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ANTI-AGING: Does Human Growth Hormone (HGH) Help?

We have all heard and seen commercials on products that promise to keep us looking younger, even the possibility of reversing the aging process. These commercialized products come in a variety, from powder, cream, facial solution, and even pills. One promising agent, gaining recent attention, is human growth hormone (HGH, aka: somatotropin), which is a natural hormone that the body makes, but is now widely synthesized for many uses. One of its controversial uses is in the claim that it can work as an anti-aging agent. Let’s look at what growth hormone is and how it affects the body.

What Is Growth Hormone?

Growth hormone is produce naturally in the anterior pituitary gland, which is a pea-size gland located in the brain. The gland makes, stores, and releases the hormone to the rest of the body when needed. The hormone is extremely essential for the normal physical growth in children and adolescents. Its levels rise during childhood and peak during the time of puberty when there is a rapid acceleration in growth. Growth hormone works by regulating body composition, increasing body fluids, building muscle and stimulating bone growth. It also increases the breakdown of fats. All of these activities contribute to physical growth. As the body reaches a full physical and reproductive maturation, the production of growth hormone starts to decline.

Does Growth Hormone Really Affect Aging?

Growth hormone is currently used to increase livestock production, such as increasing milk production in cows. It is also prescribed by physicians to treat conditions such as constitutional short stature, heart and kidney failure, and other conditions that cause loss of body mass. Its controversial use for performance enhancement is also well-known and publicized. However, can it really alter the aging process? There are some studies that were performed on adult subjects with documented lower than normal levels of growth hormone. The results showed that the additional human growth hormone helped increase the muscle mass, increase bone mineral density, and decrease body fat. Overall there was also an improvement in the general well-being in these patients. However, when similar studies were done on healthy adults who had normal levels of growth hormone, the result was not promising. The studies showed very small improvements in body composition. Muscle mass growth was shown to be mainly due to increase in water content in the muscle cells. Also, there were a considerable number of undesirable side-effects. These side-effects included swelling in the arms and legs, joint and muscle pain, and carpal tunnel syndrome. In addition, growth hormone may also contribute to other diseases such as diabetes and heart disease. There is still not enough evidence to support growth hormone’s ability to slow down the aging process in healthy individuals. On the contrary, the risk of undesirable and detrimental side-effects seems to outweigh any potential beneficial effects in normal healthy individuals.

In conclusion, growth hormone should only be used in individuals who have lower than normal levels of growth hormone. It should also be only prescribed and monitor by a qualified physician. If you are concerned about the effects of aging and looking for ways to counteract the natural aging process, you should talk to your doctor or pharmacists about alternative way to improve your health. In the meantime, one thing that we all can do to feel our best as we’re getting older is choosing a healthy lifestyle such as eating a balanced diet and routine exercise.

Channary Long

PharmD Candidate, 2015

California Northstate College of Pharmacy

Weight loss: Is Phentermine The Drug For You?

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Losing weight can be a daunting task, and often times we just need something that will make it a bit easier. For many, weight loss drugs seem to be the ray of hope to overcome their challenge in losing weight. Phentermine, a prescription medication, is one such drug that may help some lose weight. However, it is important to be aware that phentermine is not the magic weight loss drug for everyone.

Phentermine works by decreasing the feeling of hunger and makes the individual feel fuller. Ideal, right? However, phentermine is not for those who want to shed a few pounds, it is actually for those who are facing dramatic health consequences due to being significantly overweight. Phentermine is also not recommended for those who have heart disease, hypertension, overactive thyroid, glaucoma, history of drug use, are pregnant or could be pregnant.

If you do qualify for phentermine there are many salient points to know to optimize weight loss while on phentermine. Phentermine will help you lose weight but it is contingent on the diet and exercise pattern that is set during the phentermine course. Regular exercise with strict diet can provide a larger percent of weight loss then infrequent exercise and no portion control. Another key point that many do not realize about phentermine is that it is supposed to be a short therapy of 12 weeks. It is not recommended to go beyond this period because the body may develop resistance to phentermine and the weight loss aspect of the drug may dissipate while the side effects will remain. Due to the short therapy it is vital for the patient to develop a diet and exercise plan during the phentermine course and continue it when the phentermine is tapered off and eventually discontinued. If the diet and exercise program is not continued after phentermine is stopped then it is likely that a person will see an increase in weight.

