With such diverse people in the world that have individual needs and requirements, it is understandable that not everyone responds the same to every type of medication. Many people have specific conditions that prevent them from taking medicine using traditional manufactured pharmaceuticals. Sometimes the type of medicine required by a particular patient is not manufactured by traditional drug companies, or a patient may need to ingest the medicine using a different method than traditionally prescribed. This is when Compound Pharmacists come in to meet the unique individual patient needs.

Compounding pharmacists customize an individual patient’s prescription according to the specific need of the patient. There are a number of circumstances that require consultation with a compounding pharmacist. For instance, a patient will need a compound pharmacist if they are unable to ingest ingredients that are included in traditional medicines such as preservatives, alcohol, dyes, sugar, gluten, lactose, and casein. Patients may also need an alternate route of medicine ingestions such as if a patient has trouble swallowing. Alternate administration routes can include: Transdermal such as a skin patch, nasal spray, liquid form, lozenge, lollipops, creams, and inhalation. If a patient is susceptible to drug side effects or require allergen free medications, using medication prepared by a compounding pharmacist can drastically reduce the potential for side effects and eliminate allergic reactions. A compounding pharmacy can help cancer patients reduce discomfort caused by their medication during treatment.

If a patient requires a specific dosage that is not normally manufactured by a traditional drug manufacturer, a compounding pharmacist can provide the uncommon dosage in order to meet the required strength. Patients who are in need of medications that have been discontinued by pharmaceutical manufacturers can get the medications from a compounding pharmacist. As well, children who will only medications that have a palatable flavor will be able to get a specific drug that has a pleasant tasting flavor from a compounding pharmacist.

Compounded prescriptions are the ideal solutions for a patient that is in need of an alternate route of delivery and an uncommon dosage. Compounding pharmacists are needed in such medical areas as: Bio-identical Hormone Replacement Therapy, Sports Medicine, Wound Therapy, Veterinary practices that include both large and small animals, Chronic Pain Management, Dental Practices, Hospice, Pediatrics, Infertility, Ophthalmic, Dermatology, Neurology, Gastroenterology, and more.

Pharmacy compounding is not just a science of preparing medications, but it is also an art to customizing medications for patients. Compounding is not a new method of providing medications. This type of pharmacy has been around for centuries. However, with increasing more patients requiring alternative forms of drugs and innovations in technology and research, there has be a significant increase in compounding pharmacists. As well, The Food and Drug Administration support the use of compounding, and it is regulated by each State’s Board of Pharmacy.

With the consent of a physician, a compounding pharmacist can modify almost any kind of a medication to make it easier to ingest by the patient and have the exact same effect as traditional manufactured medicine. For many patients, compounding has made the ingestion much easier and less unpleasant. For patients who feel they may require the expertise of compounding pharmacists, it is recommended that they discuss what compounding can do for them with their physician.

Compounding dental mouthwashes or rinses may offer numerous advantages over commercially available preparations. It is more desirable to compound mouthwashes using pharmaceutical grade bulk powders as a source of active ingredients (antibiotics, anesthetics, etc.) versus the common practice of combining available liquids, due to concerns of palatability, flavour (different products have different flavours, which may not be compatible), limit of alcohol content, and elimination of dyes used to colour liquid preparations which may stain exposed mucosa.

Stability and compatibility are significant issues when drugs are manufactured and must have extended shelf-lives to endure the distribution cycle. When a medication is prepared at the time it is needed to meet the needs of a specific patient, many of these concerns can be eliminated. Compounding allows numerous active ingredients to be incorporated into customized mouthwashes, gels, troches, etc. For example, to treat periodontal disease, antibiotics can be formulated as a mouthwash, or added to an oral adhesive paste or a plasticized gel that will maintain the contact between the tissue and medication for a longer period of time.

