This guest blog post, about how compounding pharmacies can be a tremendous resource for families raising children with ASD, comes from Ashley Dick, who is a practicing compounding pharmacist and co-owner of PharmaCare Compounding Solutions in Tennessee.

Helping the Medicine Go Down: Addressing the special needs of ASD patients

By Ashley Dick, PharmD

For the parents of a child with an autism spectrum disorder (ASD), the many difficulties that come with caring for their child can cause significant stress and frustration, to the point of being overwhelming. Often amplifying these feelings is the fact that the very characteristics of the condition make it exceedingly difficult to treat the symptoms or simply help the child to feel better. Because of the extreme sensory and dietary issues experienced by many ASD patients, traditional forms of medication or nutritional supplements are either difficult or impossible to administer, but there is a solution through pharmacy compounding.

Compounding is the art and science of preparing customized medications for patients, and while its practice dates back to the origins of pharmacy, modern technology and research have recently allowed more pharmacists to customize medications to address very specific needs not met by major manufacturers. Compounded dosage forms are most needed by patient groups that don’t respond well to the more widely-available forms of medication, such as capsules or injections, and children with ASD exemplify this type of patient.

From simple headaches to flu, and everything in between, medicating a child with ASD is complicated by sensory and dietary sensitivities, as well as barriers in communication. Because of sensory issues, autistic children often have an aversion to cold or things that are hard, such as cough drops. Some cannot take liquids, and many cannot or will not swallow capsules or tablets. Add to this an aversion to certain textures or altered taste perception, and parents are faced with what could seem like an insurmountable challenge.

Because every child is unique, pharmacists and medical practitioners working with patients on the spectrum need to be patient – and inventive – to realize treatment success. But compounding provides a number of options that have shown to be very successful. Certain drugs can be compounded into almost any form, so when capsules or injections are impossible, the pharmacist can provide a different delivery method, such as sprays, medicated popsicles or gummy treats. If those aren’t suitable, many medications – such as sore throat treatments – can be compounded into other innovative forms for oral administration. There is even a promising dosage form using bubble gum.

Alternatively, there are special “transdermal” creams that can actively carry the drug, across the skin, into the bloodstream and the child will get benefit within 15 to 20 minutes. The parent can usually put it either on the wrist or the back of the knee because there is good blood flow there and it’s less likely to be rubbed off. There are numerous medications that can be administered this way.

Gastrointestinal problems accompany almost all cases of ASD, so specialized diets play a significant role in many treatment plans. Many children respond particularly well to diets that are free of gluten, casein, dyes, preservatives, sugar, soy and corn. Some children need to avoid only some of these foods or ingredients, but for those that need ALL these qualifiers, it’s almost impossible to find commercially-available medication. A prime example is the antifungal nystatin. The “gut issues” seen in many autistic children can promote overgrowth of fungi and other microbes, so these children often respond to anti-fungal treatment. A standard 10-day treatment with commercially-available versions of nystatin contains up to four grams of sugar, making it problematic for patients on a sugar-free diet. A compounding pharmacy, though, can prepare a sugar-free version.

Nutritional support is one of the first aspects of autism treatment, and many biomedical practitioners that take a more holistic approach will start with a specialized diet and then move to supplements. The children that see marked benefits from taking these supplements require a long list, including pharmaceutical-grade multivitamins, fish oil, probiotics, enzymes, amino acids, magnesium, zinc and others. Some children require more than 10 supplements a day, but if they won’t swallow capsules, already stressed parents can be thrown into a panic. Compounders can help, however, offering individualized vitamin or amino acid mixtures, and flavored syrups into which all of the child’s daily supplements can be mixed and then administered without a struggle.

In addition to difficulties taking medicines for general illnesses, children with ASD also cope with ailments that commonly accompany their condition, requiring even more medication that they might have trouble taking in traditional forms. The previously mentioned gut issues require an array of antifungal and antibacterial medicines that pharmacists can offer in different delivery methods. Many ASD patients also exhibit impaired detoxification capabilities, or a reduced ability to isolate and eliminate toxic substances, such as mercury, lead and arsenic, among other chemicals. Many practitioners will turn to chelation to treat this problem, but it’s normally only available intravenously. Pharmacists, though, can compound numerous chelating agents in a variety of dosage forms, such as suppositories or transdermal creams, also incorporating nutritional support to prevent mineral depletion.

There are other issues, too, that a compounding pharmacist – working with a child’s doctor – can help to address, including atypical immune function and sleep issues. Parents struggling to administer medication or nutritional supplements to a child with ASD might ask their doctor: “Is this a situation where compounding might help?” Alternately, it is relatively easy to research compounding pharmacies in specific areas to determine which have a specialty in preparing dosages forms for children with special needs. To find a pharmacy nearby, go to www.findacompounder.com.

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Ashley Dick is a graduate of Samford University's McWhorter School of Pharmacy, where she earned her Doctor of Pharmacy in 2006. Following was her community practice residency at Reeves-Sain Pharmacy in Murfreesboro, TN, and completion of the Primary Training course with the Professional Compounding Centers of America in Houston, TX. Currently, she is a practicing compounding pharmacist and co-owner of PharmaCare Compounding Solutions in Mount Juliet, TN.