With any drug there is the risk of side effects and it is important to know them when considering it as a choice of therapy. There is a risk of hypertension, heart palpitation, constipation, euphoria, headaches, insomnia, hyper-stimulation. Phentermine also has a significant chance of dependence and it is not recommended as a first resort for weight loss. Many individuals have reported that they were unable to taper off and have remained dependent on taking phentermine even though they were not seeing any more weight loss. The abuse potential of phentermine has placed it under a special class of controlled medications that prescribers are hesitant to give to their patients.

Losing weight is a task that takes determination and time and there are medications that can aid in the task. However, the risk and benefit should carefully be looked over when thinking about adding medications to a weight loss regime because we do not want to be causing more harm in the long run.

Priya Patel

PharmD Candidate, 2014

California Northstate College of Pharmacy

 

Compounding Has and Continues to be a Medical Necessity

Pharmacy is one of the most transparent professions. You can walk up to any pharmacy and literally watch what a pharmacist does. You can talk directly to a pharmacist almost immediately and ask for advice. Even with this easy access and availability, many people are not aware of how valuable a pharmacist can be in their health care.
Prior to the 1950s all pharmacies compounded medications; however, by the end of that decade, almost all medications were mass produced by pharmaceutical companies. Since then, pharmacists have changed into drug dispensers. Amazingly, compounding pharmacies have survived and are now starting to become more and more popular. Compounding pharmacists work with other health care providers to find the appropriate medication, strength and dosage form for each patient. This investment into each patient opens up communication between all parties and ultimately results in improved patient care.
While commercial medications may be sufficient to treat some people, others may benefit greatly by using compounded medications. By compounding medications, the ability to individualize medication is almost limitless. Compounded medications can be made from commercial products or from raw ingredients. In the event of a drug shortage, this means that the compounding pharmacy may be able to obtain the raw ingredient and make that medication just for you. Dosage strength and how the medication is applied can also be customized.
Compounded medications are also very important in the dentistry, dermatology and veterinary fields. In dentistry, specialized oral medications allow for dentists to effectively prevent infection and anxiety. In dermatology, multiple medications can be mixed together into one cream, ointment or gel. This makes the therapy easier to use and more effective. In animals, medications can be tailored specifically to the pet, with flavorings such as chicken, beef or tuna.
Specific patients may benefit form receiving compounded medications more than others, including young children and the elderly. These patients are different in size and body function and therefore process medication differently than the rest of the population. Therefore, the commercial medications are not available in appropriate dosage strengths for pediatric and geriatric patients. Usually these two groups of patients have difficulty swallowing tablets or capsules, and need compounding pharmacies to make the necessary medication in a different dosage form, like an oral liquid or topical cream.
Compounding pharmacists are working with physicians in finding the optimum therapy for patients. This will continue as more physicians and patients lean towards individualized therapy. With the utilization of genetic testing and adjusting medication based on genes, the need for specific dosage strengths will increase. Ironically, big pharmaceutical companies are also proving that compounding pharmacies are needed. As research and production costs rise, so will drug shortages. This encourages patients to use compounded medications. Compounding pharmacies have stood the test of time. The ability to make medication dates back to the beginning of pharmacy and continues to be a necessity in providing proper medical care. While compounded medications may not be utilized by all patients, for those that need specialized dosage strengths or forms, compounding pharmacies are lifesavers.

Heather Sakai
PharmD Candidate, 2013
California Northstate University, College of Pharmacy

Male Hormone Replacement

It is well known that women go through menopause, but what about men?  Men experience something very similar, known as andropause or late-onset hypogonadism.  Starting as early as 35 years old, the level of testosterone in men can start to gradually decline at a rate of 1-1.5% annually.  This decline in testosterone may not effect every man, but is seen in about 39% of the male population > 45 years old.  Many of the signs and symptoms of low testosterone are overlooked as signs of old age, including weakness, fatigue, decreased muscle mass and decreased bone density.  Other effects of low testosterone include depression, hair loss and sexual issues, such as decreased libido and erectile dysfunction.  If men start to experience these symptoms, it is important for them to talk to their physicians and get labwork done to see if their testosterone level is truely low.