Many practitioners are familiar with formulations used to treat stomatitis, such as Kaiser’s, Kraemer’s, Powell’s, Reynold’s, Stanford’s, and T-N-D-D (tetracycline, nystatin, diphenhydramine, and dexamethasone). Customized mouthwashes can be formulated to treat:

• Burning Mouth Syndrome: A double-blind, randomized, multicenter parallel group study evaluated the efficacy of topical use of clonazepam. Forty-eight patients (4 men and 44 women, aged 65+/-2.1 years) were included, of whom 41 completed the study. The patients used clonazepam 1 mg or placebo topically (intraorally) for 3 min and then expectorated. This protocol was repeated three times a day for 14 days. The intensity was evaluated by a 11-point numerical scale before the first administration and then after 14 days. Two weeks after the beginning of treatment, the decrease in pain scores was 2.4+/-0.6 and 0.6+/-0.4 in the clonazepam and placebo groups, respectively.
Pain. 2004 Mar;108(1-2):51-7

• Chemotherapy or Radiation-induced Mucositis: for prevention of mucositis (i.e., glutamine), to relieve pain (i.e., morphine), to reduce inflammation, or to treat superinfections.

• Intraoral Infections: Antibacterial, antifungal, and antiviral preparations.

• Aphthous Ulcers: “Rinse #5” (tetracycline, nystatin, triamcinolone, and 2-deoxy-d-glucose) has been used to reduce pain and promote the healing process.

Customized mouthwashes can be compounded to be
• alcohol-free to reduce burning of irritated mucosa.
• sugar-free to reduce cariogenic potential and for diabetic patients.
• flavoured to please each patient.

Burning mouth syndrome (BMS, stomatodynia), also referred to as glossopyrosis or glossodynia (when the burning occurs on the tongue only), is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. BMS occurs most often among women especially after menopause and is often accompanied by xerostomia (dry mouth) and taste disturbances. The dorsal tongue, palate, lips and gingival tissues, individually or in combination, are the most common sites involved. Bilateral or unilateral oral burning pain has been found to be associated with jaw pain or uncontrollable tightness, taste changes, subjective dry mouth, geographic and fissured tongue, painful teeth, headache, neck and shoulder pain, difficulty speaking, nausea, gagging and swallowing difficulties. BMS has been reported to follow dental treatment, antibiotic usage and a severe upper respiratory infection. Pain is constant, progressively increases over the day, and usually decreases during eating. The lack of pathology to account for the pain can be frustrating. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes, taste alterations, and changes in salivary function and dry mouth.

Recent studies have pointed to dysfunction of several cranial nerves as a possible cause of burning mouth syndrome. Recently, a neuropathological basis has been proposed; therefore, BMS may be regarded as an oral dysesthesia or painful neuropathy. Therapy for BMS may include the use of centrally acting medications for neuropathic pain, such as low doses of tricyclic antidepressants, benzodiazepines or anticonvulsants such as gabapentin. Topical medications, including clonidine, may be considered for application to local sites.

A combination of oral medications for the management of BMS (clonazepam, gabapentin, baclofen, and lamotrigine) significantly decreased pain in 38 of 45 patients. These results suggest that BMS may be treated with lower doses of a combination of medications rather than higher doses of a single medication, which may help to limit adverse effects such as drowsiness or dizziness.

Clonazepam is a benzodiazepine used either topically or in low doses orally, which appears to have excellent efficacy in the relief of the symptoms related to BMS. It is hypothesised that clonazepam acts locally to disrupt the mechanism(s) underlying stomatodynia. A double-blind, randomized, multicenter parallel group study evaluated the efficacy of topical use of clonazepam. Forty-eight patients (4 men and 44 women, aged 65+/-2.1 years) were included, of whom 41 completed the study. The patients were instructed to suck a tablet of either clonazepam 1 mg or placebo and hold their saliva near the painful sites in the mouth without swallowing for 3 minutes and then to expectorate. This protocol was repeated three times a day for 14 days. The intensity was evaluated by a 11-point numerical scale before the first administration and then after 14 days. Two weeks after the beginning of treatment, the decrease in pain scores was 2.4+/-0.6 and 0.6+/-0.4 in the clonazepam and placebo group, respectively. The formulation for a mouth rinse containing clonazepam 1mg /5ml has been reported, and may be easier to use.

Emerging evidence supports the effectiveness of the antioxidant alpha lipoic acid (ALA, thioctic acid). Alpha lipoic acid is able to increase the levels of intracellular glutathione and eliminate free radicals. A double-blind study compared the use of alpha lipoic acid versus placebo for two months in 60 patients with constant BMS, in whom there was no laboratory evidence of deficiencies in iron, vitamins or thyroid function and no hyperglycemia. Following treatment with alpha lipoic acid 600 mg orally daily, there was a significant symptomatic improvement compared with placebo. This improvement was maintained in over 70% of patients at the 1 year follow-up. Another study showed that patients with BMS who had previously been treated with benzodiazepines responded poorly to therapy with alpha lipoic acid compared with those who had not received benzodiazepines.

