# Compounding pharmacies



## nrlaurin

Are there compounding pharmacies in France,
as there are in the US? Also, is it difficult to get mental health medications in France, with or without a prescription? Is it difficult to find a doctor to write prescriptions outside of major cities? Thanks everyone!


----------



## DejW

Npt sire whata compunding pharmacy is could you explain.

In general you need a doctor's prescription of anything more than mild OTC medications. Medicine traitants (gp) can prescribe most medicaments, but some have to be be prescribed by a specialist. 



DejW


----------



## NickZ

A compounding pharmacy can make pills etc . A normal pharmacy only sells you prepacked stuff.

They exist in Italy so it's likely they exist in France.


----------



## nrlaurin

Yes a compounding pharmacy makes
pills that combine various amounts different medications into one pill. They have to basically build a pill according to a doctor’s orders (prescription) rather than give you a premade
pill.


----------



## Bevdeforges

Most pharmacies here have the ability to make custom pills or capsules. And to do so for either humans or animals. (I had the local pharmacy compounding capsules for one of my cats who had a heart condition.) FWIW, pharmacies also can compound suppositories and other forms of medications.

Mental health conditions may be treated somewhat differently here than in the US. There is a tendency to favor "behavioral" treatments over pharmaceutical ones (at least according to a friend of mine whose daughter has had psych problems in both countries). There may also be somewhat different medications authorized for treatment, though in most cases the meds are equivalent to something you would get in the US. 

Generally speaking, once you have "specialized" medications prescribed by a specialist (psychiatrist, for example), you can usually get refills written by your "referant" (i.e. primary doctor) for at least a while. And most "referants" can write a 3 or 4 month prescription for something you have been taking on a US prescription - long enough for you to find a local specialist to evaluate you and decide what treatment is appropriate.


----------



## EuroTrash

Do you know I had no idea that there even was such a thing as a pharmacy that doesn't make up prescriptions. I'm trying to get my head round it, it seems a strange concept to have a shop that just sells OTC medicines. Are the staff trained and qualified at all, can you ask for advice, or is it the same as buying pills at a supermarket?


----------



## berkinet

EuroTrash said:


> Do you know I had no idea that there even was such a thing as a pharmacy that doesn't make up prescriptions. I'm trying to get my head round it, it seems a strange concept to have a shop that just sells OTC medicines. Are the staff trained and qualified at all, can you ask for advice, or is it the same as buying pills at a supermarket?


A compounding pharmacy usually does the custom drug preparation in addition to dispensing the standard fare of pills. However, also note that in the US pills are usually counted out by hand, from some big jar, and placed into little plastic bottles. This is as opposed to the blister packed pills we tend to see here in Europe. So, even a standard US pharmacy has more hands-on involvement than a French pharmacy.

The staff certainly use different skills than in a standard pharmacy. However, I suspect all those skills are taught in pharmacy school but just never applied.


----------



## NickZ

EuroTrash said:


> it seems a strange concept to have a shop that just sells OTC medicines.



It's not OTC . A compounding pharmacy can do non standard dosages. Or they can use different mixes. Or I guess even different binders/fillers.

https://en.wikipedia.org/wiki/Compounding


----------



## Bevdeforges

I know when I had to have capsules compounded for my cat, there was one pharmacist in the shop who handled this. When she was gone (vacation, sick time, etc.) they could, I suppose, send out the order to one of their vendors for compounding. But as far as I know, compounding medications is one of the functions of a pharmacy/pharmacist here.

Oddly enough, you can also have your blood pressure taken at a pharmacy and get advice about OTC medications, including which ones are covered by sécu if prescribed by a medical doctor. There are times I go to the pharmacy first to ask about various options and then go to the doctor.


----------



## Bevdeforges

EuroTrash said:


> Do you know I had no idea that there even was such a thing as a pharmacy that doesn't make up prescriptions. I'm trying to get my head round it, it seems a strange concept to have a shop that just sells OTC medicines. Are the staff trained and qualified at all, can you ask for advice, or is it the same as buying pills at a supermarket?


