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Reprinted from https://commons.wikimedia.org/wiki/File:Th%C3%A9riaque1.jpg under the Wikimedia Commons-Public Domain.

most influential and widely distributed books in Europe were those that described Greco-Roman herbal medicines (4). Lady Grace Mildmay, a well-to-do 16th century English woman, collected compounding recipes from various reliable sources and tweaked them based on the outcome of the patients she treated. Like her contemporaries, she used a wide range of ingredients: plants, metal salts, minerals, animal parts (hooves, horns, and claws), ale, and wine. Her compounding methods often involved rituals, as well as procedures. For example, Mildmay’s “precious balm” consisted of more than 160 ingredients, required 10 distillations in a complicated ritual of 14 steps, and took at least 5 weeks to prepare (6). The most enduring of all medicinal compounds was theriac, which dates from the time of Nero (37-68 AD). Fearful of poisoning, Nero directed his physician, Andromachus, to develop new and better antidotes (3). Andromachus took a traditional and already effective antidote and increased the number of ingredients to 64, including chunks of viper flesh. He also increased the opium content by 500% (3).

Theriac became wildly popular—no doubt due to opium addiction. Galen wrote a whole book about it, Theriaké. Those who could afford the expensive preparation took it for everything, from the Black Death to routine prophylactic use for almost anything (3). By the 13th century, theriac had been adopted in China, and versions of it were also available in India. In Europe, it survived the Renaissance, with even more elaborate ceremonies required for its preparation. Theriac was included in the official German pharmacopoeia until 1872 and in the French pharmacopoeia until 1884 (3).

Compounding in the US In the US, compounding pharmacies began emerging in the early 1800s (5, 7). Several of today’s well known drug companies originated as 19th century shops owned by pharmacists: George Merck (Merck & Co.), William Warner and Jordan Lambert (Warner-Lambert—now Pfizer), John K. Smith (GlaxoSmithKline), and Eli Lilly (7). The medicines these pharmacists compounded were crude mixtures from natural sources, such as opium and belladonna. To increase the potency of their remedies, they often performed an extraction using water or alcohol and concentrated the solution through evaporation (e.g., laudanum, a tincture of opium). An estimated 80% of all prescriptions were made by compounding up to the 1920s (5). By the 1940s, compounding accounted for about half of all medications (7, 8). As modern pharmaceutical manufacturing became established, compounding declined and pharmacists simply dispensed formulations that had been manufactured by drug companies (5, 8). Although compounding now represents only about 1% of all US prescriptions, it remains an integral part of the pharmacy profession and is practiced in the pharmacies of hospitals, chain drug stores, and local communities (9). Customized drugs are needed by patients who may be allergic to a manufactured drug’s ingredients (e.g., preservatives and dyes), need a liquid to alleviate difficulties in swallowing pills, or need a nonstandard dosage strength (9, 10).

Vessel for storing Theriac

Reprinted from The Pharmacologist • June 2017

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2018 Special Compilation Issue of The Pharmacologist  

ASPET is pleased to present the second in a series of special editions of our quarterly news magazine, The Pharmacologist. This special com...

2018 Special Compilation Issue of The Pharmacologist  

ASPET is pleased to present the second in a series of special editions of our quarterly news magazine, The Pharmacologist. This special com...