For references, more information, or to discuss a particular problem, please contact Canada’s 2005 “Compounding Pharmacist of the Year” Marvin Malamed, B.Sc.Pharm., at Haber’s Pharmacy, 416-656-9800, or visit haberspharmacy.com.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S39.e1-13
J Eur Acad Dermatol Venereol. 2004 Nov;18(6):676-8
J Oral Pathol Med. 2002 May;31(5):267-9
Adv Otorhinolaryngol. 2006, 63:278–287
Int J Pharm Compounding July/Aug 2005, 9(4):310
Pain 2004 Mar;108(1-2):51-7
Pain Med. 2000 Mar;1(1):97-100

Tranexamic acid is an antifibrinolytic agent, which can be applied topically or used as a mouthwash to prevent post-surgical bleeding in anticoagulated patients after oral surgery or extractions, without discontinuation or dose reduction of anticoagulant therapy. The hemostatic effect of tranexamic acid solution (4.8%) used as a mouthwash was compared with a placebo solution in 93 patients on continuous, unchanged, oral anticoagulant treatment undergoing oral surgery. The investigation was a randomized, double-blind, placebo-controlled, multicenter study. Before suturing, the surgically treated region was irrigated with 10 ml of tranexamic acid (46 patients) or placebo solution (47 patients). The patients then used the active or placebo solution as a mouthwash: 10 ml of the solution for 2 minutes four times daily for 7 days. In the placebo group, 10 patients developed bleeding requiring treatment, while none of the patients treated with tranexamic acid solution had bleeding. Tranexamic acid mouthwash was well tolerated.1

A double-blind, placebo-controlled, randomized study of the hemostatic effect of tranexamic acid mouthwash after oral surgery was conducted in 39 patients receiving anticoagulant agents because of the presence of cardiac valvular stenosis, a prosthetic cardiac valve, or a vascular prosthesis. Surgery was performed with no change in the level of anticoagulant therapy, and treatment with the anticoagulant agent was continued after surgery. The research concluded that local antifibrinolytic therapy is effective in preventing bleeding after oral surgery in patients who are being treated with anticoagulants.2

A two-day postoperative course of a 4.8% tranexamic acid mouthwash may be equally effective as a 5-day course in controlling hemostasis for post-dental extractions in patients anticoagulated with warfarin.3

Tranexamic acid mouthwash was shown to be as effective and more cost effective than autologous fibrin. This study supports the consensus that dental extractions can be performed without modification of oral anticoagulant treatment.4

Bleeding complications and transfusion requirements after scalings and extractions in patients with hemophilia have also been significantly reduced by local treatment with tranexamic acid.5, 6

1 J Oral Maxillofac Surg 1993 Nov;51(11):1211-6
2 N Engl J Med 1989 Mar 30;320(13):840-3
3 Int J Oral Maxillofac Surg. 2003 Oct;32(5):504-7
4 J Oral Maxillofac Surg. 2003 Dec;61(12):1432-5
5 Br Dent J. 2005 Jan 8;198(1):33-8; discussion 26
6 Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Mar;99(3):270-5

Controlling Hemorrhage in Hemophiliacs After Dental Scaling

A double-blind cross-over randomized control trial at a London (UK) hospital dental practice for patients with inherited bleeding disorders compared the effectiveness of tranexamic acid mouthwash (TAMW) in controlling gingival hemorrhage after dental scaling with that of using factor replacement therapy (FRT) prior to dental scaling in people with hemophilia. The dentists concluded that oral rinsing with TAMW four times daily for up to eight days after dental scaling was as effective as using FRT beforehand in controlling gingival hemorrhage for hemophiliacs.

Br Dent J. 2005 Jan 8;198(1):33-8; discussion 26

Tranexamic acid mouthwash is not commercially available and must be compounded by a compounding pharmacy. When selecting a compounding pharmacy, be certain that the professional staff has received advanced training in current compounding technique We welcome your questions.