Having low testosterone can greatly impact a man’s health and general well-being.  Men with low testosterone are more likely to have other diseases, such as high blood pressure, high cholesterol, and diabetes.  There have also been studies linking low testosterone with cognitive impairment and a higher risk of cardiovascular disease.  Ideally, restoring the hormal balance in men will not only help resolve symptoms, but also decrease their risk for concurrent diseases.

Currently there are a few different products on the market which provide supplemental or replacement testosterone.  Testosterone can be injected into the muscle, applied topically to the skin by a patch (Androderm) or gel (Androgel, Testim), absorbed through the inner lining of the mouth (Striant SR), or absorbed from a pellet implanted underneath the skin (Testopel).  These treatments are all FDA-approved, which means that they have gone through rigorous testing for safety and efficacy.

These conventional treatments are not the only options available.  Recently bioidentical hormone replacement therapy (BHRT) has picked up popularity as a solution to resolve menopause in women.  Heralded as a safer and more effective treament compared to conventional products, BHRT is the supplementation of hormones that are molecularly identical to the hormones produced in the human body.  While most studies have focused on the treatment of women with BHRT, men can also benefit.  The concept of using BHRT in men is similar to the treatment of women, just with different hormones.  BHRT for both men and women, are available as compounded medications produced by a compounding pharmacy.  The main benefit of using compounded medications is the ability to provide individualized treatment.  The strength of the medication, schedule of when to take the medication, and how the medication is administered, can all be easily customized.

In general, testosterone replacement therapy should only be started in men with reported low levels of testosterone and those experiencing symptoms.  Choosing to start conventional treatments or BHRT depends on each individual’s situation.  It is best to seek the advice of doctors and pharmacies who are well informed about testosterone replacement therapy, both conventional and BHRT, in order to recieve the best health care possible.

 

Heather Sakai

PharmD Candidate, 2013

California Northstate University, College of Pharmacy

What is Parathyroid Hormone?

When we discuss hormone replacement we typically talk about putting back what is missing.  Whether insufficient, or out of balance inadequate hormone levels can cause all sorts of disruptions in our body.  But not all hormones are so temperamental that we would consider monitoring or supplementing them.  Some reliably perform their duties and almost never cause upset.  Despite their importance to the body they are ignored and often their potential therapeutic value goes unnoticed.

For example, the parathyroid glands synthesize and secrete a hormone that is responsible for regulating the amount of calcium, vitamin D, and phosphorus in our bloodstream.  The task of maintaining the level of calcium in our blood within a very narrow range is essential to our survival. Excess calcium is stored away in our bones and teeth to provide strength and serve as a reservoir when levels in the blood drop.  The 1% of calcium found outside this is responsible for creating the electrical energy that allows us to function.  It enables our muscles to contract, our nervous system to relay messages, and is responsible for every beat of our heart.

Fortunately, the four tiny parathyroid glands function properly in the vast majority of people.  In very rare cases major surgery on the head or neck can result in what is typically a temporary state of hypoparathyroidism.  Even less often an autoimmune disease or genetic disorder will cause absent or underactive parathyroid glands. Typically treatment for these conditions consists of vitamin D and calcium replacement along with frequent bloodwork, but not parathyroid hormone replacement.

And so you would assume there would never be a use for a parathyroid hormone replacement. Yet a synthetic version of the hormone is available and has an important application, just not in treating hypoparathyroidism.  ForteoÒ (teriparatide) is a synthetic version of parathyroid hormone.  It is a unique injectable medication used to treat certain types of osteoporosis.  It mimics the activity of parathyroid hormone by promoting the restructuring of bone, in fact it actually helps to build new bone.

