Wellness Solutions Blog

thoughts from our expert team

Category Archives: Compounding

Tips for managing multiple prescriptions


By: Justin Ceravolo, PharmD, assistant pharmacy manager for Cypress Pharmacy

Managing multiple prescriptions can be a daunting task. As we age, we often find ourselves taking more and more medications. In fact, a study found that 40% of older Americans take five or more prescription drugs at the same time. Ninety percent of people over the age of 65 take medication daily.

Called polypharmacy, it’s the simultaneous use of multiple drugs to treat a single ailment or condition or simultaneous use of multiple drugs by a single patient for one or more conditions.

There are many risks in taking multiple medications, including interactions that can diminish or amplify the effects of some drugs. Pair this with over-the-counter treatments and supplements, and potentially dangerous interactions are possible. Multiple prescriptions with similar side effects can make adverse reactions even more intense.

While it can be difficult to keep track of so many medications, there are ways to manage:

  • Make sure your doctors know every treatment you are on in order to monitor for possible interactions. While you may go to different doctors for different conditions, it’s best to have one pharmacy manage all your prescriptions. Your pharmacist will also know what foods can influence the effectiveness or safety of the drugs.
  • Find a pharmacist who uses Medication Therapy Management (MTM) to reduce the risk of adverse events. Your pharmacist is your advocate and can prevent problems before they happen by reviewing all medications and supplements to consider therapy duplication, adherence issues or potential drug interactions, providing medication education, consultation and advice for proper use.

Your pharmacists may point out if they think your drug dosage is a bit low or high or suggest an alternative with fewer side effects or one that needs to be taken less frequently. They can help space medicines that may interact, so they are more effective, and avoid problems by using information such as your weight and height. Research shows that people who use MTM have fewer problems and can save money.

  • Ask your pharmacist if they offer medication packaging solutions. Color-coded cards, sorting and personalized doses, labeled by date and time of day to be taken, can help you manage even the most complex regimens.
  • A compounding pharmacy may be able to compound multiple prescriptions into one dose. While compounding is a longtime practice, it has become less common since the advent of standard drug strengths. Unfortunately, a one-size-fits-all approach may not meet your unique needs – this is when custom compounding can provide great benefits.

Compounding pharmacies help patients who are unable to use their medication as directed or who prefer their medication in a certain form. For example, patients may be allergic to preservatives or dyes or require a dosage that is different from standard strengths. While compounded medications are not FDA-approved, the Food and Drug Administration supports compounded prescriptions that are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. In addition, state boards of pharmacy regulate the practice of compounding.

With a physician’s permission, a compounding pharmacist can adjust the strength, avoid unwanted ingredients, make the medication taste better and prepare another way to deliver the medicine, such as topical gels, creams, suppositories or sublingual troches. For example, if a patient has difficulty swallowing, a compounding pharmacist may prepare the drug as a flavored liquid suspension.

Medication can help us live longer. While managing multiple prescriptions can be challenging, it doesn’t have to be.

Could it be your Thyroid?


According to the American Association of Clinical Endocrinologists, nearly 30 million Americans have thyroid disease. Unfortunately, many go undiagnosed or undetected for years.  This number includes three times more women than men and includes something called subclinical hypothyroidism.

Subclinical hypothyroidism presents clinically with many of the same symptoms as classic hypothyroidism, but, is just below the threshold in terms of diagnostic lab values regarding TSH (thyroid-stimulating hormone), and T4 or thyroxine.

If you suspect a thyroid problem, the first thing your doctor will probably do is order a thyroid-stimulating hormone (TSH) blood test.  This is covered by insurance and typically might be the only component of the thyroid test panel to be checked by the doctor. Typically, the higher your score, the more likely you are to be hypothyroid.  The American Academy of Clinical Endocrinologists believes levels between 0.3 and 3 are indicative of an underachieving thyroid.  However, many functional or natural medicine practitioners believe any score higher than 2.0 on the TSH score, plus classical symptoms is indicative of hypothyroidism.