For more information, or to discuss a particular problem, please contact Marvin Malamed, B.Sc.Pharm. at Haber’s Compounding Pharmacy, 416-656-9800, or visit haberspharmacy.com.

Complementary Solutions for Dental Problems

Dentists and oral surgeons often encounter problems that do not respond to traditional allopathic therapies, or may require special preparations that are not commercially available. Nutritional deficiencies can affect the integrity of the oral mucosa. Supplementation to replace deficient vitamins, minerals, amino acids, and enzymes, as well as the use of specially-formulated medicated dosage forms can greatly enhance dental care.

Here are just a few examples of dosage forms that can be compounded by prescription to meet the unique needs of dentists and their patients:

- Lip balms for cold sores which contain the natural anti-viral 2-DDG (2-deoxy D-glucose), a glucose derivative which exerts anti-viral activity against herpes simplex and HPV by interfering with the viral replication process. 2-DDG has no known toxicities, and can be incorporated into a variety of topical preparations.
- Electrolyte lozenges to suppress the gag reflex prior to taking an impression or for patients who can not properly perform oral hygiene procedures at home due to a gagging problem1
- Troches or long-acting pilocarpine capsules for dry mouth, which stimulate salivation while avoiding the problems associated with immediate-release pilocarpine products
- Topical muscle relaxants/pain relievers for temporomandibular joint (TMJ) disorder caused by injury or inflammation of the joint. A topical gel containing an anti-inflammatory and a muscle relaxant can be applied over the affected joint to deliver the medication where it is needed and decrease the risk of adverse side effects such as gastrointestinal irritation and drowsiness that occur when medications are administered orally. Iontophoretic delivery of dexamethasone and lidocaine has improved mandibular function in patients who had concurrent temporomandibular joint capsulitis and disc displacement without reduction.
- “Mucosal bandages”, muco-adhesive bases, and oral pastes to cover ulcerated, infected, or tender areas on the oral mucosa, or to maintain medication contact with the oral mucosa

Topical Anesthetics

Novel formulations of topical anesthetics, including intra-oral anesthetics in plasticized gel or an adherent base, may prevent pain associated with laser and soft tissue procedures; phrenectomies; deep scaling, root planing, and curettage; and prior to extraction of primary teeth, and often eliminate the need for injections. The use of topical anesthetics may improve patient recall, because an aversion to injections in patients with recurrent disease or who have dentinal sensitivity may negatively affect their compliance with treatment plans. Vasoconstrictors can be added to preparations to promote local hemostasis, decrease systemic absorption, and prolong the duration of action.

Approximately 1700 pediatric dentists responded to a survey conducted by West Virginia University School of Dentistry, and indicated that most pediatric patients (89%) disliked the taste of topical anesthetics. Compounding pharmacies can customize topical anesthetics in a variety of appealing flavours.

In November 2006, Health Canada issued an advisory regarding an association between the local anesthetic benzocaine and a potentially serious blood condition known as methemoglobinemia (MHb). MHb is an uncommon adverse reaction known to be associated with benzocaine. This condition reduces the ability of red blood cells to deliver oxygen throughout the body, which can lead to bluish discoloration of the skin, nausea and fatigue. It can progress to stupor, coma and death. As of November, 2006, Health Canada had received reports of nine cases of suspected MHb associated with the use of benzocaine. None of the reported cases had a fatal outcome. Almost all reported cases of benzocaine-induced MHb were associated with high-concentration preparations (14 percent to 20 percent benzocaine). Compounding pharmacies can formulate benzocaine-free topical anesthetics, including combinations such as lidocaine and tetracaine or prilocaine.

Topical Medications for Orofacial Neuropathic Pain

The most common neuropathic pain syndromes in the orofacial region include trigeminal neuralgia, traumatic neuropathy; trigeminal neuroma; postherpetic neuralgia; diabetic neuropathy; cancer-related neuropathy; neuropathy induced by AIDS; and chronic-continuous trigeminal nociceptor neuropathy. The pain mechanisms that generate these problems are different for each neuropathy, and treatment protocols need to be structured accordingly. Numerous studies have shown that NMDA-receptor antagonists such as ketamine and gabapentin, may be useful in the treatment of neurogenic pain. Cyclobenzaprine, a muscle relaxant, has been used for peripheral application to relieve muscle trismus and spasm.2

