Dosage Forms

We compound a variety of tablets based on the type of medication to be delivered, preferred speed of absorption, or other patient needs.

Oral Tablets

Tablets are swallowed by mouth and are considered a straightforward way to administer medication. They can consist of a single medication or a combination of multiple ingredients. Taking a single dosage form that contains more than one medication can limit pill load and impact patient adherence. In addition to the active pharmaceutical ingredients (APIs), tablets may be compounded with inactive ingredients called fillers. These additional ingredients are minimal but necessary for the compounding process. Advantages:

• Easy administration
• Scored for dose titration
• Conveniently portable

Fast-burst Sublingual Tablets

Our fast-burst sublingual tablets are scored tablets that dissolve quickly under the tongue. The active pharmaceutical ingredients are designed to be absorbed through the mucosa in the mouth, delivering the drug into the bloodstream. Advantages:

• Scored for easy dose titration
• Multiple hormones can be combined into single tablet
• Dissolvable and designed for rapid release of the medication
• Shelf-stable

Sublingual tablets have select advantages over troches; they do not melt if they get hot and don’t have special shipping requirements.

Vaginal tablets and vaginal suppositories can provide fast, targeted relief from localized conditions affecting the vaginal tissue. These solid-form medications are inserted into the vagina, where they melt as they reach body temperature and are designed to absorb into the tissues and bloodstream. Vaginal tablets and suppositories can address vaginal infections or relieve vaginal irritation and dryness due to menopause. Our vaginal tablets are pH balanced. Maintaining the normal pH balance of the vagina is important to vaginal health because its normal acidity helps fight off infections. Vaginal suppositories and tablets can deliver other medications, such as diazepam, to relax pelvic muscle spasms often present in conditions like vaginismus. Advantages:

• Avoid first-pass metabolism
• Localized absorption
• Avoid nausea and vomiting that can be caused by gastric irritation
• Requires a lower dose to reach the site of action, reducing potential systemic side effects.

Rectal suppositories are also available through Belmar.

Hormone pellets are a unique delivery form designed to closely replicate how hormones are naturally released in the body. In a simple, quick office procedure, these rice-grain-sized pellets are inserted under a patient’s skin near the hip area via a trocar. Delivering bioidentical hormone replacement therapy (BHRT) in pellet form has multiple benefits:

• Convenience  — No need to worry about remembering to take medication daily. Hormone pellets may only need to be inserted 3-4 times per year.
• Minimal side effects — Pellet therapy sends hormones into the bloodstream, avoiding potential side effects of taking medications orally.
• Consistency — Pellets are designed to supply the body with a consistent level of hormonal support as they slowly dissolve into the bloodstream.

Some patients report feeling significant symptom benefits in as little as four weeks, although maximum benefits may take up to six months. It’s important to note that pellet therapy is not new; physicians in the United States have been using it since the late 1930s.

Belmar Select Outsourcing Pellets

Belmar Select Outsourcing is our 503B outsourcing facility, able to compound and ship hormone pellets to licensed providers’ offices, without requiring patient-specific prescriptions. The pellets we manufacture consist of a bioidentical hormone with small amounts of stearic acid and sterile water. There are no additional fillers. Our bioidentical testosterone pellets include testosterone sourced from yams; the bioidentical estradiol in our pellets is sourced from soy; and the cholesterol is from sheep wool.

What About Cholesterol Pellets?

Belmar also compounds testosterone (cholesterol) pellets. These pellets have the same ingredients as our standard testosterone pellets, with the addition of cholesterol. Since cholesterol is a naturally occurring substance, the body tends to recognize it when it’s used as a binder in pellets. Some providers advocate that cholesterol pellets can limit inflammation, infections, fibrosis, and extrusions in some patient populations.

We offer several creams and gels that can be compounded for different medications, purposes, and preferences.

Creams

Creams are a semisolid dosage form that penetrates the skin, allowing active pharmaceutical ingredients to absorb through the tissue. Topical creams can provide systemic support for symptoms occurring throughout the body while avoiding oral administration.