I wouldn’t typically think to supplement the body with hormones that are already present in sufficient amounts, but I recognize the utility of this drug in treating certain individuals.  Looking at this example makes me believe it may be time to broaden our views on hormone replacement.  In our search for the next miracle drug maybe we should spend less time creating something from nothing and more time learning from what nature has already perfected.

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Kendra Morotti
2012 PharmD Candidate
California Northstate College of Pharmacy

In Response to: “NO CLEAR HOTFLASH SOLUTION”

While it is firmly established that the most clinically effective treatment for menopausal symptoms is hormone replacement, one common distinction that too many fail to make is that “conventional” hormone replacement and “bioidentical” hormone replacement are not one and the same.  It amazes me how often patients tell me their physician has said to them “hormones are hormones”– even the OB/GYN who really should know better.  My own personal research, and that of countless other scientists and physicians in this area of medicine, tells us that all hormones are NOT created equally.

The Women’s Health Initiative study looked at two very specific drugs, namely Premarin and Prempro.  Premarin is a distillation of various non-human hormones derived from pregnant mares’ urine.  The drug’s package insert vaguely describes the pill’s content of “conjugated estrogens” without providing much more detail of the assorted components or their chemical structure.  But, if one is able to examine with an understanding of chemistry and physiology the specific make-up of the non-human hormones in Premarin, it becomes inconceivable that these chemicals could possibly behave identically to the body’s own innate forms of estrogen.  Likewise, in the case of Prempro, the other drug studied by the WHI, it is actually a combination of two drugs–Premarin and Provera.  Provera, or medroxyprogesterone acetate (MPA) is a potent progestin(a  progesterone-like substance) that is very “sticky” with regard to its target cell receptors, meaning it stays engaged longer and more stubbornly than the body’s own naturally produced progesterone.  Though it has progesterone in its name, MPA is not nearly identical to natural human progesterone

 

 

 

The chemical differences between the body’s own hormones and those foreign hormones described above are unquestionably very subtle.  But, if one looks at the chemical structure of the three main ovarian hormones, progesterone, estrogen and testosterone, each of these differ only slightly from the other by the arrangement and placement of hydrogen here, a carbon there, and double-bonded oxygen there.  Obviously, these three hormones behave and have very different effects from each other on the tissues and organs of the body—nobody in his right mind would question this.  But, somehow people, scientists, and yes, even physicians quite easily assume these other chemicals, since they all have estrogenic and/or progestin-like properties and appear very structurally similar, will all produce the same short and long term effects, one just the same as the other.  This is where the erroneous thinking begins in the minds of those inclined to make over-generalizing conclusions from the results of the WHIstudy.  First, whatever was found to be true in the WHIstudy of conjugated estrogens, must also be true of all estrogens, even those made in the human body’s own organs and glands.  Similarly, the resulting long-term effects of years of exposure to MPA must also be expected to follow from supplementation with bio-identical progesterone. This is just wrong thinking!  Why properly educated and esteemed doctors and scientist make this clumsy leap, I cannot figure.

Bioidentical hormone replacement therapy (BHRT) has enjoyed some prime-time publicity and increased popularity over the last several years.  Suzanne Summers, Oprah Winfrey, Robin McGraw (Dr. Phil’s wife), and even Dr. Oz have endorsed the use and practice of BHRT.  In other words, it’s alternative therapy that has now become mainstream.  Does this mean everybody should jump on the bandwagon and start slathering with hormone creams to feel young again?  I think not.  Obviously, as a compounding pharmacist whose most profitable niche is BHRT compounding, I have a strong bias in favor of this therapy—complete transparency here, folks.  But, I promise you, I am not in it only for the money.  I truly believe it is the best therapy.  I recommend it for my wife, my mom, my grandmother– every woman I think could benefit from it, because it is the right therapy.  It is, very simply stated, putting back into the body exactly what it is deficient in.  Bio-identical hormones are molecularly indistinguishable– exactly the same substances that Mother Nature has helped you make your entire life.