A shop that sells just OTC stuff is generally called a "parapharmacie" here. But then again, what Americans consider OTC meds is somewhat different from what we mean by OTC. Here, OTC literally means that you purchase them "over the counter" - meaning that you have to ask the pharmacist for them. OTC stuff is NOT out on the shelves for customers to help themselves. And OTC stuff includes aspirin, ibuprofen, acetaminophen, etc.


----------



## berkinet

Bevdeforges said:


> ... I suppose, send out the order to one of their vendors for compounding. But as far as I know, compounding medications is one of the functions of a pharmacy/pharmacist here.
> 
> Oddly enough, you can also have your blood pressure taken at a pharmacy and get advice about OTC medications, including which ones are covered by sécu if prescribed by a medical doctor. There are times I go to the pharmacy first to ask about various options and then go to the doctor.


Which brings up a general point, While the French _Pharmacie_ is similar to the American _Pharmacy_, the two are rather different.
Each French pharmacy is owned by the pharmacist.
A pharmacist may not own more than one pharmacy.So, there are no pharmacy chains.
Most pharmacies, at least those in populated areas, get two or more deliveries a day from their suppliers. So, you can order a drug in the AM and have it in the PM.
Many pharmacies will still check wild mushrooms for you - to separate the edible from the not-so-edible.
Pharmacists are either allowed some degree of freedom or just take it. So, you can get small changes in a prescription, say smaller dosages, or get an emergency supply of some common drugs.
Pharmacists also can, or just do, sell some medications without prescriptions. This is more common with creams and ointments than pills and capsules.
And, as Bev noted, a pharmacist will usually give you a consultation and advise visiting a doctor if needed.
So, back to your original question... while your local pharmacy may not compound prescriptions. It is very likely they can order it for you and have it in a day or less.


----------



## EuroTrash

What a very informative thread this has turned out to be 

I have a Brit friend who's a keen photographer and over the years he's made a collection of literally 100s of photos of French pharmacy signs. They're many and varied and some are quite elaborate - blinking lights, alternating LED images etc etc.


----------



## DejW

Yes, dear ET, I've learned a lot too. Fascinating.

I think the training period for pharmacists in France is longer than that in the UK. Someone said that there are no chains of pharmacies in France. Well there are, my local is one of them However, I suspect it is a purchasing "club" to lower prices, rather than a branch of a shop in the usual manner.

As Berky said, if you want something they haven't got in stock it will arrive either today or tomorrow. I am very impressed by the knowledge and customer service found in French pharmacies. 

DejW


----------



## Bevdeforges

berkinet said:


> Each French pharmacy is owned by the pharmacist.


Basically true, but only a licensed pharmacist can own a pharmacy. I believe it is OK for say, a retired pharmacist to own a pharmacy that is then run by his successors. (But I'm not sure about that.) I know when my husband and his sisters inherited the pharmacy their parents had owned and run, they could only inherit the building - and so became landlord to the pharmacy that was there (and had been for some time).


> A pharmacist may not own more than one pharmacy.So, there are no pharmacy chains.


Not so sure about this. At one point, my husband's parents owned two pharmacies in the same town. Maybe they were considered "branches" of a single business? 

But the number of pharmacies in a town is strictly controlled by the government, based on the town's population. Even a pharmacist can't set up a new pharmacy in town if they already have their requisite number.



> Most pharmacies, at least those in populated areas, get two or more deliveries a day from their suppliers. So, you can order a drug in the AM and have it in the PM.


I suppose it depends on vendors and delivery services in the area, but this does seem to be the case.


> Many pharmacies will still check wild mushrooms for you - to separate the edible from the not-so-edible.


I've been told this is still the case in the US - but have never tried (nor required) the service. My mother-in-law still had all her books on mushrooms and could tell you what kind you had or what kind to avoid.


> Pharmacists are either allowed some degree of freedom or just take it. So, you can get small changes in a prescription, say smaller dosages, or get an emergency supply of some common drugs.


