How Are Sterile Compounded Medications Made?

Compounded Medication Header

Sterile Compounded Prescriptions

When commercially available medications don’t fit the patient’s needs, compounding pharmacies fill the gap. But not all compounded medications are created equal.

Medications that bypass the immune system, such as injectables, must be made in a sterile environment to prevent bacterial contamination.

So, how are sterile compounded medications made? Why does sterility matter? And what sets a quality compounding pharmacy apart?

Frequently Asked Questions

A sterile environment is required for some compounded medications such as injectables.

 

Since these medications bypass our immune system, they must be prepared in a contaminant-free (ISO-certified) cleanroom.

Options include:

  • Liquids
  • Topical creams & transdermal gels
  • Troches
  • Rapid dissolve tablets (RDTs)
  • Suppositories
  • Lollipops
  • Pet-friendly treats

Yes!

 

We prepare micro-doses (e.g., 0.25mg) or high-strength formulations unavailable commercially, perfect for hormone therapy or sensitive patients.

 

This also helps more easily titrate medications.

Absolutely!

 

We eliminate common triggers like gluten, lactose, dyes, or preservatives. This method is ideal for patients with celiac disease, sensitivities, or mast cell disorders.

Patients may use compounded medications due to necessity or even preference.

 

If you have allergies to dyes/fillers, need precise doses (e.g., pediatric or geriatric), require discontinued drugs, or struggle with swallowing pills, compounding offers a solution.

Making Sterile Compounds

Creating a sterile compounded medication is a detailed process that demands strict training, specialized equipment, and careful attention to detail.

Here’s how we do it:

Step 1: The Cleanroom Environment

Sterile compounding takes place in an ISO-classified cleanroom, a controlled environment designed to minimize airborne particles.

Most pharmacy cleanrooms operate at ISO Class 5 or better, meaning fewer than 3,520 particles per cubic meter of air (compared to millions in regular room air).

Key features of a sterile cleanroom include:

  • HEPA filtration systems that continuously clean the air
  • Positive air pressure to push contaminants out
  • Controlled temperature and humidity to inhibit microbial growth
  • Smooth, non-porous surfaces that can be easily sanitized
The Cleanroom Environment

Step 2: Garbing for Sterility

Before any compounding begins, staff must follow a strict garbing procedure:

  1. Remove all jewelry and personal items.
  2. Wash hands up to the elbows, similar to how surgeons prepare.
  3. Dress in sterile garb in this order: shoe covers, hair net, face mask, protective eyewear.
  4. Put on sterile coveralls without touching the exterior.
  5. Apply sterile alcohol-based hand sanitizer.
  6. Put on sterile gloves, then sanitize gloves with alcohol.

Every movement is deliberate to avoid contaminating the sterile suit or gloves.

Step 3: Cleaning and Preparation

All items entering the cleanroom, including ingredients, equipment, and packaging, are sprayed with sterile isopropyl alcohol and wiped down.

Surfaces are cleaned with specialized disinfectants according to a rotating schedule to prevent the development of microbial resistance.

Garbing for Sterility

Step 4: Compounding Under the Hood

The actual preparation occurs in a laminar airflow workbench (LAFW). These hoods provide an ISO Class 5 environment by directing HEPA-filtered air over the work surface.

The pharmacist or technician:

  • Gathers all necessary ingredients and equipment
  • Sanitizes gloves again with sterile alcohol
  • Works slowly and deliberately, never reaching over open containers
  • Uses aseptic technique to transfer and mix ingredients without introducing contaminants

Step 5: Quality Control Checks

Throughout the process, multiple checks ensure accuracy and sterility:

  • Visual inspection for particulates or cloudiness.
  • Weight verification to confirm correct dosing.
  • Media fill tests are performed regularly to validate aseptic technique.
  • End-product testing when indicated.
Compounding Under the Hood

Step 6: Packaging and Labeling

The finished sterile preparation is sealed in sterile containers, labeled with patient-specific information, and often placed in overwraps for protection.

Some preparations undergo additional sterilization through filtration before final packaging.

Step 7: Environmental Monitoring

Maintaining sterility doesn’t end when compounding stops. Cleanrooms are continuously monitored for:

  • Air particle counts.
  • Temperature and humidity.
  • Surface contamination through contact plates.
  • Staff technique through fingertip sampling.

Certification by an independent third party is required at least every six months.

Sterile Packaging and Labeling

Factors to Consider

  1. Sterile Compounding Certification: Ensure the pharmacy follows USP <797> standards for sterile preparations.
  2. Experience: Ask about their history with the specific type of medication you need.
  3. Transparency: A quality pharmacy welcomes questions about its processes.
  4. Location and Delivery: Consider proximity for time-sensitive medications and shipping options.

Understanding Regulations and Certifications

  • USP <797>: The official standard for sterile compounding in healthcare settings.
  • USP <795>: Standards for non-sterile compounding.
  • State Board of Pharmacy: All compounding pharmacies must be licensed in the state where they operate.
Sterile Compounding Factors to Consider
Green Leaf

Partner with ClearSpring Pharmacy for Sterile Compounded Medications

We serve patients and prescribers across Colorado with customized sterile preparations. Partner with us for sterile compounded medications your patients can trust.

We work closely with prescribers to ensure every preparation meets your exact specifications.

Reach out to start a conversation about how we can support your practice.

With the Busy Holiday Season

Please Allow Extra Time For Prescriptions

The holidays bring us joy, but they also bring us more prescriptions to fill and ship. Our pharmacy continues to work diligently, but an increase in demand may result in slightly longer processing times.

Please consider doing the following:

  • Anticipate and account for the mail system taking a bit longer.
  • Request refills earlier.
  • Keep track of the amount of medication you have left.

Thank you,
ClearSpring Team