Sleep, Mood and Compounding

Poor sleep and low mood are among the most common reasons Australians see their GP. Good sleep habits come first, and where a medicine or supplement is appropriate, a commercially available product is the usual starting point. Sometimes that product does not suit the person in front of the prescriber. That is where a compounding pharmacy comes in.

When a commercial product does not suit

A doctor or other prescriber may order a compounded medicine or supplement for an individual patient when:

• The strength is not available. The prescriber wants a dose that sits between, below or above the strengths sold commercially, or wants to adjust it in small steps.
• The dose form does not work for the patient. Some people cannot swallow tablets and need a liquid, a troche (lozenge) or a capsule that can be opened.
• An inactive ingredient is a problem. Commercial products can contain lactose, gluten, dyes, sweeteners or preservatives that a patient cannot tolerate.
• The prescriber wants a combination. Several ingredients can be combined into one capsule or liquid so there is less to take at bedtime.
• The product is unavailable. It has been discontinued or is out of stock.

Ingredients you may recognise from the pharmacy shelf

Many Australians start with a sleep supplement from the pharmacy or health food aisle, and for plenty of people that is a good place to begin. Products with an AUST L number on the label are listed medicines. The TGA requires them to use only ingredients from its permitted low-risk list and to be made to set quality standards, and the company behind each product must hold evidence for what its label says.

Ingredients commonly found in listed sleep and relaxation products include:

• Herbs such as valerian, passionflower, hops, lemon balm, chamomile, lavender and ziziphus
• Minerals such as magnesium

These are familiar, widely used ingredients with a long history in Australian pharmacies. Many of the same ingredients can also be used in a compounded supplement. What compounding adds is tailoring: your practitioner can specify the amount of each ingredient, combine several into one capsule, powder or liquid, and ask us to leave out inactive ingredients you cannot tolerate.

A compounded supplement does not carry an AUST L number and has not been through the listing process, so we make no claims about what it will do for your sleep. Your practitioner decides what goes into it and why.

What we prepare

We prepare sleep-related medicines and nutritional supplements only to the order of your prescriber or practitioner, in the strength, form and combination they specify. Dose forms include capsules, oral liquids, troches, powders and drops. We can leave out specified inactive ingredients where the formulation allows.

What compounding does not promise

A compounded product is not a stronger or better version of a commercial one. Compounded medicines are not assessed by the TGA for safety, quality or efficacy in the way registered medicines are, which is why they are reserved for patients whose needs cannot be met by a commercial product. Whether a compounded option is right for you is a decision for you and your prescriber.

Sleep and mood

Sleep and mood are closely linked. A run of bad nights can leave anyone flat, irritable or anxious, and feeling low or worried can make it harder to fall asleep or stay asleep. Because each can feed the other, it helps to mention both when you talk to your doctor, even if only one is bothering you.

Regular daylight and movement, steady meal and sleep times, less alcohol and staying connected with other people support both sleep and mood. If low mood, worry or loss of interest lasts more than two weeks, or is getting in the way of work, relationships or daily life, see your GP. They can assess what is going on and talk through the options, which may include psychological support.

We do not suggest any medicine or supplement for mood. If your prescriber decides one is appropriate and a commercial product does not suit you, the same reasons for compounding described above apply.

If you need to talk to someone now: Lifeline 13 11 14 and Beyond Blue 1300 22 4636 are available 24 hours a day. In an emergency, call 000.

Start with your doctor

Ongoing sleep problems have many possible causes, including sleep apnoea, restless legs, pain, stress, other medicines, caffeine and alcohol. See your GP if poor sleep lasts more than a few weeks, if you snore heavily or stop breathing in your sleep, or if you are very sleepy during the day. Questions worth asking:

• What could be causing my sleep problem?
• What can I change in my routine before trying a medicine or supplement?
• If you recommend a product, is there a commercial option that suits me?
• If not, would a compounded option be appropriate, and how long should I use it before a review?

How compounding works at NCC

• Your prescriber writes a prescription or practitioner order for you.
• You or your prescriber send it to us, or to one of our partner pharmacies.
• Our pharmacists review it and contact your prescriber if anything needs clarifying.
• We prepare it in our Gold Coast laboratory under our quality management system and send it to you, or to a partner pharmacy for collection.

You can send us your prescription online, find a partner pharmacy near you, or contact our pharmacists with questions about your own prescription.

This page is general information only. It is not medical advice and does not recommend any medicine or supplement. Talk to your doctor or pharmacist about your own circumstances.