Conventional doctors will follow the standard of care and recommend Synthroid or Levothyroxine, which may temporarily improve symptoms, but not address the underlying cause.

According to Dr. Mark Hyman M.D. functional medicine expert and Chief of the Functional Medicine Division at the Cleveland Clinic, it is important to consider changes in diet, lifestyle, and to prescribe a natural prescription form of thyroid like Armour Thyroid or Natur-Throid as a starting point, with combinations of both T4 thyroxine and T3 or triiodothyronine, which is the active form of thyroid.

Classic Low Thyroid Symptoms to Consider

If you experience some of the following, you may want to rule out classic hypothyroidism, subclinical hypothyroidism, or Hashimoto’s thyroiditis as the underlying cause of why you are not feeling like yourself or feeling your best.

Do you experience any of the following symptoms?

  • thick or brittle fingernails
  • dry skin
  • cold hands and feet regardless of warm temperature
  • fatigue
  • lack of stamina
  • brain fog
  • course or thinning hair
  • thin eyebrows
  • excessive sweating
  • menstrual irregularities
  • swollen hands or feet
  • palpitations
  • high cholesterol
  • changes in weight with difficulty losing weight
  • mild depression
  • anxiety
  • muscle aches or joint pain

Many times this exhaustive list of symptoms or a cluster of these signs is indicative of a disturbed thyroid which deserves further clinical investigation.  Doctors may overlook thyroid disease because sometimes the symptoms are non- specific, and the lab results fall within the normal reference range.

Typical Patient Story of Missed Thyroid Diagnosis

Angelina Smith is a busy mother of two young boys who suddenly found herself exhausted in the middle of the morning.  Her doctor told her to “get more sleep” and to try to relax.  When she reported that her hair was falling out and she was feeling more sad or depressed, her doctor attributed her symptoms to everyday ups and downs of life.  Angelina also noted, that her regular clothes were fitting tighter, and she was gaining some weight despite some regular moderate exercise, and no change in diet.  The doctor shunned this off as just her age of 35 years, and that her “metabolism was changing”.  Angelina knew something was just not right with her body and decided to change physicians for another opinion. After deciding to step outside the traditional medicine box and make an appointment with a functional medicine doctor educated on hormonal imbalance, Angelina’s issue was uncovered as hypothyroidism with an imbalance of estrogen and progesterone which was contributing with her present symptoms. Once these hormone issues were addressed and treated with compounded formulations specific for her body, Angelina began to regain her health and feel once again like her old self.

What are the Different Types of Thyroid Disease? 

Thyroid disease can be classified according to overactivity or under activity of the gland.  The thyroid gland is a butterfly-shaped gland located anatomically at the base of your throat and produces hormones that control every function in your body.

Thyroid disease consists of hyperthyroidism, goiters, nodules, hypothyroidism, Hashimoto’s thyroiditis, and sub-clinical hypothyroidism.  Thyroid hormone, when it is in balance, helps improve moods, skin, hair, sex drive, heart function, cholesterol, infertility, muscle aches, joint pain, body temperature, and metabolism to name a few.  In addition, hypothyroidism has been associated with fibromyalgia and osteoporosis according to Dr. Jacob Teitelbaum M.D., medical director of the National Fibromyalgia and Fatigue Centers.

Trusting the Thyroid Thermostat

According to Brian F. Mandell M.D., Ph.D. contributing author in the Cleveland Clinic Journal of Medicine, 2019 February:86 (2):77-78 who suggests that the natural history of all patients with subclinical hypothyroidism is not alike, and it thus should not be surprising that there does not seem to be a one-size-fits-all approach to management of the disorder.  Furthermore, the management of subclinical hypothyroidism or other forms of thyroid disorder should be based on both good clinical examination and laboratory testing that includes complete thyroid profiles with TSH, T3, free T3, T4, free T4, TPO, and reverse T3.

