Compounded Preparations You May Not Realize Are in Your Toolbox

Compounding has always been a part of medicine. From ancient healers mixing herbs to local pharmacists customizing formulations at soda fountains, the art and science of compounding is foundational to patient care. In veterinary medicine, however, compounding sometimes carries an undeserved stigma. Whether due to high-profile tragedies in equine medicine, a professor who discouraged its use, or the skepticism that arises when a vendor offers a dizzying array of options, so many that it seems improbable, it’s easy to see how distrust may creep in.

But compounding isn’t snake oil—it’s a necessary and valuable aspect of veterinary practice. When applied appropriately and in compliance with regulatory and scientific standards, compounded preparations fill essential gaps in therapy, especially when no suitable commercial options exist.

Here are a few compounded dosage forms and applications that may already be in your treatment toolbox—but perhaps you haven’t realized how powerful and versatile they can be:

Filling the Gap After Market Withdrawal or Shortage
Over time, certain drugs have been withdrawn from the human market due to safety concerns or commercial decisions, while others have become temporarily unavailable due to manufacturing or supply chain issues. Despite their removal or shortage in the human sector, some of these medications remain clinically valuable in veterinary medicine. For example, cisapride—withdrawn from the human market due to cardiac risks—continues to play an important role in managing conditions such as reflux and megacolon in cats. Because it is no longer commercially available, cisapride must now be sourced through compounding. Similar compounding solutions have bridged the gap during shortages of critical veterinary drugs, including previous supply disruptions of pimobendan and intermittent lapses in availability of medications like telmisartan (Semintra).

Utilizing Oral Compounded Liquids
Tapering medications such as prednisolone can be challenging when using commercially available tablets, especially when small or incremental dose adjustments are required. Compounded oral liquids provide a flexible and accurate alternative, allowing veterinarians to prescribe precise doses tailored to the patient’s tapering schedule. With a single prescription, the full course of therapy can be dispensed in one bottle, simplifying administration and eliminating the need to split tablets or authorize new prescriptions mid-taper.

Addressing Palatability Challenges
Some veterinary medications are notoriously bitter, making them difficult to administer. Drugs such as tylosin, gabapentin, fluoxetine, and metronidazole are common examples. Compounding offers practical solutions through the use of flavoring to reduce aversion or by encapsulating powders to completely mask the taste. For instance, tylosin powder—known for its notoriously foul taste—can be compounded into gelatin capsules, significantly improving acceptance without compromising efficacy.

Transdermal Medications
Although not all drugs are appropriate for transdermal delivery, certain medications have shown effectiveness when applied to the pinna—an especially useful approach in feline patients where oral administration can be difficult. Methimazole is a well-established example. It can cause gastrointestinal upset when given orally, and pilling fractious or elderly cats can strain the client–patient relationship.

Multiple studies support the use of transdermal methimazole:

• Pharmacokinetic evaluations confirm that appropriate transdermal dosing can achieve reliable systemic absorption.¹
• A prospective study of 13 cats showed significant decreases in serum T4 by day 28 with minimal side effects.²
• A randomized trial involving 47 cats found fewer gastrointestinal adverse effects with the transdermal formulation compared to oral dosing, despite a slightly slower reduction in T4 levels.³

Transdermal options like these can improve medication adherence and reduce stress for both pets and caregivers.

Eliminating Powder Clouds
Some medications are only available in large, human-sized dosage forms, leading technicians or clients to split tablets or capsules into quarters or eighths. This practice often results in dosing inaccuracies and unintended powder exposure—especially when the final portion crumbles into dust. Compounded suspensions or properly sized capsules and tablets provide safer, more precise alternatives.

Protecting the Client–Patient Bond with Medicated Chews
Compounded medicated chews are invaluable when oral dosing creates fear or resistance in patients. For example, abused or anxious animals may react negatively to forced pilling, and aging dogs may become less cooperative or physically sensitive. In these cases, flavored chews containing medications like gabapentin can be gently added to food or offered as treats, preserving trust and ensuring adherence. Speaking from personal experience, when my rescued dog needed sedation for heartworm treatment, gabapentin chews made the process stress-free for both of us.

Veterinary compounding, when used responsibly, is not a fallback—it’s a professionally appropriate solution. It allows us to care for patients in ways that are practical and tailored to the species’ needs. Rather than dismissing compounded preparations as questionable or outdated, we should embrace them as essential tools in modern veterinary care.

References:

1. Hill KE, Gieseg MA, Bridges J, Chambers JP. The pharmacokinetics of methimazole in a novel lipophilic formulation administered transdermally to healthy cats. N Z Vet J. 2014;62(4):208-213.
2. Lecuyer M, Prini S, Dunn ME, Douce MY. Clinical efficacy and safety of transdermal methimazole in the treatment of feline hyperthyroidism. Can Vet J. 2006;47:131-135.
3. Sartor LL, Trepanier LA, Kroll MM, Rodan I, Challoner L. Efficacy and safety of transdermal methimazole in the treatment of cats with hyperthyroidism. J Vet Intern Med. 2004;18(5):651-655.

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Compounded Preparations You May Not Realize Are in Your Toolbox