Belmar can compound hormones for transdermal absorption in an exclusive cream base. Our cream base contains ingredients that are fit for chemically sensitive patients and is free of food allergens, as well as parabens and petroleum products. Advantages:

• Feels heavier than a lotion upon application, but never greasy
• Petroleum- and paraben-free, non-comedogenic
• Luxurious feel, can be used alone as a face and skin moisturizer

Vaginal Creams

Vaginal creams can penetrate vaginal tissue, offering localized benefit directly to the site to address conditions specific to the region. Targeted vaginal therapies may allow patients to minimize systemic side effects while helping with vulvovaginal problems like dyspareunia and vulvodynia. Chronic vaginal dryness can lead to discomfort or pain, disrupting healthy sexual activity. Advantages:

• Lower therapeutic doses may be possible when applied directly to the site of activity
• Vaginal compounds can target genitourinary needs with precision

Gels

Compounded gels are a semisolid system made up of at least two constituents — a condensed mass and an interpenetrating liquid. Gels are sometimes used as bases for ointments. They tend to be water soluble and washable, as well as greaseless. Preparations in gel form can provide cutaneous and percutaneous targeted drug delivery nasally, orally, topically, vaginally, and rectally. Advantages:

• Less greasy than some other bases and can be easily removed from the skin
• Topical administration avoids gastrointestinal and liver breakdown

An ointment is a preparation for topical use that contains an oil base. Ointments have a higher concentration of oil than creams, which have a higher concentration of water. Advantages:

• May stay on skin longer than creams or gels, allowing topical therapies more exposure time to penetrate the skin
• Hydrating benefits can be helpful with chronic dry and scaly conditions

Compounded capsules offer a customizable dosage form designed for systemic support and easy administration. Powder capsules are formulated with the prescribed active pharmaceutical ingredients and minimal filler. The powders are encapsulated in a gelatin or vegetable shell. Alternative fillers are available for providers with specific preferences and patients with ingredient sensitivities. Advantages:

• Individualized dosing
• Extended shelf stability
• Portability

Troches are small, semisolid dissolvable lozenges typically placed in the mouth under the tongue or between the cheek and gum. They are a convenient way to get personalized doses of prescribed medications. Flavored troches are easy to take, especially for patients who have difficulty swallowing solid dosage forms, and are scored for easy dose titration. Advantages:

• Quick absorption
• Designed to bypass gastrointestinal and liver enzymatic breakdown
• Elegant dosage form that avoids swallowing

Nasal sprays use a spray system releasing fixed doses of active ingredients into the nasal mucosa for absorption. This delivery system simplifies medication dosing and is designed to quickly release into the mucosa and bloodstream for effect. Advantages:

• Non-invasive administration
• Nasal mucosa offers therapeutic potential for local, systemic, and central nervous system activity

Compounded sterile injectables provide a way for patients to benefit from medications that may not be optimally absorbed orally or topically. Injectable preparations bypass bodily roadblocks, like liver digestive enzymes, that can negatively impact drug bioavailability. Sterile injectables can be administered subcutaneously (SQ), intramuscularly (IM), or via intracavernosal injection (ICI). The prescription will designate how the injectable medication should be given.

Injectable medications are often dispensed in a sterile vial with injection supplies. Injection supplies allow providers and patients to draw up the appropriate dose and introduce the medication into the body by breaking the skin barrier. Prescribed needles and syringes may vary in size and length to match the administration technique. Injectables are available as:

• A subcutaneous (SQ or SC) injection delivers medicine into the fatty layer between skin and muscle. Typical injection sites include the fatty areas on the upper arm, abdomen, and thigh. Medications given by SQ route tend to be smaller in volume.
• An intramuscular (IM) injection delivers medicine into the muscle tissue. Typical injection sites include the muscular tissues of the deltoid, thigh, hip, or buttocks. Medications given by IM route may be larger in volume.
• An intracavernosal injection (ICI) is administered along the shaft of the penis. Injectable compounded medications given by this route tend to address sexual support needs and are very small in volume.

Injectable medication advantages:

• Designed to be available to the body quickly, as they are delivered directly into the bloodstream
• May be ideal for patients who have trouble absorbing active ingredients via different routes of administration.

For all injectable preparations, it is very important to rotate injection sites to optimize proper medication absorption and minimize injection site complications. Properly disinfecting the dosing site using alcohol swabs prior to injection, and using new, clean injection supplies for each administration will limit the risk of infection.

For oral or topical use, solutions are liquid medications where the active ingredient is completely dissolved into the mixture. Suspensions are liquids containing fine particles of active ingredients. Many oral medications can be compounded into liquid form, helping patients that have trouble swallowing solid dosage forms such as elderly populations and younger children. Advantages:

• Easier to swallow than solid dosage forms
• Flexible concentrations allow for small administration volumes
• Can be flavored and customized to make more palatable