Simple, At-Home Thyroid Testing

Many functional medicine or holistic medical doctors recommend doing your own thyroid screening test in the comforts of your home.  This can be accomplished by placing a thermometer under the arm ( axillary area) upon awakening.  Hold still for 5 minutes, then record your time and temperature.  Do this for three consecutive days to see a pattern of your basal body temperature.  If your reading is below 97.2 consistently, and you suffer from the cluster of symptoms mentioned above, it is likely your thyroid is underactive and needs some medical attention.

Proactive Approach to Managing Your Thyroid

Early detection of thyroid disease is very important, just like any other major condition.  The sooner you have a definitive diagnosis, the faster you can begin to get your life back and expect to feel as if you are in control again.  Encourage your physician to order a complete thyroid profile, take your own basal body temperature test at home, and start appropriate therapy to regain homeostasis once again. In addition, there are some very good nutritional supplements that support the thyroid gland and can help rebalance your metabolism and give you more energy.  One, in particular, called THYROID SUPPORT WITH ZINC improves low thyroid and metabolic function by combining key vitamins, minerals, and herbal ingredients specifically targeted at this gland.  This supplement can be taken as an adjunct to prescription natural thyroid medicine, or as a stand-alone product for milder symptoms.

If you have questions, you may reach us at Cypress Pharmacy by calling (239)-481-7322 or stop by to discuss with one of our healthcare professionals.

Menopause and Perimenopause: Will it Ever End?


Ladies, you don’t have to suffer with symptoms!

Many women who have gone through or are going through menopause may wonder why anyone would want to create World Menopause awareness events.

To spotlight women’s midlife health, the World Menopause Society and the World Health Organization have designated October as World Menopause Awareness Month.

One out of three women experiencing a variety of menopause symptoms – anxiety, insomnia, headaches, night flashes, moodiness, weight gain, joint pain, low sex drive, increased cardiovascular risk, hot flashes and more – are likely already very aware of menopause and its impact.

In the decade after menopause, defined as a full year without having a period, women also become vulnerable to chronic diseases such as osteoporosis, cognitive decline and cancer.

When I talk about menopause awareness, I want women to be aware they don’t have to suffer. There are ways to relieve the symptoms of menopause and improve their quality of life and well-being. After all, about one-third of women’s lives are lived after menopause!

The whole key to a healthy body is balance. Shifting hormones, complicated by stress, lack of exercise and poor diets with too many carbs, sugars and alcohol, put our bodies out of balance, resulting in various symptoms associated with PMS, perimenopause and menopause.

As women age, sex hormones estrogen, testosterone and progesterone can drop by 90%! Hormones are tricky chemical messengers that change every day and are so important because they regulate many bodily processes, particularly impacting how we feel.

As a natural health practitioner, I believe that lifestyle choices impact well-being. Getting adequate sleep, drinking plenty of water, reducing alcohol intake and stress and not smoking will help keep the body in balance. Lifestyle measures including a healthy diet, exercise and regular health checks for chronic conditions are critical.

During perimenopause and menopause, many doctors prescribe synthetic hormones to get the body back in balance through medications that replace female hormones the body no longer makes.

At Cypress Pharmacy, we offer another option: bioidentical hormone replacement, hormones that are identical in molecular structure to the hormones women make in their bodies in combinations not commercially available.

As a compounding pharmacy, our pharmacists can create bioidentical hormone formulations to fit the unique needs of each biochemically diverse woman. Bioidenticals are natural and closely mimic what the hormones the body produces on its own.

The formulas are created with a doctor’s prescription following blood or saliva tests to determine hormone levels. Tests can be ordered by a doctor, or Cypress Pharmacy offers a saliva test kit that can be completed at home. Once lab results pinpoint hormonal imbalances, we can work with your doctor or connect you with a bioidentical prescribing doctor who can talk about treatment options.

Be aware of this: the key to quality of life is balance. It’s important to make sure the symphony is in tune.

%d bloggers like this: