacement strategy should focus on a woman's total hormone balance.

Progesterone is often prescribed to.....provide a balance for the estrogens, and help with sleep, anxiety and depression. Progesterone is also a precursor to our stress hormone, cortisol. Progesterone levels may decline during periods of extreme, chronic stress.

Androgens, which include DHEA and testosterone, are important for libido as well as the integrity of skin, bone, and muscle. These hormones may also decline as women enter menopause.

Bio-Identical or "Natural" VS Synthetic

Bio-Identical means that the hormones are an exact match to the hormones produced by the human body. They could also be called human-identical. These hormones get their start in nature, found in soy beans and wild yams, and can then be easily converted into the exact hormones that the body makes. The body can recognize these bio-identical hormones and use them just as they would if they were being produced by the ovaries, testes, or adrenal glands. Some of the side effects usually seen with bio-identical hormones are associated with incorrect dosing. By making slight variations in the dosing, or dosage form, these side effects disappear.

Synthetic hormones are not easily recognized by the body even though they may produce similar effects. Because they can be hundreds of times more potent than the hormones that our bodies make, they are linked to many side effects. The side effects that caused the Women's Health Initiative (WHI) study to be stopped have actually been suspected for several years.

Also, since Bio-Identical hormones can not be patented, drug companies will not spend the money necessary to bring them to market. They could not recover the cost of the studies nor the development of these new drugs, to make it profitable. Therefore, it is much more difficult for doctors and patients to get information on Bio-Identical hormones.

Estrogens

Estrogens are prescribed to relieve menopausal symptoms and treat postmenopausal problems such as vaginal dryness and tissue breakdown, painful intercourse, and various urinary disorders. Estrogens have been shown to decrease the risks of osteoporosis and colorectal cancer.

There are three main forms of estrogen including Estrone (E1), Estradiol (E2), and Estriol (E3). Each form of estrogen has it's own particular functions and effects.

Estradiol (E2) (the predominant form of estrogen in non-pregnant, reproductive women) primarily aids in the cyclic release of eggs from the ovaries. E2 has beneficial effects on the heart, bone, brain and colon. Reduction in the levels of E2 cause common menopausal symptoms such as hot flashes and night sweats.

Estrone (E1) is produced in the ovaries, adrenal glands and fat cells and is the predominant estrogen in postmenopausal women. Estrone is a stronger estrogen than Estriol, but weaker than Estradiol. Overweight women have high circulating estrone levels. Estrone can be broken down by the body into 3 known metabolites: 2-hydroxyestrone, 4-hydroxyestrone and 16-alpha-hydroxyestrone. The 2-hydroxyestrone is thought to be a protective estrogen, while the 4- and 16-alpha hydroxyestrones have been associated with increased development of cancer. The ratio between 2-hydroxyestrone and 16-alpha-hydroxyestrone (2:16 ratio) is sometimes determined to assess possible risk for estrogen dependent cancers. This ratio can be favorably effected by 3,3'-Diindolylmethane (DIM) and indole-3-carbinole (I3C) which are components of cruciferous vegetables.

Estriol (E3) is secreted in large quantities by the placenta during pregnancy. Estriol is a comparatively weak estrogen. Estriol can compete with E2 and E1 at estrogen binding sites. In this way Estriol may have some protective attributes in estrogen sensitive cancers.

Progesterone

Progesterone provides the balance for estrogens during the menstrual cycle in young women. Progesterone acts to prepare the uterus for implantation with a fertalized egg and to support the early stage of pregnancy. If pregnancy does not occur, progesterone levels drop and another cyle begins.

Progesterone has been used in BHRT to relieve menopausal symptoms such as insomnia, anxiety, depression, and heavy or irregular menstrual bleeding.

In some studies, Progesterone has been shown to have anti-proliferative effects on breast cancer cells. It is thought by many to have a protective effect.

Progesterone occurs very early in the hormone cascade which begins with cholesterol. This means that the body can convert it to other hormones that are also very critical. Our stress hormone cortisol is made from progesterone.