“Miracle Mouthwashes”

Customized oral rinses can be formulated to treat problems such as:

Burning Mouth Syndrome:  Burning mouth syndrome (BMS) is characterized by a burning sensation on the tongue or other oral sites, usually in the absence of clinical and laboratory findings. Burning mouth is reported most often by women, especially after menopause. Typically, patients awaken without pain but note increasing symptoms throughout the day and into the evening. Conditions that have been reported in association with BMS include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes, taste alterations, and changes in salivary function and dry mouth. Recent studies have pointed to dysfunction of several cranial nerves as a possible cause of BMS. Given in low dosages, benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective in treating BMS. The formulation for clonazepam 1mg per 5ml mouthwash was reported in the International Journal of Pharmaceutical Compounding. Topical capsaicin has also been used successfully.3

Gingivitis:  Folate mouthwash appears to have an influence on gingival health through local rather than systemic influence. Use of a mouthwash containing folate 5mg/5ml (twice daily for 4 weeks, rinsing for 1 min before expectorating) reduced gingival inflammation and bleeding in patients with periodontal disease. Folic acid mouthwash and oral tablets both significantly increased folate levels in pregnant women, but only folic acid mouthwash showed a highly significant improvement in gingival health.4 Topical folate has been shown to inhibited gingival hyperplasia to a significantly greater extent than administration of systemic folate or placebo.5

Post-Surgical Bleeding in Anticoagulated Patients:  Tranexamic acid is an antifibrinolytic agent, which can be applied topically or used as a mouthwash to prevent post-surgical bleeding in anticoagulated patients after oral surgery or extractions, without discontinuation or dose reduction of anticoagulant therapy.6, 7

Coenzyme Q10 for Peridontal Therapy

Topical application of Coenzyme Q10 (CoQ10) to the periodontal pocket was evaluated with and without subgingival mechanical debridement. Significant improvements in the modified gingival index, bleeding on probing and peptidase activity derived from periodontopathic bacteria were observed only at sites treated with CoQ10. These results suggest that topical application of CoQ10 improves adult periodontitis not only as a sole treatment but also in combination with traditional nonsurgical periodontal therapy.8

Therapy for Mucositis Caused by Chemotherapy or Radiation

Patients with cancer are at high risk for numerous oral problems. Cytotoxic chemotherapy, radiation to the head and neck, and immunosuppression prior to bone marrow transplantation commonly cause significant inflammation and painful lesions of the oral and esophageal mucosa which lead to difficulty swallowing and can result in a compromised nutritional status. Oral mucositis is the dose-limiting toxicity for patients receiving concurrent chemoradiotherapy regimens for tumors of the head and neck area. Dry mouth secondary to radiation can lead to rampant dental caries. Oral rinses can be formulated to prevention mucositis (i.e., glutamine), relieve pain (i.e., morphine), reduce inflammation, or treat superinfections (bacterial, viral, or fungal).9, 10

Glutamine is a nutrient for rapidly dividing cells. Administration of glutamine suspension after chemotherapy has resulted in significant amelioration of stomatitis and decreased the duration of mouth pain by 4.5 days when compared to placebo. The severity of oral pain may also be reduced significantly when glutamine is provided with chemotherapy. No toxicity has been observed. Oral glutamine appears to be a safe, simple and useful measure to increase the comfort of children and adults at high risk of developing mouth sores as a consequence of chemotherapy.11, 12, 13, 14

Persistent mucosal pain may be helped by topical preparations that provide local protection or anesthesia. For patients with head and neck carcinomas receiving concomitant chemoradiotherapy, morphine mouthwash is a simple and effective treatment to decrease the severity and duration of oral lesions and the duration of functional impairment.15 Also, a three-drug mouthwash containing lidocaine, diphenhydramine and sodium bicarbonate in normal saline has been reported to provide effective symptomatic relief in patients with chemotherapy-induced mucositis.16

Fungal infections of the oral mucosa are common in patients with compromised immune status. Candidiasis usually appears as adherent white plaques but can also present as erythema or angular cheilitis. Amphotericin B and nystatin are potent antifungal agents which are active against most pathogenic fungi like Aspergillus and Candida, and can be formulated as an oral rinse.17 Melaleuca (tea tree oil) rinse has been effective in treating fluconazole-resistant candidiasis in AIDS patients.18

Malignant oral lesions are often associated with anaerobic bacteria that produce a foul odour. The odour can be reduced with a topically applied metronidazole gel.

Relief for Aphthous Ulcers

Aphthous ulcers affect up to 25% of the general population and three month recurrence rates are as high as 50%.19 Aphthous ulcers may be helped with topical corticosteroids prepared as a mouth rinse or paste, or oral rinses containing a combination of medications to combat the various possible causes of these painful oral lesions.

Patients suffering from recurrent aphthous stomatitis (RAS) may have low levels of vitamin B12. A common cause of vitamin B12 deficiency is low intake of meat or other animal products. Administration of vitamin B12 has led to rapid improvement of RAS and complete recovery within several weeks.19

Zinc promotes wound healing and maintains epithelial integrity. Zinc sulfate in doses of up to 660 mg/day produced a significant reduction in frequency of RAS in zinc-deficient patients.20

Licorice can be processed to remove glycyrrhiza, resulting in DGL (deglycyrrhizinated licorice), which does not appear to share the potential metabolic disadvantages (hypertension, hypokalemia, and fluid retention) associated with high doses of licorice. Patients with aphthous ulcers who used DGL mouth wash experienced 50-75% improvement within one day followed by complete healing of the ulcers by third day.21

Application of 5-aminosalicylic acid (5-ASA; mesalamine) 5% cream three times daily for up to 14 days for the treatment of aphthous ulcers shortened healing time and reduced the difficulty in eating. No significant side-effects were reported.22

“Rinse #5″ (tetracycline, nystatin, triamcinolone, and 2-deoxy-D-glucose) has been used to reduce pain and promote the healing process.

Therapy for Osteoporosis

Bisphosphonates (i.e., Fosamax) used to treat osteoporosis and decreased bone density in postmenopausal women have been shown to cause osteonecrosis of the jaw (ONJ; “dead jaw”; slow death of bone tissue that occurs because of poor blood supply). Patients using bisphosphonates intravenously, or who have undergone chemotherapy, have a history of cancer, Paget’s disease or osteoporosis, use steroids while on alendronate, or have a history of major dental work are at an increased risk for ONJ. While osteonecrosis can be managed, it is irreversible. Bio-identical hormone replacement therapy is another option for prevention and treatment of osteoporosis. Compounding pharmacists work together with patients and other health care providers to optimize therapy for each woman.

In summary, dental preparations can be compounded to meet specific patient needs:
-  alcohol-free to reduce burning of irritated mucosa.
- sugar-free to reduce cariogenic potential, decrease risk of fungal and superinfection, and for diabetic patients.
- dye-free to prevent staining of the oral mucosa
- flavoured to improve compliance.

Compounding pharmacies can assist dental professionals by providing customized medications including:
- novel dosage forms such as lozenges, freezer pops, intraoralor topical gels, and muco-adhesive pastes, chewable “gummy treats”, and lollipops which are ideal for children or patients who have difficulty swallowing, or when a medication (such as an antifungal or anesthetic) needs to be held in contact with the oral mucosa.
- combinations of medications such as a mouthwash that contains a topical anesthetic, corticosteroid, antifungal, antibiotic, and/or antiviral.
- topical or transdermal gels for those who can not swallow or to minimize the risk of systemic side effects.
- Recently developed anhydrous bases to deliver medication through lipophilic tissues.

Compounding pharmacists are in a unique position to work with both patient and dentist to customize medications that meet specific patient needs and solve medical problems.

Marvin Malamed, B.Sc.Phm., C.C.N., has owned Haber’s Compounding Pharmacy (Toronto, ON) for over 16 years. He is a national award winning pharmacist (PCCA’s 2005 Canadian Compounding Pharmacist of the Year), a clinical nutritionist, and a founding member of the Ontario Compounding Association. The Professional Compounding Centers of America has described Marvin as “a community leader in the pharmacy compounding profession.” Under his influence, Haber’s Compounding Pharmacy has evolved into a pharmacy with a unique blend of traditional and holistic approaches, always with the focus on solving individual problems. Marvin can be reached by calling 416-656-9800 or by emailing marvin@haberspharmacy.com.

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