C 3 Compounded Drugs of Value
in Outpatient Hospice Care
John P. “Jack” McNulty, MD, FACP, FAAHPM
Founder
Palliative Care Institute of Southeast Louisiana
George B. Muller, BS in Pharm., R.Ph
Owner
Muller Compounding Consultants LLC d/b/a
Compounding Business Services
A compounded preparation is needed when
no commercially manufactured medication is
available to adequately address a patient’s
medical needs. Among the greatest therapeutic
challenges faced by both patients and caregivers
is the treatment required by individuals who
have a terminal condition. It is difficult to find
evidence-based studies on the management
of end-of-life situations because each patient’s
medical case is unique. In addition, maintaining
a controlled environment for such patients is
difficult. End-of-life care is multifaceted; it does
not lend itself to “cookbook medicine,” and
people with a terminal illness are among the
most vulnerable patients in need of effective and
compassionate care. When those patients suffer
in spite of commercially available therapies,
the innovation and experience of clinicians
and compounding pharmacists can often yield
a solution to the most challenging treatment
problems. In this presentation, we discuss some
of the most often prescribed compounds used
in outpatient hospice and palliative care to
treat common conditions (wounds, pain and
dyspnea, intractable cough, nausea and vomiting,
depression, bladder infections caused by an
indwelling catheter, rectal pain). The effectiveness
of the preparations we describe is substantiated
in the medical literature and by our personal
experience, which together encompasses nearly
100 years of clinical practice. The medications
described in this report have been shown over
time to be effective.
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