Testosterone

Testosterone is important for women also. It helps to maintain lean muscle mass, bone density, and libido. It is often also used in combination with estrogen to decrease incontinence and other vaginal symptoms. Low levels of testosterone has been associated with fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.

Side effects of too much testosterone include acne, oily skin, facial/body hair growth, scalp hair loss, irritability and increased aggressiveness. If you have diabetes your blood sugar may be affected.

DHEA

DHEA (Dehydroepiandrosterone) is a hormone produced by the adrenal glands and is a steriod precursor of both androgens and estrogens. Concentrations of DHEA and its metabolite, DHEA Sulfate, peak at about age 20 and progressively decrease with adavancing age.

A few studies have demontrated low levels of DHEA in obesity, cardiovascular disease, non-insulin dependent diabetes, chronic fatigue syndrome and some types of cancer. There is speculation that low levels of DHEA might be partially responsible for age-related degenerative diseases and replacement therapy may be of value. A blood test can determine if a person is deficient.

Side effects of too much DHEA are thought to be due to its conversion to testosterone. Conversion to estrogen is also possible so women at high risk of estrogen dependent cancers should you caution and should be monitored carefully by their healthcare provider. Because DHEA is metabolized in the liver, patients with a history of liver disease should also be monitored closely. Some reports of rapid or irregular heart beats have been reported.

Pregnenolone

The conversion of cholesterol to pregnenolone is the first of many steps in the synthesis of some of the body's key hormones, including DHEA, Progesterone, the androgens, the estrogens and cortisol. Nicknamed the "mother hormone", pregnenolone is a vial building block in the hormone cascade. Pregnenolone is thought to play a role in memory and cognitive function.

Thyroid Replacement Therapy

Thyroid Basics

The thyroid gland is located in the lower part of the neck. It secretes two essential thyroid hormones: triiodothyroine (T3) and thyroxine (T4). These hormones regulate cell metabolism. They promote optimal growth, development, function and maintenance of all body tissues. They are also critical for nervous, skeletal and reproductive tissue as well as regulating body temperature, heart rate, body weight and cholesterol.

The normal thyroid gland secretes all of the circulating T4 and about 20% of the circulating T3. The T4 made by the thyroid gland circulates throughout the body and is converted into T3 and a tiny amount of reverse T3 in the kidneys, brain and fat tissue. Most of the biological activity of thyroid hormones is due to T3. Reverse T3 has no action on the cell except it binds to T3 receptors blocking the action of T3. In normal thyroid function, however, T3 dominates and reverse T3 is not a problem.

A reduction in the conversion of T4 to T3 or a decreased production by the thyroid gland may lead to hypothyroidism. The synthesis and secretion of thyroid hormones is influenced by a hormone released by the pituitary gland called thyroid-stimulating hormone (TSH). The activity of the thyroid gland is regulated by a negative feedback loop. Therefore, if levels of T3 and T4 are high, the level of TSH will go down and if the levels of T3 and T4 are low, the level of TSH will go up.

Hypothyroidism is characterized by a generalized reduction in metabolic function that most often manifests itself as slowing of physical and mental activity. The most common signs and symptoms of hypthyroidism are: weight gain, fatigue, lethargy, sleepiness, cold hands and/or feet, low body temperature, depression/anxiety, constipation, headache, menstrual problems, reduced sex drive, hair loss, swollen eye lids and general fluid retention, poor memory and concentration and dry skin, hair and/or nails.

Thyroid Hormone Replacement

Thyroid replacement is one of those areas that is greatly benefited by compounding. Therapy can be precisely adjusted to each patient's needs. Specific strengths can be created. Combinations of T3 and T4 can be tailored to the patient's needs. Even dessicated thyroid can be formulated in a strength specific to each patient. Capsules can be created that have an extended release delivery system to help decrease the surge of hormones associated with immediate release commercial tablets. This can help with tolerability. Capsules are created using hypoallergenic ingredients.

Customized Pet Medications

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Preparation of specialized pet medication requires chemicals and equipment that are not available in most pharmacies. Our pharmacists have received extensive additional training in compounding techniques and have a support network that generates a constant exchange of ideas and innovations.

You questions are welcome!

With over 20 years experience working with veterinarians and other compounding pharmacists nation wide, our pharmacists can design medications specifically for the animals in your care.

Dermatology

Riverpoint Pharmacy is proud to offer dermatology compounding services.

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Our experienced compounding pharmacist carefully creates dermatological medications to treat almost any skin care disease or condition. Our custom medications treat skin conditions ranging from serious diseases to simple cosmetic improvements, and everything in between, including:

  • Psoriasis
  • Eczema
  • Skin Cancers
  • Severe Acne
  • Rosacea
  • Alopecia
  • Warts
  • Body Rashes Such as Tinea Versicolor

Riverpoint Pharmacy stays on the cutting edge of dermatology and skin care compounding through our unique relationships with dermatologists, aestheticians, cosmetic or plastic surgeons, and other skin care professionals across the nation.

We are able to prepare dermatological compounding medications in various forms, including:

  • Topical Gels & Creams
  • Ointments & Lotions
  • Liquid Solutions
  • Occlusive Pastes
  • Oral Medications (for certain conditions)
  • Sprays

We are constantly increasing the number and types of dermatological medications which we are able to successfully compound. We compound a wide variety of compounded medications, individually tailored with specific medication dosages and strengths to meet each patient's specific needs. Some examples of

Riverpoint Pharmacy's compounded dermatological medications include:

  • Triamcinolone with Camphor, Menthol and/or Phenol - For Chronic Pruritus.
  • Anti-Infectives (Metronidazole, Ketoconazole, Itraconazole, Fluconazole, Amphotericin) -

For any topical infections of the skin, nails, scalp, and/or mucous membranes

  • Retinoic Acid - Customized Strengths Ranging from 0.001% to 0.4%.
  • Hydroquinone - Strengths up to 10%.
  • Hydrocortisone - Concentrations from 0.1% to 20%.
  • Anti-Inflammatories - Ketoprofen, Ibuprofen, Diclofenac.
  • Bleaching Creams & Combination Bleaching Creams - For bleaching and tightening of the face.
  • Acne Creams & Alternate Acne Creams - Cosmetic anti-acne formulas compounded accordingto physician recommendations.
  • Anti-Aging Creams - Cosmetic creams which help reduce wrinkles and age spots on the face and body.
  • Wart Removal - Lactic and/or Salicylic Acids.
  • Anesthetic Creams - Lidocaine, Tetracaine, Benzocaine, Prilocaine.
  • Wound Care - Skin Ulcers - Such as Diabetic Foot Ulcers Creams.
  • Pain Creams & Custom Compounded Pain - For Conditions such as Diabetic Neuropathy
  • Special Mix Solutions For Hair Growth - For Men and Women, aids in reactivating hair follicles.

Regardless of your individual dermatology needs, Riverpoint Pharmacy has the solution for you. We are a professional compounding pharmacy, experienced in creating customized medical solutions for dermatology conditions. We work closely with our patients and physicians to create dosage forms and strengths which are engineered based on your specific medical needs. Please contact us today to learn more about our skin care and dermatology compounding services!

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PCCA PracaSilTM-Plus

Scarring can have many causes, including surgeries, accidents, infections and burns. Regardless of the source, many scars impact patients in ways that are much more than skin deep.

PCCA PracaSilTM-Plus is the only compounding base created for scar therapy – and it’s helping make a huge difference for patients with scars, including keloid and acne scars.

That’s because its proprietary blend of ingredients, including silicones (in a semipermeable polymer network that’s ideal for healing) and Pracaxi oil (which is rich in skin-friendly fatty acids and lipids):

  • Provides long-lasting moisturization, protects the skin’s barrier and reduces water loss
  • Promotes a healing, soothing and nurturing environment

PracaSil-Plus is ideal for:

  • All kinds of scars, including new scars, old scars, surgical scars, keloids, stretch marks (from pregnancy or growth), acne scars and more
  • Formulations with pain relievers, steroids, debriding ointments and more
  • Surgery centers, plastic surgeons, weight loss clinics, orthopedics, bariatric surgery centers, OB/GYN