So, let’s talk about the FDA and its non-approval as well as the varying quality and strength issues related to compounded hormone replacement.  Does FDA approval mean a drug or food or device is unquestionably safe?  No.  It means that a company has proven that it’s patented product is safe enough to meet with the FDA’s approval to proceed with marketing that product for specific indication(s) or use(s)—plain and simple.  The FDA gets all of its revenue, millions and millions of dollars, from drug companies’ participation in their approval process.  Bio-identical hormones are not patent-able.  Therefore, they are not a potential revenue source for the FDA.  Furthermore, they stand, potentially and actually, to compete with other products out there the big Pharma companies produce.  Products the big Pharma companies have gone through all the FDA’s expensive hoops in order to be able to market to the public and its medical professionals. Let’s not be naive, big Pharma owns the FDA with all the revenue it provides, and devotes enormous amounts of additional dollars in lobbying efforts to help shape the FDA’s stance on such “public health threats” as pharmacy compounding.  This is how we little compounding pharmacists see the playing field—sound a little paranoid and conspiracy theorist?  Well, you can be the judge on that one.

So,what about quality and strength?  I will agree one hundred percent that there is undoubtedly going to be a lot of varying quality and consistency out there when you take into account all the thousands of different pharmacies across the nation performing various levels and scales of compounding. Each pharmacy is inspected and held accountable to the standards determined by their own state’s board of pharmacy.  And, what it boils down to, really, is the skill-level, the expertise, the infrastructure and the integrity of each particular operation.  I know, firsthand, there are operations out there that are really sub-par as far as professional and industry standards go.  That being said, there exist others who hold themselves to a standard higher than what is expected of a plant subject to FDA inspection.   Lucky for me, I was professionally trained and personally instilled with the  mindset and practice approach of one of these very top-notch operations.

At the end of the day, my advice to anyone receiving or even considering receiving a compounded preparation, is to first establish with a presciber who has substantial experience in BHRT practice, so that you will be prescribed appropriate doses to treat your symptoms with minimal exposure to risk.  Secondly, by doing so, you will presumably be referred to a pharmacy or, better yet, choice of pharmacies, with which the presciber has had consistent reliable experience and results.  Next, though it may be tempting to price shop once one has begun using compounds in order to get the “best deal”, I strongly advise against changing compounding pharmacies too frequently.  Not all will use the same bases and inactives, hence the results may vary significantly as well.  Also, saving a few dollars here or there doesn’t necessarily ensure the best quality of compounded preparation.  Go see the pharmacy, ask the pharmacist questions, ask for referrals.  Who are his/her big prescribers?  How long as he/she been in practice?  It’s your body, it’s your health.  Do the right thing.

John Ortego, PharmD

Parkside Pharmacy

Why do I need compounding?

The specific answer to this question may be different for each individual you ask, but generally they will fall into one of three categories.

Veterinary: For about 1/3 of the customers we serve, the answer is that Parkside makes a pet-friendly delivery system that enables one to administer his/her pet’s medicine with less difficulty or resistance from the animal, or the medicine their veterinarian has prescribed is not commercially available in the needed strength or dosage form.

Another 1/3 of Parkside’s customers need compounding because the hormones their provider prescribes requires compounding to deliver the unique strength, combination and/or dosage form they require–this is commonly referred to as BHRT (bio-identical hormone replacement therapy).

Everybody else: The remaining 1/3 of patients who need compounding is a “mixed bag”.  In this group are often pediatric patients who require a lower than conventionally available dose or a medicine made into a liquid that is otherwise only dispensed in pill form.  Patients whose prescription is for a discontinued drug or drug in short supply, a “back-ordered” medicine will need compounding.  Other times a patient will need something made exactly to mimic a conventional product, but will require that an ingredient be left out, due to an allergy or intolerance.  Also, commonly, patients will require a dose of a drug that falls out of the common range of strengths conventionally available because their doctor is prescribing “off-label” or for an indication not approved by the FDA.  This doesn’t necessarily mean it’s less safe, only that the makers of the drug did not seek approval for marketing the drug for this specific use.  Pain management incorporates compounding quite often for various reasons; one example is that medicine can be delivered topically to painful areas and give relief without the systemic “side-effects” that can be problematic with oral drugs.

There are many more exapmles, as this is just a brief overview, but we’ll get into more depth in future blogging for those of you who want to know more.