Generally speaking, they can "advance" you meds you normally take - say, if you couldn't get in to see your doctor before you ran out. Or, they can advance you certain standard items (like a small dosage antibiotic for a urinary infection) but are supposed to make you swear to get the appropriate prescription from your doctor within a day or two. (They can't collect their money from the sécu or the mutuelle without the prescription.) One of the big reasons you want to always use the same pharmacy for all your needs. Once they know you and have your records on file, they can do all sorts of "favors" like this for their customers of record.


> Pharmacists also can, or just do, sell some medications without prescriptions. This is more common with creams and ointments than pills and capsules.


Pharmacies sell a whole range of medications that are not subject to prescription - including stuff like aspirin and various creams and ointments. Certain items, however, are reimbursable by the sécu if prescribed by a doctor. This is the case for things like gauze, bandages, simple antiseptics needed for treatment of a wound or suture.

When I was operated on for carpal tunnel, I had a "prescription" to have a nurse come by and change the bandage every two days for a couple of weeks. My prescription for filling at the pharmacy included a certain size of bandage, plus antiseptic and a box of cotton gauze pads for the nurse to use in the cleaning. (Which I could have easily done myself if I'd had to.) And, because the nurse was then supposed to remove the stitches, I also had a prescription (filled at the pharmacy) for a little stitch-removal kit made up of little scissors and a plastic, throw-away set of tweezers for the nurse to use in the process.

Similarly, when I broke a bone in my shoulder and needed a sling to hold my arm steady, they didn't give me anything at the hospital, but rather gave me a prescription to get the appropriate sling at the pharmacy. 



> And, as Bev noted, a pharmacist will usually give you a consultation and advise visiting a doctor if needed.


Also great for "minor issues" - like dry eyes, insect bites, tummy problems and minor "wounds." (They are often more sympathetic than a doctor for these kinds of minor things. <g>)

In case you haven't guessed - my DH's parents were pharmacists and he was the one who turned me on to all the stuff you can rely on the pharmacy for. He tells me that on weekends he used to run the little machine to make the suppositories for his Dad. Actually, I have a favorite recipe that calls for "cream of tartar" which isn't available here in France. What it is, however, is basically something called "tartric acid" which is a chemical sometimes used at a pharmacy for compounding medications. Because we are good buddies with our local pharmacy, they provide me with all I need, and generally for free. (I suppose it's a frequent customer bonus of sorts. <g>) Apparently you used to have to get your bicarbonate of soda at a pharmacy, since it was mostly used here for upset stomachs, not for baking or cleaning.

More than you wanted to know, I suppose. But like EuroTrash said, it's an informative thread.


----------



## 95995

Pharmacists in France do not always have the time not the ingredients on hand to compound drugs, though they are all trained to do so. However, they can generally order ingredients in as quickly as they can order in most packaged medications and usually will agree to do the compounding for a patient who has a genuine special need and the relevant prescription and will do so when the doctor's prescription can only be filled via compounding, albeit they might get another pharmacy or even a supplier to do that for them.

Pharmacists can also prepare hand sanitiser, and were supposed to do so at the height of the Covid-19 crisis, but for a wealth of mostly good reasons, most did not do so.

One of the issues in France is that pharmacists don't get paid for the time they spend compounding and what they can charge is generally regulated.


----------



## nrlaurin

This is wonderful and specific info!! Thank you all so very much for taking the time to give me such thoughtful responses.


----------



## trishahrx

I came upon this thread and thought I might ask. In the hospital setting, where are your regulations on sterile drug compounding? Example, for IVs and such?


----------



## SPGW

Regulations for sterile drug (and all medicinal compounding and manufacturing, irrespective of mode of admin IV/IM etc) are set by the ANSM Agence Nationale de la Sécurite du Medicament et des Produits de Santé. The ANSM is also responsible for inspecting premises and granting licences to manufacture. Same / equivalent in all EU member states who share common pharma Good Manufacturing Practice regulations and directives (see Eudralex).

Incidentally, this same regulatory body grants marketing authorisations for medicines, some being at EU level (by the Euroopean Medicines Agency. They decide whether a drug is OTC or Prescription only, as the US FDA does for the US population. This is why a OTC drug in US may be prescription only in EU (related to perceived patient safety, risk of abuse, cost/reimbursement....)


----------

